Cardiff and Vale University Health Board IM&T Strategy · Information Management and Technology...

Cardiff and Vale University Health Board IM&T Strategy

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DDOOCCUUMMEENNTT HHIISSTTOORRYY

Final Document Approval Document Reference:

Version: Signed: Date:

Originator:

Checked:

Approved:


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TTAABBLLEE OOFF CCOONNTTEENNTTSS

Document History ................................................................................................................................. ii Table of Contents................................................................................................................................. iii 1 Executive Summary.......................................................................................................................1

1.1 INTRODUCTION............................................................................................................................1 1.2 INFORMATION AND COMMUNICATION TECHNOLOGY (ICT) STRATEGIC CONTEXT ............................1

1.2.1 A Platform for Moving Forward..........................................................................................2 1.3 HEALTH STRATEGIC CONTEXT.....................................................................................................2 1.4 INFORMATION REQUIREMENTS.....................................................................................................3

1.4.1 Clinical Information Requirements ....................................................................................3 1.4.2 Citizen information requirements.......................................................................................3 1.4.3 Business Information Requirements .................................................................................4

1.5 CLINICAL SYSTEMS – ELECTRONIC PATIENT RECORD (EPR) STRATEGY .......................................5 1.5.1 EPR Infrastructure Plan.....................................................................................................7 1.5.2 EPR Strategic Plan............................................................................................................8

1.6 ENABLING IMPROVED ACCESS TO IT SYSTEMS / APPLICATIONS FOR CITIZENS AND STAFF...............9 1.6.1 Enabling citizen Access.....................................................................................................9 1.6.2 Smartphone Connectivity Project - Bring Your Own Device (BYOD) Staff .......................9 1.6.3 Internet Services................................................................................................................9 1.6.4 Social Media Sites.............................................................................................................9 1.6.5 Eduroam (UK Academia Wireless Network) .....................................................................9 1.6.6 Improved 3G Signal into UHB Hospitals .........................................................................10 1.6.7 Bring Your Own Device (BYOD) for Patients / Public .....................................................10 1.6.8 Mobile Working................................................................................................................10 1.6.9 Timescale ........................................................................................................................10

1.7 BUSINESS INFORMATION REQUIREMENTS STRATEGIC PROGRAMME ............................................11 1.8 ICT INFRASTRUCTURE...............................................................................................................13

1.8.1 Network ...........................................................................................................................13 1.8.2 PCs and Desktop Infrastructure ......................................................................................13 1.8.3 Desktop Software ............................................................................................................13 1.8.4 Email Infrastructure .........................................................................................................13 1.8.5 Server Infrastructure........................................................................................................13 1.8.6 Storage Infrastructure......................................................................................................14 1.8.7 Backup Infrastructure ......................................................................................................14 1.8.8 Telecommunications and Voice Services .......................................................................14

1.9 IM&T INFRASTRUCTURE SUSTAINABILITY ...................................................................................14 1.9.1 Infrastructure ...................................................................................................................14

1.10 ALTERNATIVE OPTIONS..........................................................................................................15 1.10.1 Cloud Technology........................................................................................................15 1.10.2 Office 365 ........................................................................................................................15 1.10.3 National Data Centre.......................................................................................................15 1.10.4 Sharepoint .......................................................................................................................15

1.11 BENEFITS..............................................................................................................................16 1.12 BACK OFFICE SYSTEMS REVIEW – LINKS TO WORKFORCE MODERNISATION PROGRAMME ........16 1.13 PARTNERSHIPS .....................................................................................................................17 1.14 RESOURCE CHALLENGE .............................................................................................................18

1.14.1 IM&T Resource Plan .......................................................................................................18 1.14.2 Comparative Resource Information................................................................................19 1.14.3 EPR Resource Plan ........................................................................................................19

1.15 INVESTMENT PRIORITIES........................................................................................................20 1.15.1 Infrastructure ...................................................................................................................20 1.15.2 EPR Priorities ..................................................................................................................21 1.15.3 PARIS Priorities...............................................................................................................22 1.15.4 Business Information Priorities........................................................................................23

1.16 GOVERNANCE .......................................................................................................................23 1.17 CONCLUSION ........................................................................................................................23

2 Introduction ..................................................................................................................................24 2.1 A PLATFORM FOR MOVING FORWARD ........................................................................................25


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3 Strategic Context .........................................................................................................................26 3.1 INTRODUCTION..........................................................................................................................26 3.2 HEALTH STRATEGIC CONTEXT...................................................................................................26

3.2.1 Annual Quality Framework (AQF) ...................................................................................27 3.2.2 Strategic Vision as set out in 5 year Strategic Framework and Operation Plan .............27 3.2.3 Together for Health .........................................................................................................27 3.2.4 Setting the Direction ........................................................................................................28 3.2.5 Communications and Information Implications of Setting the Direction..........................30

3.3 NATIONAL ICT STRATEGIC CONTEXT .........................................................................................30 3.3.1 ICT Strategy for the Public Sector in Wales....................................................................31 3.3.2 National Data Centre Technical Strategy........................................................................31 3.3.3 NWIS National Applications Strategy for NHS Wales.....................................................32 3.3.4 NWIS ...............................................................................................................................32 3.3.5 National Architecture Design Board ................................................................................33

4 Information Requirements ..........................................................................................................34 4.1 CLINICAL INFORMATION REQUIREMENTS .........................................................................................34 4.2 CITIZEN INFORMATION REQUIREMENTS.......................................................................................34 4.3 BUSINESS INFORMATION REQUIREMENTS...................................................................................36

5 Strategic Principles .....................................................................................................................37 5.1 KEY PRINCIPLES........................................................................................................................37 5.2 WHERE DO WE WANT TO BE .......................................................................................................38 5.3 MODERNISING THE PATIENT PATHWAY.......................................................................................38

6 IM&T Strategic Priorities .............................................................................................................39 6.1 INTRODUCTION..........................................................................................................................39 6.2 CLINICAL SYSTEMS – ELECTRONIC PATIENT RECORD (EPR) STRATEGY .....................................39 6.3 INTEGRATING GP SYSTEMS INTO THE ARCHITECTURE: ................................................................40 6.4 EPR INFRASTRUCTURE PLAN ....................................................................................................41 6.5 ICT PRIORITIES ........................................................................................................................43

7 ICT Strategic Work Programme..................................................................................................45 7.1 EPR STRATEGIC PLAN................................................................................................................45 7.2 NATIONAL PROGRAMME DEVELOPMENTS ....................................................................................46

7.2.1 Welsh Clinical Portal (WCP)............................................................................................46 7.2.2 Medicines Transcribing and Electronic Discharge (MTED) ............................................47 7.2.3 Hospital E-Referrals Project ............................................................................................49 7.2.4 Welsh Clinical Communications Gateway (WCCG)........................................................50 7.2.5 E- Communication...........................................................................................................51 7.2.6 Individual Health Record (IHR)........................................................................................52 7.2.7 Radiology Management System (RADIS2).....................................................................53 7.2.8 Laboratory Information system (LIMS)............................................................................54 7.2.9 Cancer Histopathology Reporting Project (CHIRP) ........................................................55 7.2.10 My Health Online (MHOL) ...............................................................................................55 7.2.11 Enterprise Master Patient Index *EMPI) .........................................................................57 7.2.12 National Active Directory and Exchange (NADEX).........................................................58 7.2.13 Encryption........................................................................................................................58

7.3 UHB DEVELOPMENTS ...............................................................................................................60 7.3.1 Patient Management System (PMS)...............................................................................60 7.3.2 Bed Management ............................................................................................................61 7.3.3 Ward Clinical Workstation (WCW) ..................................................................................61 7.3.4 EU Workstation (Emergency Unit Workstation) ..............................................................62 7.3.5 Communications Hub (Comms Hub) ..............................................................................63 7.3.6 Medical Records Digitisation ...........................................................................................64 7.3.7 Mental Health and Community System (PARIS).............................................................65 7.3.8 Ophthalmology Open Eyes Application...........................................................................66 7.3.9 Oracle Financial System .................................................................................................67 7.3.10 Electronic Staff Record (ESR).........................................................................................68 7.3.11 E-Expenses .....................................................................................................................69 7.3.12 Rosterpro Central ............................................................................................................69

7.4 ENABLING IMPROVED ACCESS TO IT SYSTEMS / APPLICATIONS FOR CITIZENS AND STAFF ............71 7.4.1 Enabling citizen Access...................................................................................................71 7.4.2 Smartphone Connectivity Project - Bring Your Own Device (BYOD) Staff .....................71


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7.4.3 Internet Services..............................................................................................................71 7.4.4 Social Media Sites...........................................................................................................71 7.4.5 Eduroam (UK Academia Wireless Network) ...................................................................72 7.4.6 Improved 3G Signal into UHB Hospitals .........................................................................72 7.4.7 Bring Your Own Device (BYOD) for Patients / Public .....................................................72 7.4.8 Mobile Working................................................................................................................72 7.4.9 Timescales ......................................................................................................................72

7.5 MAINTAINING A SUSTAINABLE INFRASTRUCTURE.........................................................................73 7.5.1 Network ...........................................................................................................................73 7.5.2 PC’s and Desktop Software ............................................................................................73 7.5.3 Server Infrastructure........................................................................................................75 7.5.4 Storage Infrastructure......................................................................................................76 7.5.5 Backup Infrastructure ......................................................................................................76

7.6 TELECOMMUNICATIONS AND VOICE SERVICES ............................................................................77 7.7 ALTERNATIVE OPTIONS .............................................................................................................80

7.7.1 Cloud Technology ...........................................................................................................80 7.7.2 Office 365 ........................................................................................................................81 7.7.3 National Data Centre.......................................................................................................81 7.7.4 Sharepoint .......................................................................................................................81

8 Business Informatics Strategic Work Programme...................................................................82 8.1 INTRODUCTION..........................................................................................................................82 8.2 DATA WAREHOUSE ...................................................................................................................83 8.3 BUSINESS INTELLIGENCE SYSTEM..............................................................................................83 8.4 TOP HOSPITAL ASPIRATION .......................................................................................................84 8.5 FUTURE DEVELOPMENTS...........................................................................................................85

8.5.1 Patient Level Costing ......................................................................................................87 8.5.2 Discharge Planning .........................................................................................................87 8.5.3 Ward / Nursing Dashboard..............................................................................................88 8.5.4 Community and Mental Health Information.....................................................................89 8.5.5 Theatre Improvement Programme ..................................................................................90 8.5.6 Divisional Scorecards......................................................................................................90 8.5.7 Healthcare Resource Groups – V4 .................................................................................91 8.5.8 Executive Dashboard and Exception Reporting..............................................................92 8.5.9 Outpatient Data Availability Referrals and Workflow Information ...................................92

9 Benefits and Return on Investment (ROI) .................................................................................94 9.1 DELIVERING THE NATIONAL AND LOCAL PROGRAMMES ...............................................................94 9.2 BACK OFFICE SYSTEM REVIEW – LINKS TO WORKFORCE MODERNISATION PROGRAMME .............95 9.3 TRANSFORMATION OF ADMINISTRATIVE PATHWAYS – POTENTIAL BENEFITS.................................95

10 Partnerships ...........................................................................................................................107 11 Finance and Resources.........................................................................................................108

11.1 WHY IM&T IS IMPORTANT ....................................................................................................108 11.2 DEMAND FOR IM&T RESOURCES .........................................................................................108 11.3 CURRENT POSITION SUMMARY ............................................................................................108

11.3.1 Finance..........................................................................................................................108 11.3.2 Resources .....................................................................................................................109

11.4 COMPARATIVE FINANCIAL POSITION .....................................................................................110 11.4.1 IM&T Revenue Budget Allocation .................................................................................110 11.4.2 IM&T Capital Budget Allocation.....................................................................................111 11.4.3 IM&T Resources............................................................................................................111 11.4.4 Comparable Organisations............................................................................................112

11.5 COST OF IMPLEMENTING THE STRATEGY ..............................................................................113 11.5.1 Gap Analysis .................................................................................................................113 11.5.2 IM&T Infrastructure Sustainability .................................................................................113 11.5.3 IM&T Revenue Requirements .......................................................................................113 11.5.4 Investment Priorities......................................................................................................114

12 Horizon Scanning and Emerging Technologies .................................................................118 12.1 MOBILE TECHNOLOGY .........................................................................................................118 12.2 DIGITISATION OF MEDICAL RECORDS....................................................................................118 12.3 DIGITAL DICTATION..............................................................................................................118 12.4 DIGI-PENS ..........................................................................................................................118


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12.5 TELECOMMUNICATIONS INITIATIVES ......................................................................................119 12.6 EVIDENCE-BASED INFORMATION...........................................................................................119 12.7 PATIENT SELF-MONITORING ................................................................................................119 12.8 TELEMEDICINE ....................................................................................................................120 12.9 SPEECH RECOGNITION ........................................................................................................120 12.10 THE SINGLE HEALTH & SOCIAL CARE RECORD .....................................................................120 12.11 CLOUD COMPUTING.............................................................................................................120 12.12 SHARED SERVICES..............................................................................................................121 12.13 DATA CENTRES...................................................................................................................121 12.14 INTERNET AND INTRANET .....................................................................................................121 11.15 WIRELESS LOCAL AREA NETWORK (WLAN).........................................................................122 12.16 PATIENT ENTERTAINMENT....................................................................................................122 12.17 USE OF PERSONAL DEVICES................................................................................................122 12.18 PUBLIC SERVICE BROADBAND AGGREGATION (PSBA) ..........................................................123 12.19 SOCIAL NETWORKING..........................................................................................................124

13 Governance.............................................................................................................................125 13.1 INFORMATION REQUIREMENTS GROUP (IRG) .......................................................................125 13.2 CHANGE MANAGEMENT .......................................................................................................126 13.3 POST-IMPLEMENTATION REVIEWS ........................................................................................126 13.4 IM&T INFRASTRUCTURE MATURITY MATRIX REVIEW.............................................................126

14 Conclusion..............................................................................................................................128 Appendix I NWIS Programme Plan...........................................................................................129 Appendix 2 UHB Programme Plan .............................................................................................131 Appendix 3 UHB System List......................................................................................................136 Appendix 4 IM&T Resource Plan ................................................................................................144


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11 EEXXEECCUUTTIIVVEE SSUUMMMMAARRYY

11..11 IInnttrroodduuccttiioonn

Technology has brought major advances in Health Care over recent years and dramatic advances are both likely and necessary in the years ahead. Full advantage of these technologies need to be taken in order to deliver fair, personalised, effective and safe care for individuals. The potential benefit of these technologies needs to be given the highest level of attention by the Health Board. The Strategic vision of the Health Board in relation to its Information Strategy is: "To improve the delivery and support of patient care locally and nationally through the better use of information and supporting information technology in all aspects of the Health Board's activities." Put simply: “The right information in the right place at the right time”. This document describes the UHB Strategic intent to deliver an Information Management and Technology (IM&T) programme which has the potential to help transform and modernise UHB services putting the citizen at the centre of integrated care systems. It will demonstrate the benefits and return on investment which can be achieved provided the programme is resourced appropriately. The Strategy is based on the information requirements of our citizens, our clinicians and UHB management requirements. The UHB will seek to deliver an Electronic Patient Record (EPR) programme supplemented by a modern Business Intelligence (BI) platform and facilitate citizen access as the backbone of its Information Management and Technology (IM&T) strategy. It will be based on a “Digital by default” approach throughout the UHB using IM&T to help deliver services which are safer, better and cheaper.

11..22 IInnffoorrmmaattiioonn aanndd CCoommmmuunniiccaattiioonn TTeecchhnnoollooggyy ((IICCTT)) SSttrraatteeggiicc CCoonntteexxtt

A number of key strategic principles are integral in this strategy foremost of which is that all initiatives should deliver benefits and return on investment (ROI). This document sets out the IM&T strategic direction for the UHB for the next 3 years. It has been compiled to form part of the ICT strategy for Wales as Cardiff and Vale play a major role in its delivery. As such it should be read in conjunction with:

• National Infrastructure Strategy for Wales • National Applications Strategy for Wales • National Security Guidance for Wales • ICT Strategy for the Public Sector in Wales

The UHB will continue to ensure that all initiatives are aligned with National Strategy and work with the NHS Wales Informatics Service (NWIS) in the planning and delivery of the programme to ensure maximum benefit on investment on an All Wales basis. The UHB need to acknowledge the National strategy and the potential for National veto of local initiatives if not in line with the National Strategy


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11..22..11 AA PPllaattffoorrmm ffoorr MMoovviinngg FFoorrwwaarrdd The Strategy outlines each area in terms of vision, current status, next steps and benefits. It is important to recognise however the opportunities available to the UHB as a result of achievements and progress made to date. The UHB has made massive progress in IM&T provision despite resourcing constraints. The following areas serve as just a few examples but illustrate a platform from which the UHB is better placed than most to move forward:

• One of the most extensive network and PC infrastructures • The only pervasive Community and Mental Health Informatics system in Wales • The only extensive Business Intelligence System implementation in Wales

• One of the most extensive Clinical mobile working facilities in the UK

• The first in Wales to implement Web Portal technology allowing the UHB to benefit from this

functionality whilst awaiting the delivery of the National Welsh Clinical Portal product

• A stable fully pervasive, in house developed PAS system which provides the benefit of flexibility and provision of UHB required functionality such as EU workstation and Ward Clinical Workstation.

• A flexible and skilled workforce which benchmarking information demonstrates is highly

efficient in resource terms.

• A skilled innovative team who are the first in Wales to develop and take forward eReferrals, Hospital eReferrals, eMedicines Management and eDischarge on behalf of NHS Wales

All of this provides the UHB with a good baseline position, however ambition must be at the highest level in identifying and delivering the expectations of our users and therefore there is a significant distance to travel.

11..33 HHeeaalltthh SSttrraatteeggiicc CCoonntteexxtt The Strategy has been developed to ensure that all ICT initiatives are geared towards support of the strategic direction of the Health Service in Wales particularly in relation to:

• The strategic vision as set out in the UHB 5 year Framework and Operational Plan • “Together for Health” • “Setting the Direction”

The programme describes in particular how IM&T can be exploited to support the challenge of delivering new ways of working to provide effective care for the Citizen, cutting across traditional boundaries and supporting integration between Health, other Public Sector bodies and the third sector. The IM&T Strategy will need to be flexible and responsive in relation to the emerging South Wales Clinical Services Strategy and the requirements outlined in “Making a difference 1 & 2”


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11..44 IInnffoorrmmaattiioonn RReeqquuiirreemmeennttss The Strategy is based on the information requirements of our citizens in terms of how they access our services, Clinicians in terms of what they need to support clinical care and the UHB in terms of the Business information required to manage the organisation efficiently.

11..44..11 CClliinniiccaall IInnffoorrmmaattiioonn RReeqquuiirreemmeennttss The original Clinical Applications Strategy that was published in 2007 by Informing Healthcare defined 5 types of information services that Clinicians need:

• Information services that help me undertake day to day tasks • Services that enable me to view previous records • Information services that enable me to analyse what's happening • Information services that let me communicate with other people • Services to provide me with knowledge to keep me up to date

This provided a framework within which a strategy could be developed to provide a single view of the patient’s record. The Strategic Electronic Patient Record (EPR) plan details how these Clinical information requirements are being addressed. 11..44..22 CCiittiizzeenn iinnffoorrmmaattiioonn rreeqquuiirreemmeennttss The citizen will shift to become the centre of care as a result of the global revolution in telecommunications. We will revise our privacy and security models to enable citizens to use their network connection and devices to communicate with public service; this will drive the change in the technology we use. The diagram below illustrates the paradigm shift in the way we will use information services in the future that is now underway. This change will also enable the carers and third sector to be included in the communications and circle of care from which our previous technology excluded them.

Putting the Citizen at the Centre in our networked world Paradigm shift as we use the technology they have to communicate

One global network, global services, no outside, no inside Mobile always on, any time, any place, anywhere Each of the links can carry voice, video and data The security of each link can change depending on the type of communication and citizens requirement or confidentiality


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The availability of reliable and secure cloud services for the citizen will also drive a change towards cloud based services for all desktop and communications technologies in public services, providing an ”Apps" store delivering software as a service. The support for self care will be increased using My Health On Line (MHOL) and other services to which citizens now have access. These services are summarised in the diagram below:

The shift in the technology towards the consumer and the change in their expectations will require us to rapidly evolve the approaches we take to ensuring privacy and information security. This evolution is the key to enabling public services in Wales to harness the new technologies and put the Welsh Citizen First. 11..44..33 BBuussiinneessss IInnffoorrmmaattiioonn RReeqquuiirreemmeennttss The Department of Health’s new Information Strategy encapsulates the message: The power of information: putting all of us in control of the health and care information we need Improved information quality and information sharing is critical to the modernisation of health care services. Today’s NHS organisation needs fast, responsive and above all accurate information on which to base its decisions and importantly support the UHB to consistently deliver safe, effective, equitable and efficient care. Data collected throughout a patient’s journey is hugely valuable for secondary uses such as capacity planning, commissioning, management, research, audit and patient level costing. In order to turn this data into knowledge the UHB needs a modern business intelligence function. Managers and clinicians will need access to intuitive functionality and the skills to interpret and understand the


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information presented to them. The availability of self-service access to information via comprehensive business intelligence tools including on-line analysis, interactive reporting, dashboard, scorecards and predictive modelling is essential to the operational and strategic running of the health board.

11..55 CClliinniiccaall SSyysstteemmss –– EElleeccttrroonniicc PPaattiieenntt RReeccoorrdd ((EEPPRR)) SSttrraatteeggyy The UHB is progressing with the implementation of an electronic patient/citizen record (EPR). There are two options:

• Procure a whole system solution • Enable the creation of an EPR across the whole health and social care environment by

interfacing the current core systems The first option is not considered feasible on the grounds of cost (no capital funding available) and is contrary to NWIS national policy. Therefore the UHB will continue with its strategy of interfacing the current core systems through the development of enabling systems, the latter mainly in conjunction with NWIS national projects. The UHB’s main core systems are:

• GP based systems (currently being reprocured) • PARIS - community, therapies, mental health and social care system • PMS/WCWS/EU - hospital administration system • Pathology system (NWIS national replacement programme – implementation in 2013) • Radiology system (NWIS national replacement programme, implementation date delayed

and uncertain) • Pharmacy system

In addition there are a considerable number of service specific applications, which are set out in appendix 3 of the strategy. The main NWIS enabling systems being developed are:

• Welsh Clinical Portal (WCP) • Welsh Clinical Communication Gateway (WCCG) • Enterprise Master Patient Index (EMPI) • Hospital E-Referrals (HERS) • Medicines Transcribing and eDischarge (MTED)

The Main UHB enabling systems being developed are: • Business Intelligence system (BI) • Digitisation of Health Records • Communication Hub • Electronic Network Access improvements including Smartphones


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Integrating GP Systems into the architecture The GP systems are mature commercial systems which have now enabled all practices in Wales to become paper light. They provide GPs and their staff with a fully functional system that enables the management of identity, clinical records, medications, tests etc. In addition they support workflows within the practice and communications including the provision of mobile solutions that work effectively in the community. Community nursing staff in some areas makes extensive use of these systems in their day-to-day work. Historically each of the 480 GP practices in Wales had their own system and these were not connected to other clinical systems except to receive test results. In view of the central position that general practice and the community have within the health service it is important that these systems are now fully integrated into the overall architecture to facilitate integration of care and clinical communications. NWIS have therefore started to connect the systems in a variety of ways to make best use of their rich functionality and capabilities. This is included the development of the IHR, My Health Online (MHOL) and connections to the Welsh clinical communications gateway. NWIS are currently in the process of re-procuring the GP systems which are undertaken on a four-yearly cycle. The output-based specifications now include the requirements we need to fully integrate the GP systems into the overall architecture and enhance communications with the rest of our services. The implementation of these enhanced GP systems will support fully integrated care within the community and with secondary care. A diagrammatic overview of plans to integrate GP systems can be found in the Strategy document.


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11..55..11 EEPPRR IInnffrraassttrruuccttuurree PPllaann The diagram below is a simple representation of how this vision holds together. It is based on the foundations of a modern, efficient and secure ICT infrastructure. The applications that will deliver the components of our Electronic Patient Record are the central spokes of the diagram with the communication layers that enable these to be accessed appropriately shown as the outer rings.

KEY BIS Business Intelligence System IHR Individual Health Records CHIRP Cancer Histopathology Reporting Project LIMS Laboratory Information Management System Comms Hub Communication Hub MTED Medicines Transcribing eDischarge EMPI Electronic Master Patient Index PACS Picture Archiving and Communications Systems ESR Electronic Staff Record PSBA Public Service Broadband Aggregation EU Workstation Emergency Unit Workstation WCCG Welsh Clinical Communication Gateway HERS Hospital eReferrals System WCP Welsh Clinical Portal PMS Patient Management System WCW Ward Clinical Workstation


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11..55..22 EEPPRR SSttrraatteeggiicc PPllaann The UHB is at the forefront of delivery of the components of the EPR on a national and local basis, being the first to develop and implement GP electronic referral, hospital electronic referrals and electronic discharge functionality. The UHB has a real opportunity to deliver this EPR over the 3 year period described below, providing the programme is resourced appropriately. Failure to resource the programme sufficiently could result in the timelines extending by in excess of two years. It is also important to ensure that risks associated with potential national programme slippage are managed appropriately. The vision of a citizen centred record is further enhanced by recent national agreement on plans to procure a national community, mental health and social care informatics solution. The UHB is at the leading edge of this agenda being the only UHB in Wales with a pervasive Community Informatics implementation. It will be necessary to address the UHB ICT Training requirements in relation to the delivery of this EPR plan. At each appropriate stage of the implementation of the IM&T Strategy it will also be necessary to carry out and “Equality impact assessment”. Details of the ICT and Business Intelligence Strategic work programme can be seen in section 7 and 8 of the document.

C&V Clinical Portal PMS EnhancementsCommunity Health & Social Care ProcurementWCW Real Time Bed managementPARIS Enhancements PARIS Mobile WorkingData Warehouse Dev‘Good’ Pilot BluespierPerformance ManagementDashboards development

WCCG eReferralsHERS WCP Early Phases (inc eDischarge)Medicine TranscribingEMPIIHRWCCG – Other clinical Communications

HERSLIMSMHOLAdvanced WCP inc Electronic Test Request

Digitisation of Med RecordsCommunity Health & Social Care ProcurementPerformance ManagementDashboards development

RADIS IIWCCG – GP Test Requests Complete National Applications Architecture Implementation Review Strategy

2012/13 2013/14 2014/15

CAV UHB EPR Plan

Cor

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atio

nal &

Inte

rnal

Wor

k Pl

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B

uild

ing

Blo

cks

for D

eliv

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of a

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Current Status

EPR Phase 1

EPR Phase 2

EPR 3 and onwards

Internal Projects NWIS Projects


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11..66 EEnnaabblliinngg IImmpprroovveedd AAcccceessss ttoo IITT SSyysstteemmss // AApppplliiccaattiioonnss ffoorr CCiittiizzeennss aanndd ssttaaffff The UHB as part of its strategy is actively seeking to deploy technologies which will provide further access opportunities to systems, applications and services for staff, patients and the public. The UHB is at the forefront of promoting this agenda across Wales. Timelines are outlined below. The programme is aimed at facilitating a way forward which will allow the UHB to take on these initiatives either as a package or individually. Some will have no or minimal revenue impact and some are to be determined. 11..66..11 EEnnaabblliinngg cciittiizzeenn AAcccceessss The citizen will shift to become the centre of care as a result of the global revolution in telecommunications. We will work with NWIS on this Strategy to revise our privacy and security models to enable citizens to use their network connection and devices to communicate with public service; this will drive the change in the technology we use. This change will also enable the carers and third sector to be included in the communications and circle of care from which our previous technology excluded them. 11..66..22 SSmmaarrttpphhoonnee CCoonnnneeccttiivviittyy PPrroojjeecctt -- BBrriinngg YYoouurr OOwwnn DDeevviiccee ((BBYYOODD)) SSttaaffff The UHB is working with NWIS in the development of a national solution that will enable staff to access Clinical and Business applications from their smartphone devices. It is anticipated that the national solution will not be a “single product” but a number of options that will be aligned to the UHB’s infrastructure design. It will facilitate BYOD access for staff to applications such as email, intranet and clinical portal as appropriate. 11..66..33 IInntteerrnneett SSeerrvviicceess The UHB plays a key role in the design team for NHS Wales that is currently investigating how each Health Board within Wales will have and adequate internet link to support its clinical and business users. The national design will ensure that each organisation has the ability to prioritise and manage the various types of internet traffic such as Social Media sites. The Internet Circuit has been increased from 100Mb to 300Mb in April 2012. A Task and Finish Group is being set-up to look at how every Health Board can have a 100Mb Internet Circuit design that can be expandable with minimal impact on NHS Wales. It is projected that that the Internet growth to support NHS Wales will increase by 50% annually. 11..66..44 SSoocciiaall MMeeddiiaa SSiitteess The ability to fully utilise Social Media sites is linked to being able to provide the appropriate bandwidth and agreement on policy within NWIS. The NHS Wales internet circuit has been increased from 100mb to 300mb in April 2012. A task and finish group has been established in NWIS to determine how every UHB can have a 100mb internet circuit design that can be expandable with minimal impact. This will facilitate the usage of everyday internet tools such as Facebook and Twitter in support of the delivery of Health Care in Cardiff and the Vale. 11..66..55 EEdduurrooaamm ((UUKK AAccaaddeemmiiaa WWiirreelleessss NNeettwwoorrkk)) The UHB is currently in design discussions with technical colleagues from Cardiff University on the interfacing of Eduroam (UK academia wireless network) to our Wireless Local Area network (WLAN). The design work will be transferable to other Health Board.


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11..66..66 IImmpprroovveedd 33GG SSiiggnnaall iinnttoo UUHHBB HHoossppiittaallss With the major change in mobile technology driven by Smartphone Technology and the ever improving 3G soon to be 4G signals the UHB is looking into the installation of Pico Cells to improve mobile phone access within its premises. The design work will be transferable to other Health Board. 11..66..77 BBrriinngg YYoouurr OOwwnn DDeevviiccee ((BBYYOODD)) ffoorr PPaattiieennttss // PPuubblliicc The UHB has invested heavily its in Wireless (WLAN) and will be tendering in 2012 for a solution that will enable its patients and guests secure access to the internet. The design work will be transferable to other Health Board. 11..66..88 MMoobbiillee WWoorrkkiinngg The UHB already offers extensive home working facilities providing off site access to applications to over 1200 staff. This included the mobile working project using netbooks and 3G which have been provided to District nurses and Health visitors. Options for further rollout are under review, further investment will need to be funded by improvements in productivity. 11..66..99 TTiimmeessccaallee All of these enabling programmes are being driven by the UHB’s local strategy. The following diagram shows the timescales for implementation

Enab

ling

Impr

oved

Acc

ess

to IT

App

licat

ions

/ Sy

stem

s

Current Status

Phase 1

Phase 2

Phase 3 and onwards

Internal Projects

SmartPhone Connectivity

2012 / 13 2013 / 14

Internet Services

Social Media Access

EDUROAM

Improved 3G Signal into UHB Hospitals

Bring Your Own Device (BYOD) for Patients / Public

Mobile Working

Citizen Based Access


Page 11

11..77 BBuussiinneessss IInnffoorrmmaattiioonn RReeqquuiirreemmeennttss SSttrraatteeggiicc PPrrooggrraammmmee

The UHB has the most advanced business intelligence system (BIS) in Wales providing comprehensive BI analysis and reporting capabilities. The system is designed to enable UHB staff to access a single source of trusted information on a self-service basis in a safe and intuitive environment. Currently there are over 400 users of the system and demand for increased access is high. The BI System is complimented by a fully integrated Data Warehouse which contains data from all core UHB operational systems providing a rich source of secondary uses data for operational and performance management including patient level costing.

One Trusted Information SourceData

WarehouseData Entry

Other Data Sources

Departmental Systems (EPR) Business Intelligence

SystemDashboards & Scorecards

Reporting

Self-ServiceAnalysis

Clinicians

Board

Managers

Information Professionals

The system has grown and developed over a number of years from a 50 user pilot to its existing enterprise scale implementation. The resulting increase in recurring costs of annual system support and maintenance however has not been included within the IM&T budget. This has resulted in a significant shortfall in funding reflected in the table below. There is a risk that continued under funding of the system will result in non-renewal of the software support contract. Professional supplier support is essential for a system so widely deployed and non renewal could expose the UHB to risks related to system performance and resilience. Revenue Costs 2012/13 £k 2013/14 £k 2014/15 £k Software maintenance BI 109 119 131 Software maintenance Data Warehouse

18 18 18

Staff system development & Analyst 217 217 217 Staff system support & maintenance 101 101 101 Corporate informatics staff 231 231 231 In order to support the evolving business needs of the UHB the BI System is continually under evaluation and development by the Business Intelligence Team which sits within the IM&T department. This relatively small resource covers all areas of system management including maintenance, support, user training and development. The resource available has not kept pace with the growth and enterprise deployment of the system and is now inadequate to cover all aspects of its management and development. There is an increasingly difficult and uncomfortable balance


Page 12

between maintaining and developing the system, and currently it is not being developed quickly enough to keep up with the UHB’s requirements. There is also a continual demand for new people to access the system and the lack of investment in a dedicated trainer has resulted in a backlog of 115 individuals waiting to be trained. The benefits of having a market leading Business Intelligence System and integrated data warehouse are significant and the UHB has acted as a reference site for several years in order to show other NHS organisations how far BI Systems can be used and developed in a health environment. An obvious example of tangible benefits to having the system has been the management and delivery of the Access 2009 pathway targets. It is widely acknowledged that the success in managing referral to treatment pathways has been to a significant extent due to the self-service use of the BI System. It has also enabled the number of corporate informatics staff to be maintained at a minimum level. Another area of development that has put the UHB ahead of the rest of Wales is the availability of fully integrated and costed data to individual patient events (Patient Level Costing). This provides complex and powerful information to enable managers and clinicians to understand how resources are used and enable benchmarking with colleagues and similar services. Future developments requested of the system are varied and exciting and would provide the UHB with ground breaking levels of business intelligence data. However the ability to deliver these in an acceptable timescale will depend on whether additional resource (staff and funding) can be identified. The chart below reflects what is possible with the current resource and what could be achieved if this were increased. Finally while having a Business Intelligence System undoubtedly puts the UHB in a strong position we cannot forget the ‘human factor’ which is critical to translating data into business information. The organisation is extremely data rich and the BI System aims to enable users to answer 80% of

PLC( PARIS, EU, Exec Reports Theatres Ward Dashboards APC ( Inpatient management frequent feed for Discharge Management)Business Reporting

LIMS

RADIS II

2012/13 2013/14 2014/15

BI Work Plan 2012 - 2015

Info

rmat

ics

/ Bus

ines

s In

telli

genc

e Pl

an

Current Status

Phase 1

Phase 2

Phase 3 onwards


Business Reporting Business Reporting

Outpatient Activity (increase feed clinical management)BluespeirClinical Information Repository Real time Bed ManagementHRG4 Mental Health BI Module

Finance Commissioning

Outpatient Activity (increase feed clinical management)Clinical Information RepositoryHRG4 Divisional Analysis support & Education

Additional Resource

Finance CommissioningDivisional Analysis support & Education

Business Reporting

Divisional Analysis support & Education


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their business questions without having to refer to the central information team. However an ongoing commitment to work closely with Divisions and clinical teams to ensure they have the skills and knowledge necessary to interpret and understand data available to them is critical, as is the need to provide more complex analyses when required. The provision of this level of support is something the BI Team aspires to provide; were additional resources available the team would be in a position to realise this ambition.

11..88 IICCTT IInnffrraassttrruuccttuurree

The ICT infrastructure of the UHB has rapidly expanded over the last decade as IT tools become increasingly essential to support modern patient care. There has however been little recurring investment in the refresh of aging equipment. This leaves the UHB at increasing risk of significant ICT breakdown as well as inefficiencies resulting from use of old equipment which takes longer to activate. A widespread upgrading/refresh of IT Infrastructure is therefore required including network, servers, desktop and software. There will also be a need to increase core IT support services .All users should expect very fast PCs but this will come with a funding impact. 11..88..11 NNeettwwoorrkk The network supports nearly 10,000 connected devices. In the next 3 years significant quantities of equipment will become “end of life” and require a technology refresh in order to maintain technical currency and sustainability. 11..88..22 PPCCss aanndd DDeesskkttoopp IInnffrraassttrruuccttuurree The IT Department currently supports over 7500 PCs, laptops and desktops across the UHB. It is best practice to plan for a maximum four year life, but this has not been possible due to lack of capital allocation (revenue based options are currently being explored). PC replacement is currently a Directorate responsibility when capital upgrades are unavailable. The result is a significant proportion of aging and inefficient PCs on the Network. 11..88..33 DDeesskkttoopp SSooffttwwaarree The UHB will be undertaking a review of its Microsoft Desktop applications to identify best value for money in respect of “cloud licensing”, device based desktop licensing or an Enterprise Agreement. When the UHB decides to upgrade its Microsoft software platform the will be cost £2.7 m for all 7500 devices. It should also be noted that the Microsoft XP operating system currently used throughout Wales NHS becomes “End of Life” in 2014.

11..88..44 EEmmaaiill IInnffrraassttrruuccttuurree The national approach to eMail infrastructure and in particular eMail archiving is currently under review and discussion on an All-Wales basis but is unlikely to address NHS Wales’s needs within the immediate future. The UHB’s current eMail infrastructure will allow some growth for selected users, alternatively, to significantly increase storage capacity would cost c.£108k.

11..88..55 SSeerrvveerr IInnffrraassttrruuccttuurree The UHB maintains more than 200 data servers for essential Clinical and Business applications. A risk assessment of the service specific applications has been undertaken and is included in appendix 3. It should be noted that there is a significant potential for Clinical risk if Clinical system infrastructure fails as a result of lack of investment in infrastructure replacement. The strategy is to move to virtual server farms, which is the least expensive option.


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11..88..66 SSttoorraaggee IInnffrraassttrruuccttuurree The UHB’s data storage needs will increase year on year. Current expansion levels are c30TBytes/annum, costs range from £4k - £20k per TByte

11..88..77 BBaacckkuupp IInnffrraassttrruuccttuurree The UHB will continue to invest in cost effective block level back up technology to replace standard tape centred infrastructure 11..88..88 TTeelleeccoommmmuunniiccaattiioonnss aanndd VVooiiccee SSeerrvviicceess The telephony system at UHW and UHL has recently been replaced. The UHB now has the most modern computer based telephone system in Wales. There will however be the same server refresh issue for this system as any other computer system.

11..99 IIMM&&TT IInnffrraassttrruuccttuurree SSuussttaaiinnaabbiilliittyy

11..99..11 IInnffrraassttrruuccttuurree The UHB, because of historic failure to invest in infrastructure refresh, faces the dilemma of having one of the most extensive ICT footprints in support of clinical care at risk of collapse if routine funded replacements are not undertaken. The capital replacement costs are shown below. The revenue costs shown are the maintenance and SLA costs within IM&T budget for core systems such as network, PMS Etc. There is little scope for capital funding for IM&T in 2012/13, therefore it is unlikely that these requirements will be met, significantly increasing the risk of infrastructure failure. A schedule of absolute priorities for investment to mitigate this risk as far as possible is set out in section 1.15. Infrastructure/Cost 2012/13 2012/13 2013/14 2013/14 2014/15 2014/15 Cap £k Rev £k Cap £k Rev £k Cap £k Rev £k Network 200 500 750 PCs and desktop Infrastructure

380 872 1090

Desktop software 2700 Server 200 750 750 eMail system upgrade 108 Storage 75 350 350 Backup 75 225 350 Telecommunications 0 100 100 Maintenance / SLAs 792 792 792 Total £1038 £792 £2797 £792 £6090 £792

Infrastructure refresh and replacement normally comes under the definition of capital expenditure, however recognising the constraints of a limited capital programme all revenue based options are currently being explored particularly in relation to PCs.


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11..1100 AAlltteerrnnaattiivvee OOppttiioonnss

11..1100..11 CClloouudd TTeecchhnnoollooggyy The UHB’s IT Department has carefully considered the benefits, risks and costs associated with the various levels of Cloud technology available. These considerations take into account the needs and opportunities of the UHB as a single Clinical Business unit and also as part of the Welsh NHS as whole (with associated National Strategy).

Potential advantages to small businesses of external cloud technology are not to be confused with the requirements of larger businesses such as the Health Board. It is clear that the most cost and resource efficient approach for the UHB is to utilise virtual server farm technology within the Health Board’s own network geography. This approach, whilst clearly less expensive than both physical and external offerings, also improves rather than compromises security and resilience of systems. It will also be consistent with the National Strategy which will provide access to All Wales National Systems utilising an identical approach to ‘Cloud Technology’ from the National data centres. 11..1100..22 OOffffiiccee 336655 The UHB will be undertaking a review of its Microsoft Desktop applications to identify best value for money in respect of “cloud licensing” against desktop licensing. It is however recognised that the UHB will need to invest heavily in a licence model in 2014 and will be working with NWIS in the development of our strategy Preliminary costings for Microsoft’s Cloud based Office 365 offering for 7500 devices would equate to £1.3m per annum recurring therefore making it an unlikely option. 11..1100..33 NNaattiioonnaall DDaattaa CCeennttrree The UHB will work with NWIS throughout the strategic programme and where appropriate systems and servers will be accessed from the National Data Centre. 11..1100..44 SShhaarreeppooiinntt The UHB will explore options to implement sharepoint which could provide business and potential clinical benefits in terms of the sharing and secure storage of documents within the Health Board.

Physical to Virtual

Physical Optimisation

Virtual Optimisation

Server Optimisation – C&V Virtualisation (Cloud) approach

Physical to virtual Migration delivers Efficiencies in areassuch as server counts, power, cooling and Space

Virtual optimisation allowing rapid provisioning, targetedWorkloads simplified management

Local Systems Resilience and availability

National Systems


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11..1111 BBeenneeffiittss Delivery of benefits and return on investment are an essential component of this strategy. One example is Digitisation of Health Records and is expected to deliver recurring savings increasing to £1.9 million per annum by 2015. Other areas are outlined in the table below and are set out in more detail in section 9 of the strategy. Any benefits/savings from implementation of the strategy will be assessed and factored into Divisional and service line budgets.

Examples of types of outcomes & benefits:

Patient safety increased Increased timeliness and availability of relevant clinical information decreased transcription errors & increases safety.

Positive patient outcomes increased

Easy access to relevant clinical information increases speed and relevance of diagnosis, care, treatment plan and onward referral.

Convenience of care increased

Improved availability of information make the location, timeliness or method of access for patients more convenient

Patient confidence increased

The availability and targeting of accurate and relevant information at the patient’s point of contact increases confidence in service

Legal/policy compliance maintained

Requirement to comply with policy or UK/EC legislation is met.

Health system efficiency increased

Processes are faster, or wasteful processes can be reduced to improve productivity.

Overall health system costs decreased

Informatics improvements eliminate wasteful processes and reduce expenditure.

In order to help ensure the effective delivery of these benefits the UHB should invest appropriately in business process change, systems and services aimed at auditing and realising potential benefits. This investment to appropriately deliver the benefits using IT tools should involve the Innovation and Improvement department (I&I), Workforce and Organisation Development (WOD), Clinical and Divisional management.

11..1122 BBaacckk OOffffiiccee SSyysstteemmss RReevviieeww –– LLiinnkkss ttoo WWoorrkkffoorrccee mmooddeerrnniissaattiioonn PPrrooggrraammmmee The IM&T strategy is to review all administrative systems over a period of time to assess the scope for implementation of technology to improve the effectiveness and efficiency of those systems. Technology will underpin the workforce modernisation programme moving from a paper driven system to an electronic process which has the potential to release significant efficiencies and savings however, implementation will be constrained by available funding and WG Invest to Save finance will need to be accessed. The current review timetable is set out in the following table: System 2012/13 2013/14 2014/15 Health records * Electronic coding * ESR * E-leave * E-expenses * Datix * Telemedicine *


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Rosta Pro * Digital Dictation * Electronic Admin Pathways * Communications Hub *

11..1133 PPaarrttnneerrsshhiippss The IM&T strategic programme will in particular exploit the opportunities to be gained from working with partners. The UHB will explore innovative solutions working with public and private sector partners to improve efficiency, delivering mutual capacity improvements and provide additional combined benefits. The respective IM&T Departments of the UHB and Cardiff University are currently working together on a range of initiatives including mobile working, wireless connectivity, and connection to non NHS sites and with non NHS devices. The UHB is also at the forefront of working with other partners in relation to joint IM&T initiatives and are currently exploring all possible opportunities to champion the proposal for joined up working with Social Service Departments with the potential to explore the usage of one ICT system for both. In addition the IM&T Department is working collaboratively with other public sector partners both regionally and nationally under the auspices of the Office of the Chief Information Officer (OCIO) for Wales to explore the potential for working collectively across the public sector. It is through this group, in conjunction with NWIS, that strategies for the delivery of future Cloud computing solutions, servers, back up infrastructure and email procurements will be taken forward in line with the ICT Strategy for the Public Sector in Wales. The UHB currently has in excess of 100 users connecting from non UHB desktop PCs located in both Cardiff Council and the Vale of Glamorgan premises. Staff connect to the PARIS and UHB business applications which enable the provision of an integrated Flying Start service to its residents. The Mental Health service in Cardiff has recently been integrated into a single service combining staff from both Cardiff Council and the UHB. The technical design for the management of this service has been agreed, all staff will use PARIS as the single Citizen focussed system. The PSBA- Extranet when fully operational will provide the technical solution to provide a Gateway Service for staff from both organisations to access their required systems including PARIS or their relevant business systems such as email in a seamless manner. It is also planned that the Wyn Project technical design will also replicate the business model implemented by Mental Health integrated services. The UHB is working with Cardiff University in the integration of our Wireless Local Area Network (WLAN) to Eduoroam (university’s wireless solution) which will enable university staff access to their academic resources whilst on the UHB estate. Providing such services as access to our WLAN and NHS Wales roaming will provide staff availability to their business and clinical system and patients and guest access to the internet, which will aid in the UHB obtaining ROI on the purchase of the WLAN.


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11..1144 RReessoouurrccee CChhaalllleennggee

11..1144..11 IIMM&&TT RReessoouurrccee PPllaann As has been described, the UHB is embarking on a challenging strategic IM&T agenda with the potential to modernise and transform the UHB from an ICT perspective giving a platform for improved patient care, efficiency and return on investment. In order to deliver in these areas it is first necessary to address the severe resource challenges facing the UHB in relation to the delivery of ICT services and the ICT programme. Firstly, as identified in the strategy the UHB is faced with very significant risk in resourcing its infrastructure on a sustainable basis. The infrastructure has seen a more than 3 fold increase in recent years with no increase in support resources and no planned replacement programme. This places the UHB at severe risk, as highlighted on the risk register, despite the best efforts of the IM&T Department to continually modernise and improve processes. In order to successfully take forward the IM&T strategic programme the must first invest in the sustainability of its infrastructure and secondly in the revenue resource it devotes to IM&T development and implementation as shown in the finance and resource section of this strategy. The Health Board, despite being at the forefront of many Welsh ICT initiatives, is currently resourced at 0.4% of revenue for IM&T in comparison to a Welsh average of 0.9%. The comparison is just as stark in capital terms. In order to advance on the opportunities described in this executive summary and in more detail throughout the strategy, plans to reinvest in IM&T capital and revenue will be required over a phased period. The following diagram shows that 80% of IM&T resources are committed to maintaining and supporting current systems and applications, with only 20% available for the implementation of the local and NWIS development programmes. IM&T is not currently resourced to deliver the agreed local and national programmes as scheduled. It should also be noted that there is a significant cost in supporting user training in the application of new systems. These resources are not included within the IM&T budget and for some systems are being provided by I&I staff (e.g. e-discharges, e-referrals, Bluespier)

IT Support (excluding Information)

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

Senio

r Mge

IM&T

Prog Mge

Server S

uppo

rt

PMS Su

pport

Web

Site

Sup

port

Help

Desk

Netw

ork S

uppo

rt

Telec

oms S

uppo

rt

IT Sec

urity

Proje

ct Sup

port

PARIS

Sup

port

WTE Series1


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11..1144..22 CCoommppaarraattiivvee RReessoouurrccee IInnffoorrmmaattiioonn The following tables show the comparative resource allocations in Wales for Revenue, Capital and Staffing for IM&T: Revenue Capital

Staffing

Source – NWIS analysis of financial and manpower data for LHB’s The UHB is well below the National average for IM&T Revenue, Capital and staffing, which in turn is below recommended levels. The UHB will need to address this investment deficit as outlined in section 11 of the Strategy Document. There will also be a required dialogue with NWIS regarding the national and local distribution of resources for this IM&T programme. 11..1144..33 EEPPRR RReessoouurrccee PPllaann As has been described earlier and shown in detail in appendix 1 and 2, the UHB along with all other UHBs in Wales, has embarked upon a challenging IM&T programme aimed at delivering an EPR over the medium term. The resource deficit in terms of delivering this programme is estimated at 30% of IM&T revenue as outlined in the resource plan appendix 4. Concentration on those priority investment areas as described in section 1.15 of this Executive Summary will however ensure that the UHB is well placed to address its highest risks and set a platform for delivering the most immediate EPR benefits.


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11..1155 IInnvveessttmmeenntt PPrriioorriittiieess

As has been shown significant capital and revenue investment is required by the UHB to reduce risk of infrastructure collapse and to deliver the EPR, BI, and Citizen Access programmes. However, taking into account the UHB financial position this year there are a number of key investment priorities which will remove some of the highest risks and deliver some key priority immediate benefits as set out in the rest of this section. 11..1155..11 IInnffrraassttrruuccttuurree Infrastructure requires significant investment but the following list could deliver immediate benefits and remove some of the highest risks: PC Infrastructure: The UHB is currently replacing 1100 PCs on the basis of clinical need and age, in line with funding received from discretionary capital and Welsh Government in 2011/12. An investment in a further 700 PC replacements would remove the entire stock of the most aging 6+ years old Eversham PCs providing a massive increase in performance for users. Cost: £380K this could potentially be a revenue investment as outlined earlier. Email Infrastructure: As described earlier the email infrastructure could be upgraded providing a very significant increase in mailbox size to all users. Cost: £108K Server Infrastructure: As described earlier out of the 200+ servers the UHB supports, there are 20+ that can be categorised as high risk. Following the recent risk assessment these require virtualisation or replacement. Cost: £80K Network Infrastructure: As described earlier large elements of the network infrastructure will be end of life within 3 years. Addressing the priority risk areas as described below will mitigate the highest risks. Network Edge The UHB has over 200 Network switches that are over 8 years old and have been End of Life for some time. We require 50 of these switches replacing each year as well as their associated fibre-optic interfaces. This will support the increase in Network speed to key locations such as X-Ray to enable faster and more reliable data services. Cost: £100K ICT Support The UHB is currently operating a support structure well below accepted staffing levels to maintain its infrastructure effectively. An investment of 3 WTE’s would help to address some of the highest priority support risks. Cost £80K Summary of critical infrastructure investment priorities Project COST PC Infrastructure £380K Email Infrastructure £108K Network Infrastructure £100K Server Infrastructure £80K ICT Support £80K


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11..1155..22 EEPPRR PPrriioorriittiieess The UHB, as has been mentioned previously, is at the forefront of the development and delivery of the EPR strategy for Wales. In order to deliver in line with requirements and outlined timescales investment will be required as described however priority areas with earlier benefits could be addressed with the investment outlined below: Hospital e-Referrals System (HeRS) The HeRS (Hospital e-Referrals System) is a national development project for which C&V are the main developer and project management site. Additionally C&V will be the pilot site for this fully electronic referrals system which will provide significant clinical benefit as well as clear business benefits. There is a high level of Clinical anticipation and acceptance for HeRS phase 2 and a pressing demand to deliver this product within the current financial year. The addition of 3 x WTE development resources will provide a realistic opportunity for the UHB to meet this timescale. Cost: £128K Medicine e-Transcribing and Discharge system Similarly the implementation of the national Medicine e-Transcribing and Discharge system (MTeD) will provide significant clinical and business improvements both within the acute and primary care arms of the Health Board. Phase 1 of this project is due to start beta-implementation in the near future. The UHB has a need to address phase 2 developments in order to fully realise the benefits of this system. Initial estimates are that this will require 2 x WTE developers to take forward. Cost: £85K Integration of BI and EPR Systems The Business Intelligence system has an increasing data foot print both in terms of dashboards and general reporting. Limitations in the processing power within source data systems have introduced a significant delay in BI advance. Provision of 2 WTE developers will enable this backlog to be addressed to more realistic timescales. EPR based systems agreed for deployment within the UHB requires increased integration resources. Agreed examples (not exclusive) include, Community, Orthopaedic, Neurophysiology, Cardiology and Ophthalmology systems. These demands cannot be met to aspired timescales without additional integration resource of 1 x WTE. Cost: £128K EPR implementation, training and project management Successful EPR implementation will require appropriate training, project management and implementation leads. – 3 WTE Cost £100K Summary of investment priorities for quicker implementation of EPR Project WTE (band 7s) COST HERS 3 £128K MTeD 2 £85K PMS BI Integration 2 £85K PARIS – PMS Integration .5 £21K Bluespier and other EPR Integration .5 £21K EPR implementation 3 £100K


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11..1155..33 PPAARRIISS PPrriioorriittiieess The UHB leads Wales in the development and deployment of a Mental Health and Community EPR. On a daily basis the PARIS system supports over 2000 UHB staff across 159 teams and 4 service divisions in their recording of patient care delivery. The system has grown since inception in 2005 from a user base of 50 to a user community of 3200 UHB staff members. Resource to work on the system has not however kept pace with this growth and indeed the UHB funded project resource has remained static from 2005 to 2012. The project resource covers project management, development, reporting, training, application management/support, and business analysis and system helpdesk. The UHB PARIS solution has won both National and International recognition in recent years, including a UK CPA award for ‘best support from IT’ and the hosting of 14 connections for Health (cFH) or northern Ireland Health and Social Care visits. The development resource of 1 WTE and reporting resource of 1 WTE have implemented 1000 system enhancements since 2005, at a rate of approximately 1 LIVE change every 2 days, however, as a consequence of the projects demonstrable delivery to its scoped services and PARIS’ role as the UHB’s default tool of choice in the Mental Health, Community and PC&IC arenas, an increasing ‘bow wave’ of over 300 initiatives/changes is now faced. The project is critically under resourced to respond and deliver to the UHB’s 2012-15 change agenda Clearly the UHB requires a facility in the Mental Health, Community and PC&IC areas, which is able to respond and deliver to the National Community and integrated Health and Social Care agenda in 2012-15. To support this, the UHB’s PARIS project must be appropriately resourced. The following prioritised resource and deliverables matrix allows for this: Summary of investment priorities for PARIS Project WTE COST SPOE (addictions single point of entry) and CAVERS (CaV electronic record for substance misuse) implementation System Developer/Reporting resource

1

£35K

PC&IC System Development/reporting Resource to deliver the PC&IC change agenda (CRT, cross PC&IC community teams, data links to acute record stores)

1

£35K

PC&IC Business Analyst/Service Lead for 2012-15 developments

1

£35K

WYN Campaign Business Analyst/Developer to support this implementation

1

£35K

BI Reporting Information analyst to deliver PARIS data to the corporate BI team.

0.5

£17K

System Support Officer To provide support function for existing 159 team (this is currently supported by a single 0.6WTE system manager)

1 £29K


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11..1155..44 BBuussiinneessss IInnffoorrmmaattiioonn PPrriioorriittiieess The UHB like other NHS organisations is incredibly data rich and the Business Intelligence System provides huge opportunities to turn that data into real intelligence and knowledge whenever and wherever it’s needed. However while the system is deployed widely and is an essential part of the organisations operational and performance management structures, its full potential has not yet been realised. Some key development requests made by the UHB cannot be delivered within the aspired timescales without additional resource – examples below. Summary of investment priorities for BI Project WTE COST Bluespier Data Warehouse Integration & BI module 0.5 £17K Clinical Information Repository Data Warehouse Integration & BI module

1 £35K

Finance Data Warehouse Integration & BI module 1 £35K Commissioning BI module 1 £29K BI and Informatics analysis and support for divisions 1 £29K Mental Health BI Module 1 £29K Theatres BI Module 0.5 £17K

11..1166 GGoovveerrnnaannccee

Within the National and Local context , as outlined in previous sections, the UHB is faced with a challenging list of development and implementation requirements to ensure the organisation has the systems and information necessary to support new ways of working and the modernisation agenda. It will be necessary to ensure that there is an appropriate prioritisation mechanism to determine which initiatives move ahead and when. It will also be crucial to ensure that initiatives are resourced appropriately so that they can deliver anticipated benefits In order to ensure that the ICT strategic programme is focussed on the goals of the UHB and the delivery of benefits an appropriate Governance arrangement is essential. An Information Requirements Group (IRG) has been established to oversee the program. It reports to the Strategic Planning and Performance Committee (SPPC) and has multiple Project Boards which report to it covering various initiatives

11..1177 CCoonncclluussiioonn

The 3 year strategic programme as described will provide the UHB with a platform to deliver an ICT strategic infrastructure, EPR programme and BI programme appropriate for a billion pound Health Care organisation. Working with NWIS it will also begin to deliver a the paradigm shift in the way we will use information services to put the Citizen at the centre of integrated care systems as a result of the global revolution in telecommunications. In addition it will provide the baseline for the UHB to take forward a programme of modernisation and transformation. Appropriate investment levels will enable the timely delivery of the programme, achievement of benefits and return on investment envisaged. Failure to invest will result in risk and delay. Crucially however this programme should not be seen as IM&T led but rather as a modernisation programme for the UHB taken forward by the services with the involvement of stakeholders and supported by Innovation and Improvement.


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22 IINNTTRROODDUUCCTTIIOONN

This document sets out the IM&T strategic direction for Cardiff and Vale University Health Board for the next 3 years. It fits within the strategic change agenda in NHS Wales and particularly within the national IT programme. As such it should be read in conjunction with the following documents:

• National Infrastructure Strategy for NHS Wales • National Application Strategy for NHS Wales

• National Security Guidance for NHS Wales • ICT Strategy for the Public Sector in Wales

Technology has brought major advances in health care over the years and dramatic advances are both likely and necessary in the years ahead. Full advantage of these technologies needs to be taken in order to deliver fair, personalised, effective and safe care for individuals. The potential benefits of these technologies need to be given the highest level of attention by clinical and managerial leaders and these benefits then realised through effective implementation to enable the necessary changes to the way the NHS works. The revolution in information management and technology now enables the health service to respond more quickly and more flexibly to expectations. Technology now enables important medical information and images to be transferred when and where they are needed. Advances in communications technology could transform the lives of people with long-term conditions by improved communications to maintain care in their homes. The demand for evidence based decision making requires a business intelligence approach to managing information, as is commonplace in many industries worldwide. The Health Board IM&T department has a record of success and achievement both locally and nationally, and has consistently delivered a responsive and reliable service with limited resources. At a time of financial cost pressure the department is being asked to deliver additional services and applications to support local and national objectives. At this time of restricted resources it is paramount that the overall Strategic direction and each initiative taken forward must deliver benefits for the Health Board in terms of improved efficiency and patient care. IM&T should be used as an enabler to help modernise and transform Services of the Health Board. This document describes the UHB Strategic intent to deliver an Information Management and Technology (IM&T) programme which has the potential to help transform and modernise UHB services putting the citizen at the centre of integrated care systems. It will demonstrate the benefits and return on investment which can be achieved provided the programme is resourced appropriately. The Strategy is based on the information requirements of our citizens, our clinicians and UHB management requirements. The UHB will seek to deliver an Electronic Patient Record (EPR) programme supplemented by a modern Business Intelligence (BI) platform and facilitate citizen access as the backbone of its Information Management and Technology (IM&T) strategy.


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It will be based on a “Digital by default” approach throughout the UHB using IM&T to help deliver services which are safer, better and cheaper. The Strategic vision of the Health Board in relation to its Information Strategy is: "To improve the delivery and support of patient care locally and nationally through the better use of information and supporting information technology in all aspects of the Health Board's activities." Put simply: “The right information in the right place at the right time”.

22..11 AA PPllaattffoorrmm ffoorr MMoovviinngg FFoorrwwaarrdd

The Strategy outlines each area in terms of vision, current status, next steps and benefits. It is important to recognise however the opportunities available to the UHB as a result of achievements and progress made to date. The UHB has made massive progress in IM&T provision despite resourcing constraints. The following areas serve as just a few examples but illustrate a platform from which the UHB is better placed than most to move forward:

• One of the most extensive network and PC infrastructures • The only pervasive Community and Mental Health Informatics system in Wales • The only extensive Business Intelligence System implementation in Wales

• One of the most extensive Clinical mobile working facilities in the UK

• The first in Wales to implement Web Portal technology allowing the UHB to benefit from this

functionality whilst awaiting the delivery of the National Welsh Clinical Portal product

• A stable fully pervasive, in house developed PAS system which provides the benefit of flexibility and provision of UHB required functionality such as EU workstation and Ward Clinical Workstation.

• A flexible and skilled workforce which benchmarking information demonstrates is highly

efficient in resource terms.

• A skilled innovative team who are the first in Wales to develop and take forward eReferrals, Hospital eReferrals, eMedicines Management and eDischarge on behalf of NHS Wales

All of this provides the UHB with a good baseline position, however ambition must be at the highest level in identifying and delivering the expectations of our users and therefore there is a significant distance to travel.


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33 SSTTRRAATTEEGGIICC CCOONNTTEEXXTT


The IM&T Strategy of the Health Board needs to take account of the strategic context in relation to Welsh Health Strategy and Welsh ICT Strategy. The Key Strategic drivers which impact the ICT direction for the Health are outlined in this section. The IM&T Strategy draws on and is related to many associated local and national objectives:

33..22 HHeeaalltthh SSttrraatteeggiicc CCoonntteexxtt

The Strategy has been developed to ensure that all ICT initiatives are geared towards support of the strategic direction of the Health Service in Wales particular in relation to:

• The strategic vision as set out in the UHB 5 year Framework and Operational Plan • “Together for Health” • “Setting the Direction”

The programme describes in particular how IM&T can be exploited to support the challenge of delivering new ways of working to provide effective care for the Citizen, cutting across traditional boundaries and supporting integration between Health, other Public Sector bodies and the third sector.


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33..22..11 AAnnnnuuaall QQuuaalliittyy FFrraammeewwoorrkk ((AAQQFF)) The NHS Wales Annual Quality Framework (AQF) for 2011-12, more recently complemented by the NHS Wales Delivery Framework, sets out a 5-year vision with the key aims to: • do more to protect and improve health for all, linked to the priority areas in Our Healthy Future

(OHF) and concentrating efforts on the specific key outcomes identified from the Prevention and Promotion National Programme;

• create integrated services across primary, community care and social care services, delivering

against the priorities identified within Setting the Direction; • modernise what the NHS does so that it has systems that deliver and sustain excellent

services to meet the needs of patients and maximise clinical outcomes. All support services will need to devise work programmes that align with these overall key aims, whilst at the same time delivering on service specific deliverables specified within the Delivery Framework. in the form of core targets.

33..22..22 SSttrraatteeggiicc VViissiioonn aass sseett oouutt iinn 55 yyeeaarr SSttrraatteeggiicc FFrraammeewwoorrkk aanndd OOppeerraattiioonn PPllaann ‘Cardiff and Vale University Health Board (UHB) will be the flagship UHB in Wales, with an international reputation for excellence and innovation. Our skilled and committed staff will provide safe, high quality care, at the right time, in the right place. We will work with partners and with communities to support the people of Cardiff and Vale in improving their own health and well-being. We will build a shared sense of pride and purpose in our health services.’ 33..22..33 TTooggeetthheerr ffoorr HHeeaalltthh The Bevan Commission, in a recent report, supported the ambition of world-class health and social services for Wales. It defined these as ‘services best suited to Wales but comparable with the best anywhere’. The Welsh Government and National Assembly for Wales accepted the report and its recommendations, which are in line with the actions set out in the Programme for Government:

• Improving health as well as treating sickness • One system for health • Hospitals for the 21st century as part of a well designed, fully • Integrated network of care. • Aiming at Excellence Everywhere • Absolute transparency on performance • A new partnership with the public • Making every penny count

The UHB has responded positively to these frameworks and continues to take the lead in a number of national programmes. Commitment to these priorities requires the allocation of significant Health Board resources.


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This IM&T Strategy needs to address the ICT implications of achieving this vision set out in The 5 Year Strategic Framework, Operational Plan and Together for Health. 33..22..44 SSeettttiinngg tthhee DDiirreeccttiioonn The Primary and Community Services Strategic Programme

Setting the Direction recognises that the commitment to delivering world class integrated healthcare in Wales requires a step change in the approach to developing both policy and service delivery models for primary and community care. The UHB needs to implement a new system of care delivering an easily recognisable, highly organised model of integrated and evidence based health and social care services in the community. This will act as a bridge between primary care and the acute sector, and will focus on the needs of the individual, moving from a ‘reactive’ to a ‘proactive’ model of care. It will bring together joint care and support in the community, delivered in partnership between the NHS, Local Authorities, the Third Sector and other partners including local people, carers and communities.

The following diagram describes an integrated model of care which is predicated on a system whereby patients are actively managed or “pulled” through primary, community and secondary care according to the ability to meet their needs. This is the basis of the vision for the new NHS in Wales.


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Y S

Figurere 2: Futurere System of Care “Seamless Pull System” withIntegrated Access to Information

Pull Pull

Holistic provision

OrganisedSystemof IntegratedCommunityServices

Car e which is managed

Reco r ds which a re integrated

Hospital

Assess Communications Hub

Primary

Ca

r e

L N O E C TA W

and accessible Gove r nance which is unified

Capacity which is managed

Expertise which is specified and deminishing

Based Ca re

Pull

Discharge

Shared Information based on GP Record L OI R

Community OOHResource T eam

Pull

Patient Jou rney


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33..22..55 CCoommmmuunniiccaattiioonnss aanndd IInnffoorrmmaattiioonn IImmpplliiccaattiioonnss ooff SSeettttiinngg tthhee DDiirreeccttiioonn The ICT implications of setting the Direction are many and varied and begin to be addressed in this Strategy Services need to be organised and focused around the patient/service user with high quality information and effective communication being central to the delivery of bespoke care. NWIS has a key role to ensure that enhanced access is made available to the GP record, without compromising security and confidentiality, thereby enabling relevant information to be readily available to support effective clinical decision making by all relevant professionals. In addition, work is underway to further develop integrated Communications Hubs to improve communications for patients and staff. These Hubs will develop to provide a range of services, including:

• Supporting referral processes and better scheduling the work of the Community Resource Teams;

• Providing comprehensive service registers;

• Signposting people to the right services, facilitating the navigation of the public, patients,

carers and healthcare professionals through the health and social care system;

• Supporting the sharing of appropriate information across health and social care services;

33..33 NNaattiioonnaall IICCTT SSttrraatteeggiicc CCoonntteexxtt

Introduction A number of key strategic principles are integral in this strategy foremost of which is that all initiatives should deliver benefits and return on investment (ROI). This document sets out the IM&T strategic direction for the Health Board for the next 3 years. It has been compiled to form part of the ICT strategy for Wales as Cardiff and Vale play a major role in its delivery. As such it should be read in conjunction with:

• National Infrastructure Strategy for Wales • National Applications Strategy for Wales • National Security Guidance for Wales • ICT Strategy for the Public Sector in Wales

The Health Board will continue to ensure that all initiatives are aligned with National Strategy and work with the National Welsh Informatics Service (NWIS) in the planning and delivery of the programme to ensure maximum benefit on investment on an All Wales basis. The IM&T services at Cardiff and Vale UHB operates within the national IM&T context and is leading the delivery of a number of national initiatives in collaboration with NWIS. This strategy is set within the context of these national initiatives summarised below.


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33..33..11 IICCTT SSttrraatteeggyy ffoorr tthhee PPuubblliicc SSeeccttoorr iinn WWaalleess The ICT Strategy for the Public Sector in Wales provides the technical strategy, architecture, infrastructure and standards to implement Delivering a Digital Wales. It sets out how ICT will be used to support the extensive redesign of public services that is to be expected as the implementation of One Wales takes shape. A pictorial view of the strategy and supporting architecture is shown below

Source – Public Sector Wales ICT Strategy 33..33..22 NNaattiioonnaall DDaattaa CCeennttrree TTeecchhnniiccaall SSttrraatteeggyy The Office of the Chief Information Officer has produced a Data Centre Technical Strategy which will deliver a significant rationalisation of the data centres that provide information based services to public sector organisations in Wales. This document shows how a move to 2 /3 national data centres will bring substantial savings in cost and energy consumption, and at the same time improve service standards and the ability to cope with service disruption.

The Cardiff and vale UHB strategy takes account of the overall framework and reflects the goal architecture identified above


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It must be noted that the strategy states that no new facilities will allowed to be created, nor the upgrading of local facilities unless they can meet the same standards as the national facilities, can be achieved in a cost effective manner, can be shared by other organisations and be sanctioned by the appropriate governance arrangements described above. It is also noted however that organisations will need to continue to host some services locally for technical reasons. This UHB strategy recognises the medium term ambitions of the national data centre strategy and the associated move to cloud and hosted services. 33..33..33 NNWWIISS NNaattiioonnaall AApppplliiccaattiioonnss SSttrraatteeggyy ffoorr NNHHSS WWaalleess The national applications strategy for Wales sets out a modular architecture for the delivery of patient centred applications both nationally and locally. The strategy aims to deliver a reliable, flexible, cost effective and safe solution that will meet the long term needs of health and social care in Wales. 33..33..44 NNWWIISS The NHS Wales Informatics Service was established in April 2010, as part of the healthcare reform programme. It brings together the strategic development of Information Communications Technology (ICT), the delivery of operational ICT services and information management. The new organisation has a national remit to support NHS Wales and make better use of scarce skills and resources The NWIS programme is seen as the National Solution to the Information Systems Challenge. Whilst the NWIS programme will deliver new services and applications in the medium term, Cardiff and Vale UHB also retains a programme of local development complimentary to the NWIS programme.

We have to balance our resources between commitment to NWIS and National Programmes and ensuring we can deliver on our own more immediate drivers and supporting our critical local systems and services. Whereas NWIS undertakes national developments, the UHB is responsible for local implementation and has to commit the resources to deliver this.

The UHB is fully supportive of the national applications strategy and is taking a leading role in the development of some of the key components


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33..33..55 NNaattiioonnaall AArrcchhiitteeccttuurree DDeessiiggnn BBooaarrdd The 'national architecture' is the framework that dictates how technology should be used to support better patient care and services. It is a framework for the design and development of information systems within NHS Wales. The product assurance process covers design (how systems fit together from the business perspective), safety (whether the systems will reduce risk to patients), and information governance (whether the systems maintain the confidentiality of patient information without compromising clinicians’ ability to provide care). These assurance processes are aligned to the three stages of NADB approval: NADB Stage 1: Strategic fit (the proposed product or service is aligned to the overall business and technical design strategies for NHS Wales) NADB Stage 2: Requirement (the design for the product or service is as correct as can be and has the appropriate level of assurance by clinical and technical stakeholders) NADB Stage 3: Approval to implement (the product or service is safe enough to be implemented in a clinical setting)

http://www.wales.nhs.uk/nwis/page/52508�

http://www.wales.nhs.uk/nwis/page/52618�


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44 IINNFFOORRMMAATTIIOONN RREEQQUUIIRREEMMEENNTTSS

The Strategy is based on the information requirements of our citizens in terms of how they access our services, Clinicians in terms of what they need to support clinical care and the UHB in terms of the Business information required to manage the organisation efficiently.

44..11 CClliinniiccaall IInnffoorrmmaattiioonn RReeqquuiirreemmeennttss

The original Clinical Applications Strategy that was published in 2007 by Informing Healthcare defined 5 types of information services that Clinicians need:

• Information services that help me undertake day to day tasks • Services that enable me to view previous records • Information services that enable me to analyse what's happening • Information services that let me communicate with other people • Services to provide me with knowledge to keep me up to date

This provided a framework within which a strategy could be developed to provide a single view of the patient’s record. The Strategic Electronic Patient Record (EPR) plan details how these Clinical information requirements are being addressed.

44..22 CCiittiizzeenn iinnffoorrmmaattiioonn rreeqquuiirreemmeennttss

The citizen will shift to become the centre of care as a result of the global revolution in telecommunications. We will revise our privacy and security models to enable citizens to use their network connection and devices to communicate with public service; this will drive the change in the technology we use. The diagram below illustrates the paradigm shift in the way we will use information services in the future that is now underway. This change will also enable the carers and third sector to be included in the communications and circle of care from which our previous technology excluded them.

Putting the Citizen at the Centre in our networked world Paradigm shift as we use the technology they have to communicate


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The availability of reliable and secure cloud services for the citizen will also drive a change towards cloud based services for all desktop and communications technologies in public services, providing an ”Apps" store delivering software as a service. The support for self care will be increased using My Health On Line (MHOL) and other services to which citizens now have access. These services are summarised in the diagram below:

One global network, global services, no outside, no inside Mobile always on, any time, any place, anywhere Each of the links can carry voice, video and data The security of each link can change depending on the type of communication and citizens requirement or confidentiality


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The shift in the technology towards the consumer and the change in their expectations will require us to rapidly evolve the approaches we take to ensuring privacy and information security. This evolution is the key to enabling public services in Wales to harness the new technologies and put the Welsh Citizen First.

44..33 BBuussiinneessss IInnffoorrmmaattiioonn RReeqquuiirreemmeennttss

The Department of Health’s new Information Strategy encapsulates the message: The power of information: putting all of us in control of the health and care information we need Improved information quality and information sharing is critical to the modernisation of health care services. Today’s NHS organisation needs fast, responsive and above all accurate information on which to base its decisions and importantly support the UHB to consistently deliver safe, effective, equitable and efficient care. Data collected throughout a patient’s journey is hugely valuable for secondary uses such as capacity planning, commissioning, management, research, audit and patient level costing. In order to turn this data into knowledge the UHB needs a modern business intelligence function. Managers and clinicians will need access to intuitive functionality and the skills to interpret and understand the information presented to them. The availability of self-service access to information via comprehensive business intelligence tools including on-line analysis, interactive reporting, dashboard, scorecards and predictive modelling is essential to the operational and strategic running of the UHB.


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55 SSTTRRAATTEEGGIICC PPRRIINNCCIIPPLLEESS

55..11 KKeeyy pprriinncciipplleess

The strategy is based on four key principles • Technology and systems will be used to support changes to working processes to provide

better, safer care and assist staff in their day to day work;

• The ICT Strategy for Wales will drive the focus of direction for Cardiff & Vale UHB who will also take a leading role in promoting its values to the local healthcare community;

• Management information will be derived from operational systems wherever possible which will

promote and facilitate improved data quality • IM&T initiatives will deliver a return on investment in terms of cash releasing or non cash

releasing benefits. These are inter-related principles. The first principle says that the strategy is about change, not technology. The technology is merely an enabler for improvement in ways of working, which will lead to benefits for staff and patients alike. The implication is that the introduction of the changes must be user led if they are to be sustainable. Projects will not be led by I.T. Nonetheless the I.T. service has an important role in enabling these changes, by promoting the available systems and evaluating emerging technology, communicating with stakeholders and energising the implementation process. The second principle says that Cardiff and Vale UHB will act as the agent for change in promoting and directing the implementation of the ICT Strategy for Wales. Where systems are directly under the domain of Cardiff & Vale UHB then full responsibility will be assumed for adhering to the principles of the national programme. Where systems are under the control of service providers then Cardiff & Vale UHB will encourage and incentivise those providers to deploy and fully utilise fully compliant systems. This approach will include the mandatory use of appropriate systems within contractual commitments wherever possible. Cardiff & Vale UHB will continue to be a strong voice in influencing the future direction and pace of the national ICT strategy by contributing as a strong advocate and partner of the strategy. The third principle is self explanatory. A key point is that by extracting data from systems that users rely on, the reliability and integrity of the data used will be assured. In this way there will be more confidence in the use of management information and more certainty about the decisions and actions that follow. The fourth principle is ever more important in these times of restricted resources. Each initiative taken forward must deliver benefits for the Health Board in terms of improved efficiency and better patient care. IM&T should be used as an enabler to help modernise and transform Services of the Health Board. Taken together the three principles support the mission to provide the right systems for the right information, in the right place, at the right time, every time.


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55..22 WWhheerree ddoo wwee wwaanntt ttoo bbee

Information and communication technology could transform the experience of health and health care services in the same way that other aspects of life have been changed, for example, seamless communication across boundaries so that GP, Community and hospital staff are all aware of the needs of our citizens. Systems that are supportive of this concept are PARIS (Mental Health and Community System), Welsh Clinical Portal and the Individual Health Record (IHR) Within the next three to five years best practice in information and technology in Cardiff and Vale UHB should lead to:

• Integrated care supported by the introduction of clinically agreed common assessment and

information systems so that professionals across health and social care with a legitimate need to view the same record can do so, whether seeing a service user in a general practice, at home or in hospital;

• Business intelligence approach to information management; • Delivery of care outside hospital which will be enabled by new communication systems

including telemedicine and PARIS, allowing mobile technologies to assist in delivering care in the homes of patients.

• Safety of prescribing improved by the further development of electronic protocol driven Medicines Management that reduces human error.

• Quality and safety of treatment improved by clinical staff having electronic access to the up-to-date information they need, together with improved guidance and decision support information;

• The quality of, and access to, diagnostic images has already been dramatically improved by the pervasive roll out of the picture archive communication system (PACS) so that the UHB now provides digital radiology on a film less basis. This access will be further enhanced by the NADEX project and the Welsh Clinical Portal project which will enable high quality digital images to be available on screen wherever a consultation takes place.

• Improved safety and convenience being delivered by implementing the patient-centred record system to give national access to the records of individual patients for health care professionals who have a legitimate need to view the records, wherever the patient presents in the country via the Welsh Clinical Portal;

• Provision of electronic referral services, utilising the Welsh Clinical Communication Gateway (WCCG), to facilitate referrals from primary to secondary care,

• Information for self-care and service user involvement in care being supported by assistive technology in the home and enabling service users to access their own records more easily by implementing ‘My Health on Line’ (MHOL).

55..33 MMooddeerrnniissiinngg tthhee PPaattiieenntt PPaatthhwwaayy

The formation of the new Health Boards has provided a framework for the service in Wales where a single organisation is responsible for the patient pathway, through primary care to secondary and social care. Linking these care pathways is seen as a pre-requisite to improving the patient journey and delivering the health outcomes that Wales desires. For Cardiff and Vale, together with the other health boards, this places a requirement on the Informatics service to support an increasingly wide range of systems and services at a time when resources are scarce and cost reductions are required.


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66 IIMM&&TT SSTTRRAATTEEGGIICC PPRRIIOORRIITTIIEESS


In order to respond to the Strategic requirements set out in “Together for Health”. “Setting the Direction” and the Health Board 5 Year Strategic Framework a comprehensive Strategic IM&T Work Programme is underway aimed at delivering IM&T solutions for a Billion Pound Healthcare organisation. The Health Board is at the cutting edge of Informatics developments in Wales. Many of these initiatives are being developed in Cardiff and vale for first use here with a view to then being transferable across Wales, often being project managed by the UHB. There are also areas where Cardiff and Vale are at the forefront of delivery of Informatics solutions where there are no current plans to match this level of delivery elsewhere in Wales such as Community Informatics (PARIS system) and Business Intelligence System (BIS). Being at the forefront of informatics developments provides the Health Board with early service delivery benefits. It does however bring with it a resources challenge, and a challenge in relation to managing the pace of change in the National and Local programme.

66..22 CClliinniiccaall SSyysstteemmss –– EElleeccttrroonniicc PPaattiieenntt RReeccoorrdd ((EEPPRR)) SSttrraatteeggyy The UHB is progressing with the implementation of an electronic patient/citizen record (EPR). There are two options:

• Procure a whole system solution • Enable the creation of an EPR across the whole health and social care environment by

interfacing the current core systems The first option is not considered feasible on the grounds of cost (no capital funding available) and is contrary to NWIS national policy. Therefore the UHB will continue with its strategy of interfacing the current core systems through the development of enabling systems, the latter mainly in conjunction with NWIS national projects. The UHB’s main core systems are:

• GP based systems (currently being reprocured) • PARIS - community, therapies, mental health and social care system • PMS/WCWS/EU - hospital administration system • Pathology system (NWIS national replacement programme – implementation in 2013) • Radiology system (NWIS national replacement programme, implementation date delayed

and uncertain) • Pharmacy system

In addition there are a considerable number of service specific applications, which are set out in appendix 3 of the strategy. The main NWIS enabling systems being developed are:

• Welsh Clinical Portal (WCP) • Welsh Clinical Communication Gateway (WCCG) • Enterprise Master Patient Index (EMPI) • Hospital E-Referrals (HERS) • Medicines Transcribing and eDischarge (MTED)


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The Main UHB enabling systems being developed are:

• Business Intelligence system (BI) • Digitisation of Health Records • Communication Hub • Electronic Network Access improvements including Smartphones

66..33 IInntteeggrraattiinngg GGPP ssyysstteemmss iinnttoo tthhee aarrcchhiitteeccttuurree::

The GP systems are mature commercial systems which have now enabled all practices in Wales to become paper light. They provide GPs and their staff with a fully functional system that enables the management of identity, clinical records, medications, tests etc. In addition they support workflows within the practice and communications including the provision of mobile solutions that work effectively in the community. Community nursing staff in some areas makes extensive use of these systems in their day-to-day work. Historically each of the 480 GP practices in Wales had their own system and these were not connected to other clinical systems except to receive test results. In view of the central position that general practice and the community have within the health service it is important that these systems are now fully integrated into the overall architecture to facilitate integration of care and clinical communications. NWIS have therefore started to connect the systems in a variety of ways to make best use of their rich functionality and capabilities. This is included the development of the IHR, My Health Online (MHOL) and connections to the Welsh clinical communications gateway. NWIS are currently in the process of re-procuring the GP systems which are undertaken on a four-yearly cycle. The output-based specifications now include the requirements we need to fully integrate the GP systems into the overall architecture and enhance communications with the rest of our services. The implementation of these enhanced GP systems will support fully integrated care within the community and with secondary care.


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Access to/from 3rd Party App’s

GP System(Supplier 1)

GPS Client

GP Practice

NAD

NAD

NWIS National Hosting in Wales

Patient

Browser

Community / Mobile Workers

NAD

MHoL

Secondary Care

DTS

Mobile Platform

OOH

CMIS IHR

WCCG Application Container

WCCG

GPTR

WCP

NHAIS

2DRx

Data Extraction Analysis Tools

(Audit+ & CM Web)

ITK

Scanning

NES(National Email System)

WCP

GPSYS Functional Scope 3rd Party ClientsGPSYS Integration Requirements

The UHB IM&T programme is a complex series of interconnected local and national initiatives. The diagram over page is a simple representation of how this vision holds together. It is based on the foundations of a modern efficient ICT Infrastructure. The applications that will deliver the components of our Electronic Patient Record are the central spokes of the diagram with the communication layers that enable these to be accessed appropriately shown as the outer rings. All other systems are detailed in appendix 3. Strategically the implementation of the Welsh Clinical Portal will act as the focal point for integrating solutions together in order that Clinicians can view multiple information sources through one access point.

66..44 EEPPRR IInnffrraassttrruuccttuurree PPllaann

The diagram below is a simple representation of how this vision holds together. It is based on the foundations of a modern efficient ICT Infrastructure. The applications that will deliver the components of our Electronic Patient Record are the central spokes of the diagram with the communication layers that enable these to be accessed appropriately shown as the outer rings.


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KEY BIS Business Intelligence System IHR Individual Health Records CHIRP Cancer Histopathology Reporting Project LIMS Laboratory Information Management System Comms Hub Communication Hub MTED Medicines Transcribing eDischarge EMPI Electronic Master Patient Index PACS Picture Archiving and Communications Systems ESR Electronic Staff Record PSBA Public Service Broadband Aggregation EU Workstation Emergency Unit Workstation WCCG Welsh Clinical Communication Gateway HERS Hospital eReferrals System WCP Welsh Clinical Portal WCW Ward Clinical Workstation The IM&T programme described in the diagram is comprised of multiple interconnected national and local programmes, all taking place within the overall ICT strategic framework for the NHS in Wales. The following sections describe the key developments taking place over the next 3 years.


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66..55 IICCTT PPrriioorriittiieess

The IM&T programme involves a range of initiatives which are being taken forward by the Health Board. There are however three key areas which will become the backbone of the delivery of ICT change in the Health Board. These areas are:

• Infrastructure Programme • Applications Strategy • Back Office Automation Strategy

All of these areas will be taken forward in line with the over arching National Strategies. Core infrastructure There is an urgent need to upgrade core infrastructure (server capacity, administrative software, share point, teleconferencing, system accessibility, hardware etc). There are a number of potential solutions, use of ‘cloud’ technology, connectivity of non NHS Smart devices, in house virtual server farms. Initial discussions have already taken place with the University to maximise utilisation across the two organisations and with one commercial supplier Operational patient administration systems The core systems are the hospital system (PMS), the community system (PARIS), GP systems (currently four suppliers) and the OOH system (ADASTRA). The current strategy is to develop software which will improve the connectivity between these systems and enable an EPR to be created across the whole healthcare system. The UHB is working very closely with NWIS in this respect and is at the forefront of piloting many of the new developments, which will be rolled out across Wales. When fully implemented, these will improve the safety of transactions, the quality of care for patients and provide opportunities for reducing administration costs. In addition accessibility is being improved through the mobile device solution for PARIS and through connecting non NHS Smart devices to the NHS system and clinical portal. Clinical systems The IM&T Department should now have a central record of all the clinical systems in the UHB. These are mostly stand alone systems implemented by clinicians with some Divisional IM&T support but often no support from the central IM&T Department. Previous audit reports have identified that some of these systems are at risk of future failure. The benefits and risks of these systems are currently being assessed and the results will be taken account of in the strategy. All future systems will be subject to a cost/benefit analysis and be procured after approval by the IM&T Department to ensure they are consistent with the strategy. Back office administration systems There is significant potential to reduce expenditure on back office services using IM&T as an enabler in rationalising back office processes. A schedule of opportunities has already been prepared for the review of administrative functions. A major improvement project to rationalise medical records is already well underway. Utilisation of internet Capacity has recently been increased which will speed up access. A joint development project is being taken forward with the University, which has already developed an internal social networking site and applications for Smart phones.


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Business Intelligence The UHB is the only LHB in Wales which has a sophisticated business intelligence system. Whilst this system is not yet operating at its full potential, although there has been significant integration of applications during the last 2 years (clinical workstation, EU dashboard, patient level costing, theatre dashboard). The strategy will reflect prioritisation of future developments to provide information to improve operational processes and service management. Eco-Friendly Strategic Actions The UHB is reviewing a number of methods which enable a reduction both in the carbon footprint of the use of technology and the concomitant cost savings of reduced power consumption. Examples include the de-activation of PC's (sleep and hibernation modes) during prolonged periods of inactivity (overnight for example), use of highly efficient TFT style screens and the extensive deployment of virtual server infrastructure where possible. Power usage cost reduction on use of PC's and monitors will be of one to several tens of pounds per PC per year. Cost savings on virtual servers is of the order of one to several hundreds of pounds per year per server. These initiatives need careful analysis and deployment but will certainly provide saving to the Health Board whilst at the same time reducing its impact on the environment


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77 IICCTT SSTTRRAATTEEGGIICC WWOORRKK PPRROOGGRRAAMMMMEE

In order to respond to the drivers as outlined earlier in relation to Health Strategic Context and National ICT Strategic context the Health Board has embarked on a comprehensive and challenging ICT strategic work programme as outlined in the following sections.

77..11 EEPPRR SSttrraatteeggiicc PPllaann

The UHB is at the forefront of delivery of the components of the EPR on a national and local basis, being the first to develop and implement GP electronic referral, hospital electronic referrals and electronic discharge functionality. The UHB has a real opportunity to deliver this EPR over the 3 year period described below, providing the programme is resourced appropriately. Failure to resource the programme sufficiently could result in the timelines extending by in excess of two years. It is also important to ensure that risks associated with potential national programme slippage are managed appropriately. The vision of a citizen centred record is further enhanced by recent national agreement on plans to procure a national community, mental health and social care informatics solution. The UHB is at the leading edge of this agenda being the only UHB in Wales with a pervasive Community Informatics implementation.

C&V Clinical Portal PMS EnhancementsCommunity Health & Social Care ProcurementWCW Real Time Bed managementPARIS Enhancements PARIS Mobile WorkingData Warehouse Dev‘Good’ Pilot BluespierPerformance ManagementDashboards development

WCCG eReferralsHERS WCP Early Phases (inc eDischarge)Medicine TranscribingEMPIIHRWCCG – Other clinical Communications

HERSLIMSMHOLAdvanced WCP inc Electronic Test Request

Digitisation of Med RecordsCommunity Health & Social Care ProcurementPerformance ManagementDashboards development

RADIS IIWCCG – GP Test Requests Complete National Applications Architecture Implementation Review Strategy

2012/13 2013/14 2014/15

CAV UHB EPR Plan

Cor

e N

atio

nal &

Inte

rnal

Wor

k Pl

an =

B

uild

ing

Blo

cks

for D

eliv

ery

of a

n EP

R

Current Status

EPR Phase 1

EPR Phase 2

EPR 3 and onwards



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77..22 NNaattiioonnaall PPrrooggrraammmmee DDeevveellooppmmeennttss

The Health Board is working in partnership with NWIS in the delivery of an agreed combined plan to deliver national ICT initiatives. 77..22..11 WWeellsshh CClliinniiccaall PPoorrttaall ((WWCCPP)) Current Status The NHS Wales Informatics Service (NWIS) is developing the Welsh Clinical Portal (WCP) in association with NHS Wales Health Boards. The WCP is a secure healthspace, which is being designed and tested by healthcare professionals, uniting key patient information from the many computer systems and databases used in NHS Wales. The portal gives doctors and nurses a single immediate view of the important data needed to support vital clinical decision making. It will also enable them to carry out key tasks e.g. ordering tests. Cardiff and Vale UHB is developing the Medicines Transcribing and E-Discharge (MTED) and the Hospital E-Referrals (HeRs) Phase 2 modules on behalf of NWIS. The UHB will be the pilot site for both MTED and HeRs and will test, implement and evaluate the products before they are made available for roll-out across NHS Wales. The Welsh Clinical Portal will replace the Cardiff and Vale Clinical Portal over time. Vision The Welsh Clinical Portal will be rolled-out across the UHB with new WCP modules being implemented as they become available:

• MTED, - will allow doctors and pharmacists to manage patient medication lists in secondary care

• HeRs Phase 2, - will allow clinicians to prioritise their e-referrals on-line • Pathology and Radiology Test Requesting, - will allow clinicians to order tests on-line • Alerts and Notifications, - will notify clinicians when a diagnostic result for their patient has

been returned to the WCP • Clinical Admissions, Discharges and Transfers – will allow users to admit, discharge or

transfer patients Next Steps The UHB’s Informatics Services E-communications Board (ISEC) which oversees the WCP project is working with NWIS and the local project implementation team to plan the first implementation of WCP in Cardiff and Vale.


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77..22..22 MMeeddiicciinneess TTrraannssccrriibbiinngg aanndd EElleeccttrroonniicc DDiisscchhaarrggee ((MMTTEEDD)) Current Status Cardiff and Vale University Health Board has undertaken the development of the Medicines Transcribing and E-Discharge module of WCP on behalf of NWIS.. Other Welsh Health Boards are also contributing to the ‘federated’ development of the WCP by developing other modules. When completed, Phase 2 of the MTeD module will provide functionality that facilitates the recording of medicines details against inpatient episodes of care. It will additionally allow the electronic production of a discharge advice letter, including a patient’s medication list. The e-discharge letter produced by the Welsh Clinical Portal will be delivered to primary care clinicians by the Welsh Clinical Communications Gateway, ensuring join up between two flagship national systems. Clinicians in Cardiff and Vale will be the major contributors to the development of MTED by being the first to comment on the design and to test its functionality. They will also be the first to use this exciting new software which will support and benefit patient care. Vision Medicines play a fundamental role in improving a patient’s health, yet medication errors and adverse medication events are common. One of the main reasons for this is that clinicians do not have immediate access to accurate patient information, including medications, across the primary / secondary care interface. A legible, accurate and unambiguous electronic medication list, coupled with electronic communication systems, will vastly improve the efficiency of all services, reduce the risk of transcription errors, reduce adverse events due to errors with medications, reduce hospital admissions and support the chronic disease management agenda. Subsequent phases of MTeD will allow fuller integration of the transcribing and prescribing processes with back-end Pharmacy operations to further contribute to the electronic processing of data. MTED will also support fuller integration with primary care systems to reduce manual data entry when crossing the boundary between Primary and Secondary care. Next Steps MTED Phase 1 (Work packages 1-3) will be piloted in Cardiff and Vale UHB during 2012 and then rolled out across the organisation. MTED will be made available to all other health boards in Wales by NWIS following an evaluation of the product in Cardiff and Vale.

Service delivery benefits: • Implementation of the WCP will result in increased timeliness and availability of relevant

clinical information • The production and administration of paper results will be reduced or eliminated • The transcription of pathology and radiology orders will be reduced or eliminated • The ordering of unnecessary tests will be decreased, resulting in reduced costs to the

organisation • Telephone transcription of urgent results will be reduced or eliminated • Implementation of the WCP will contribute significantly to the evolving electronic patient

record supporting accessibility, accuracy and security of patient data


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Service delivery benefits:

• The implementation of MTED will reduce medication transcription errors • Compliance with the formulary will be increased • The effectiveness of medicines reconciliation will be increased • An electronic discharge letter will be produced which will result in fast transmission of

structured and complete data to primary care. • GPs will have an up to date medication list for their patients

Work packages 4 and 5 will bring added benefit, particularly to pharmacists and pharmacy staff and lead to greater efficiency and help to support the safe treatment of our patients.


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77..22..33 HHoossppiittaall EE--RReeffeerrrraallss PPrroojjeecctt Current Status The UHB has developed Phase 1 of the Hospital E-Referrals System which has integrated the Welsh Clinical Communications Gateway (WCCG) with the UHB’s Patient Management System (PMS) so that e-referrals can be quickly routed from primary to secondary care and added to a hospital waiting list without the need for manual administration. Hospital E-Referrals (HeRs) began as a local project, the value of which was recognised by NWIS. The UHB was asked to lead a national HeRs project by NWIS which will make HeRs available to all Welsh health boards and see the product integrated with the Patient Administration System (PAS) most widely used in Wales (Myrddin). Phase 1 will be followed by a Phase 2 which includes on-line prioritisation of e-referrals by clinicians and clinical teams. The Hospital E-Referrals application will be integrated with the Welsh Clinical Portal so that clinicians carrying out the prioritisation of e-referrals can do so from within the WCP. Phase 2 will be piloted at the UHB once the development is complete, with Cardiff and Vale clinicians being at the forefront of the design and evaluation of the product. The WCP and associated MTED and Hospital E-Referrals projects are a priority for the UHB and will be of benefit to Cardiff and Vale clinicians and their patients as they become available. Vision The HeRs Project will bring many benefits for Health Boards in Wales most importantly the safe, secure and fast electronic transmission of patient data between clinicians, health records and administrative staff. Next Steps The UHB will continue to work with NWIS on the development of WCP modules including HeRs, which is expected to have further phases bringing benefits to both patients and staff over the period to 2015. The further development of the Hospital E-Referrals application will support the modernisation of the referral administration process. However, if agreed, these developments will result in an ongoing significant resource commitment for the UHB.


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77..22..44 WWeellsshh CClliinniiccaall CCoommmmuunniiccaattiioonnss GGaatteewwaayy ((WWCCCCGG)) Current Status The Welsh Clinical Communication Gateway (WCCG) has been developed by the NHS Wales Informatics Service (NWIS) with technical development and project management support from Cardiff and Vale UHB. The WCCG, based on the SCI Gateway developed by NHS Scotland, provides functionality that allows the secure transfer of clinical documents between Primary and Secondary Care IT systems. Cardiff and Vale UHB has been the early adopter for the WCCG project, the scope of which is the electronic transfer of GP Outpatient Referrals to secondary care using the National Generic Referral Template. The template has been developed with professional input from both primary and secondary care clinicians and service leads. The UHB has been working with NWIS to develop and implement the WCCG since 2007. Vision The WCCG has been integrated with all GP Practice IT Systems in use throughout Wales. GPs are able to call the WCCG from these systems and auto-populate the referral template, which is embedded within the WCCG, with data held on their local system. They can then add additional clinical comment and information and send the referral directly to secondary care – a process that can take as little as 2 minutes for a simple referral.

Service delivery benefits:HeRs contributes significantly to patient safety, patient treatment processes and business processes in the following ways:

• Safe, secure and fast electronic transmission of patient data between clinicians, health records and administrative staff

• Reduction in the time taken to add patients to a waiting list and, ultimately, a reduction in the time taken to initiate appointment booking

• Integration with the Welsh Clinical Communications Gateway (WCCG) • Integration with the UHB’s Patient Administration System (PMS) • Multi-user workflow functionality for processing referrals in medical records department(s) /

patient appointment centres / administration teams (before clinical review and prioritisation of referral)

• Flexibility – referrals can be processed by staff in devolved or other areas that are away from the main Health Records Department

• Significant reduction in turn around time between admin and clinical functions • Improved security of referral – ie referrals will not be lost or mislaid • Contributes significantly to the evolving electronic patient record thereby providing

accessibility, accuracy and security of patient data. • Improved Primary/Secondary Care communications on current patient state • Improved clinical triage management • Improved data accuracy. • Lean efficient and cost effective administrative processes • Online viewing and prioritisation by clinicians • Ordering of tests and investigations at point of clinical prioritisation • Messaging back to primary care


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Cardiff and Vale UHB has developed the Hospital E-Referrals System (HeRs) which integrates with the WCCG and Patient Management System (PMS). Health Records staff, and staff in devolved areas use HeRs to process the WCCG e-referrals and quickly add referrals to a waiting list in PMS. Next Steps The UHB has utilised the WCCG functionality to support a local e-discharge project. Electronic discharge letters are being sent via the WCCG to primary care when patients are discharged from hospital. This local project will be replaced when the Welsh Clinical Portal Medicines Transcribing and E-Discharge (MTED) functionality is implemented in the health board. The UHB is also looking at opportunities to transmit other types of e-communication to primary care by utilising the WCCG. (see E-Communications section below)

• • • • • •

77..22..55 EE-- CCoommmmuunniiccaattiioonn Current Status The Welsh Clinical Communications Gateway (WCCG) has been implemented in GP practices across Cardiff and Vale. The WCCG enables the safe transfer of electronic clinical communication between clinical settings in Wales in order to introduce efficiencies and safer working practices. The WCCG is currently used in Cardiff and Vale for GP referrals to outpatient services and for the transfer of e-discharge letters, however it could be used for a variety of other messages. Consideration has been given to other types of clinical communication that could be transmitted from secondary to primary care via the WCCG. Vision Three types of clinical communications have been identified which are currently paper based systems but could be sent electronically via the WCCG; Out Patient letters Following an out patient appointment, letters are typed in the generic letters module of PMS, printed and posted by medical secretaries to the patient’s GP. These clinic letters could be transmitted electronically to primary care by use of the WCCG.

Service delivery benefits: • The implementation of WCCG has resulted in a decrease in the manual handling of

referrals • Faster transfer of referral documents to the receiving site • A decrease in the cost of referral administration e.g. reduced telephone calls • An Increase in the relevance and completeness of patient clinical data within the referral

due the introduction of a structured template • Knowledge of referral status is shared amongst clinicians in primary and secondary care • E-discharge letter can be sent to GP practice as soon as a patient is discharged, benefiting

both patient and GP who has the latest information about the patient’s stay in hospital • Full audit capability


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Therapies letters On discharge therapists are given the option of printing a standard template with demographic and appointment details from the D&T module of PMS. Following printing they hand write additional clinical information onto the letter before posting to the patients GP. These letters could be transmitted electronically to primary care by use Emergency Unit (EU) letters Letters are automatically created in the EU module of PMS, printed and posted to GPs following attendance at the Emergency Unit. Letters containing information about a patient’s Emergency Unit attendance could be transmitted electronically to primary care by use of the WCCG. Due to the technical development and process change requirements highlighted above it is proposed that priority for development and implementation be given to Out Patient letters, followed by therapies and then emergency unit letters. This approach will enable lessons to be learnt during the easier implementations before focussing on the Emergency Unit where the business change will be more challenging. It will also deliver most significant benefit in the quickest timescales. Next Steps The health board, community directors, GPs, primary care groups and NWIS would need to be consulted to determine whether further investment in the use of the WCCG to send additional clinical e-communications to primary care is beneficial to patient care and also cost effective. 77..22..66 IInnddiivviidduuaall HHeeaalltthh RReeccoorrdd ((IIHHRR)) Current Status The Individual Health Record (IHR) is a summary of a patient’s computerised NHS GP record. The NWIS IHR Project is making this summary available to the GP Out Of Hours Service during the first phase of the project. Highly sensitive information is excluded from the IHR and patients are asked to give their consent at every consultation before the IHR can be viewed. Every patient has the right to opt out from having their GP record summarised in the IHR Data has been extracted in Cardiff and Vale from patient records where GP practices have the INPS Vision and EMIS GP systems. There is a delay with the data extraction from iSoft practices. This is expected to take place during summer 2012. Vision

The IHR is designed to support safe and effective care to patients who present to the GP Out Of Hours (OOH) service. It will enhance the safety and quality of care provided in the OOHs care


• WCCG could be used to send a range of electronic messages to GPs to improve efficiency, release resources and improve patient safety.

• Primary care clinicians would receive timely and complete information about their patients to support their ongoing care


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setting. The critical success factors, as linked to the project’s investment objectives, are the provision of a clinically useful IHR solution for the Out of Hours service that provides: • Health care benefit and value

• A usable source of information

• Support for the delivery of individual care

• Support for the overall health and care of the person

• Support for the concept of collaborating information services Next Steps The IHR will be made available across Cardiff and Vale over time. Data will be extracted from patient records in GP systems to ensure that all individuals can benefit from their records being made available to the OOH service. However, patients can opt out if they wish. The UHB’s Informatics Service E-Communications Board ISEC) has asked NWIS to make the IHR available to other emergency care settings e.g. Emergency Unit and Medical Emergency Assessment Unit. NWIS plans to make the IHR available to these areas following the implementation of the Welsh Clinical Portal at health boards. 77..22..77 RRaaddiioollooggyy MMaannaaggeemmeenntt SSyysstteemm ((RRAADDIISS22)) Current Status

The UHB is planning to move from its existing Radiology Department IT system (RADIS) to the newly developed RADIS2 which is being developed by NWIS. RADIS2 is being made available to health boards in Wales to support functions such as patient scheduling, clinical reporting, resource allocation and management reporting. The UHB expects to implement RADIS2 during 2012.

Vision Radis2 is the first stage of a national Radiology Management System (RMS) and provides a foundation on which to integrate radiology systems across Wales. The new system will allow secure shared access to diagnostic imaging services, results, images and management information across organisations. The upgrade to Radis2 is expected to bring better functionality, easier data analysis, and will pave the way for future integration with picture archiving communication systems (PACS), which are used to store digital images and x-rays.

Service delivery benefits: • Clinicians report that access to the IHR supports diagnosis in urgent situations • The speed and accuracy of medicines reconciliation is increased • Errors in treatment management are decreased • Speed of treatment initiation is increased • Reliance on the patient for medical history is decreased • Knowledge of clinical intolerances is increased • Opportunity to provide patient education is increased


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Next Steps The UHB is working with NWIS to ensure that the functionality required to support the health board’s operational processes is included in the version of Radis2 to be implemented locally

77..22..88 LLaabboorraattoorryy IInnffoorrmmaattiioonn ssyysstteemm ((LLIIMMSS)) Current Status There are 13 separate Laboratory Information Systems (LIMS) in use in the 18 Pathology Labs across Wales, each one operating with different codes and standards and unable to share information with another. The new LIMS will be an all-Wales solution. The software, TrakCare Lab, will be rolled out to every Local Health Board laboratory as well as servicing other national specialist support services Currently, the UHB has the iSoft Telepath system for Laboratory Information Management. Telepath will be replaced by the new national LIMS which has been procured by NWIS. Vision The All Wales LIMS Replacement Project will replace the various NHS laboratory systems currently in use in Wales with a single solution. The implementation of the new LIMS aims to

• Provide significant improvement in functionality and connectivity • Enhance pathology services across Wales by the inclusion of an increased range of

functionality to meet current and future service requirements

• Support the delivery of improved information flows. Data will be standardised and comparable across all laboratories

Next Steps The complexity of the pathology service within the UHB means that it will be the last on the new LIMS rollout programme. The implementation date is currently scheduled for the first quarter of 2013. The pathology service in Cardiff and Vale will be required to commit significant resource to prepare for and support the implementation of the new LIMS.


• All health boards will have a common platform from which they can move to a new All Wales Radiology Management System (RMS)

• Radis2 will be improved to allow functions such as desktop integration with picture archiving

and communications systems (PACS),

• Radis2 is will support clinical governance, operational efficiency, demand management and

forward planning

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77..22..99 CCaanncceerr HHiissttooppaatthhoollooggyy RReeppoorrttiinngg PPrroojjeecctt ((CCHHIIRRPP)) Current Status The Cancer Histopathology Reporting Project (CHIRP) is an NWIS service improvement project designed to streamline and improve the quality, completeness and availability of cancer histopathology information across Wales. The aim of the project is to integrate Telepath with the national Cancer Information System Cymru (CANISC). This will be achieved through the introduction of standard reporting templates. Next Steps Cardiff and Vale UHB will be one of the first health boards to implement CHIRP. Our clinicians are working with NWIS to develop a suite of templates for use across Wales.

77..22..1100 MMyy HHeeaalltthh OOnnlliinnee ((MMHHOOLL)) Current Status My Health Online (MHOL) is a web based application that will enable patients to record, review and schedule events with their GP practice, securely through the internet. MHOL is currently available to all patients whose GP practice has an INPS or EMIS GP System. Vision Patients will be able to have a greater involvement in their own healthcare via the internet, in a similar way to shopping or banking online.

Service delivery benefits: • Decrease in likelihood of lost/mislaid tests between organisations, leading to less frequent

duplicate testing. • Single pathology record for each patient • Improved audit trails • External user access to look up and referral of specialist tests • Transfer of tests for investigation from outside UHB will not require double entry • Blood stock can be monitored and tracked more efficiently leading to less waste and

improved safety of blood transfusion • Key enabler for the electronic patient record in Wales which will lead to more efficient and

effective patient care with reduction in costs for medical records and avoidance of duplication. • Delivery of standardised information across Wales • New and better analytical business tools for improved management. • Opportunities for better cross departmental working between sub specialties in laboratory

medicine • Consistent application of the All-Wales Pathology Handbook will be increased

Service delivery benefits: • To replace the current manual data collecting and coding systems with an electronic solution • To develop a system to enable maximum functionality and flexibility to meet required standards • To improve standardisation of processes in Histopathology departments by introducing data capture

templates for the reporting of cancer cases


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My Health Online will give patients the opportunity:

• To book GP appointments

• Order repeat prescriptions

• Update their general details such as change of address

Next Steps MHOL is being offered to GP practices across Cardiff and Vale, with many practices asking to take the product during 2012.

Service Delivery benefits: • By using the MHOL service patients will not have to wait on the phone to get through to their GP

surgery to make an appointment, order a repeat prescription or update their details

• Patient will have convenient access to GP services from home or work — or anywhere with internet access

• There will be a reduction in administration workload for the GP practice staff


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NWIS is working with Cardiff and Vale UHB to implement the following support services: 77..22..1111 EEnntteerrpprriissee MMaasstteerr PPaattiieenntt IInnddeexx **EEMMPPII)) Current Status Patient Identity Management is considered a key to the successful implementation of future national core systems. NWIS have procured an Enterprise Master Patient Index (EMPI) to address patient identity management. The E-MPI Project will help to support an improvement in demographic data quality and identify duplicate patient records to support safer patient care. It is expected that demographic data will be fed from the UHB’s Patient Management System (PMS) into the E-MPI in the first phase, followed by interfaces with other UHB systems. There is a significant operational resource requirement for this project, particularly from the UHB’s Health Records Department. Data Stewards will be required to monitor outputs from the E-MPI and to ensure issues are dealt with. e.g. duplicate patient records are merged. Vision Typically, a single patient’s clinical record will be spread across records in:

• Patient administration systems • Pathology systems • Radiology systems • A&E systems • Theatre systems • And a number of specialist clinical systems such as cardiology, endoscopy, diabetic,

maternity, community health etc. Each of which has its own master patient index and in which the patient’s demographic details may be recorded differently. The E-MPI project has been established to address business needs that arise because of this situation, including:

• Ensuring patients are identified correctly • Supporting the implementation of national systems such as the Welsh Clinical Portal and

Laboratory Information Management System. Next Steps The UHB will implement the E-MPI during 2012 - integration with PMS - and will then plan to link other systems e.g. Radis2 (national Radiology system) and the new Laboratory Information Management System (LIMS) to ensure a high standard of data quality across the organisation.

Service delivery benefits: • Support for patient safety initiatives by ensuring that patients are identified correctly • Identification and linking of duplicate records • Support for the 1000 Lives Campaign • Support for operational processes • A gold standard patient record • Support for the implementation of national systems e.g. WCP, LIMS


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77..22..1122 NNaattiioonnaall AAccttiivvee DDiirreeccttoorryy aanndd EExxcchhaannggee ((NNAADDEEXX)) Current Status NWIS has established a single directory for all users in NHS Wales to support the implementation of key national systems. Prior to the National Active Directory and Exchange (NADEX) project, each health board in Wales maintained its own user directory. Each directory provided usernames and passwords and enabled users to logon to the local network within an organisation. Logging on to the network provides access to core services such as printing, e-mail and office software e.g. word processing, as well as clinical and business application software. The National Active Directory & Exchange (NADEX) project gave all NHS Wales staff a new national email address and user name for logging on to IT systems Cardiff and Vale UHB, with one of the largest infrastructure and user bases in Wales, successfully migrated all users to the new NADEX network domain and email system. Having been asked to start last, the migration of all users at Cardiff and Vale involved significant effort by the IM&T team and was completed in line with the nationally mandated target of 31st March 2010. It involved the migration in excess of:

• 7000 desktops • 9500 network users • 8000 email accounts

Vision NHS Wales is now operating the largest single e-mail directory in Wales, with a total of 67,000 users. The countrywide installation includes 57,000 mailboxes, and provides users with a single up-to-date address book, and the ability to share diaries with colleagues across NHS Wales. The directory service is a secure foundation for the introduction of new national systems such as the Welsh Clinical Portal.

77..22..1133 EEnnccrryyppttiioonn Current Status Breaches of data protection laws by organisations across the UK public sector have enhanced the need to ensure person identifiable information (PII) is protected. Protection is particularly vital when the information is vulnerable, such as when it is transported outside organisations on laptops, memory sticks or CDs. To protect against such events within NHS Wales, NWIS procured a framework contract of standard encryption products and services, which can be used to help organisations protect sensitive information.

Service delivery benefits: • Support for the implementation of national systems e.g. WCP, LIMS • Migration of all users to a National Active Directory. • Single address book to support health professionals in the sharing diaries across

organisations within NHS Wales



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NWIS have provided and installed the administrative infrastructure for encryption linked to the national email and directory service (NADEX). This acts as a national administrative service for NHS Wales organisations to take forward the installation of encryption tools in their organisation. Cardiff and Vale UHB commenced its Encryption project in August 2010 and set about encrypting laptops and vulnerable PCs. Next Steps This is an ongoing project with resource being committed from the UHB to ensure that all vulnerable devices are encrypted.


• All portable computers, mobile devices and removable media will be encrypted • This will ensure person identifiable information is kept secure • It will also ensure NHS organisation are protected from prosecution resulting from the

loss of personal data


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77..33 UUHHBB DDeevveellooppmmeennttss

Supplementary and complimentary to the national ICT work programme the Health Board is also taking forward a comprehensive local work programme geared towards the strategic priorities of the Health Board. 77..33..11 PPaattiieenntt MMaannaaggeemmeenntt SSyysstteemm ((PPMMSS)) Current Status The UHB designed, developed and implemented its own Patient Administration System (PAS), referred to as PMS. Importantly the system maintains the core patient data set for a number of other systems and planned systems. These include (for example) the Clinical Portal and the planned referral management processes via the Welsh Clinical Communications Gateway (WCCG). PMS provides the main data feed for the Intelligent Warehouse including RTT pathway data At a national level it is recognised that all other LHB’s have either implemented or are planning to implement the Myrddin system. The UHB has reviewed the current Myrddin deployment and have concluded that there is no benefit or functionality that would warrant moving to this system in the short term. Indeed, there is a significant dis-benefit since a great deal of bespoke development has been undertaken on PMS on behalf of the UHB which is not and would not be available Myrddin. Vision Notwithstanding this the UHB recognises the long term strategic benefits of a single PAS system across all LHB’s in Wales, and is fully engaged with NWIS to participate in the design and specification of the next implementation of PAS. It is expected that this will be available in 4-5 years time, at which time the UHB will migrate to the national PAS implementation Next Steps IT will engage with the NWIS function in order to provide both a positive contribution to the longer term National System and ensure continued existence of functionality important to this HB. This is however a minimum 5 year project and as such development and enhancement of PMS to meet local and national requirements will continue. The most immediate aim will be the implementation of newer hardware infrastructure which will provide a continued and resilient platform to maintain this crucial system. Additional, the continually increasing demand on new functionality within the system has resulted in a significant performance hit. This will also be addressed by the new infrastructure implementation.


• Demand for continued additional functionality PMS will be addressed by the new hardware.

• Greater storage and processor performance will enhance options both within PMS and the Data Warehouse based BI system.

• Required enhancements to the many sub-modules of PMS can progress providing greater clinical and administrative functionality without further impact on current services and functions.

• Continued deployment and enhancement of clinical communications (correspondence and direct data interlinks) will also be a significant part of this move forward.


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77..33..22 BBeedd MMaannaaggeemmeenntt Current Status The Health Board is currently building and implementing bed management modules that interoperate with, and utilise data from, a number of the HB's patient administration modules including Ward and EU Workstations, PMS, etc.. . The Bed Management application is a real-time supply/demand system, showing lists of patients that require beds (the demand) across the embedded functions within these systems. Functions include (but not exclusively) TCIs, emergency GP referrals, EU admissions, Outliers, (etc.). These are matched against the current bed states on wards (the supply). The ward views, showing a schematic layout for each ward, provide current bed state (occupied, empty), gender and, where applicable, Predicted Discharge Date (PDD) information for current occupants. Vision The system will be used by Patient Access Coordinators to facilitate the quick admission/discharge of patients, and acts as an “early warning” system during times of excessive demand. Next Steps To provide real time data on existing patients as well as planned admission and discharge data, thus enabling management of bed states with maximum efficiency. 77..33..33 WWaarrdd CClliinniiccaall WWoorrkkssttaattiioonn ((WWCCWW)) Current Status WCW is a major module of the PMS infrastructure providing a ward based view on Patient currently on wards as in-patients. It is intrinsically linked to all other modules within the PMS infrastructure and fully rolled out to all appropriate wards within the Cardiff and Vale geography. It provides for real time clinical management of inpatients and their data. It allows for all standard administration such as admission, discharge and transfer but additionally maintains significant clinical functionality including for example (but not exclusively) clinical notes maintenance and management of reports, handover, letter production on discharge, Theory of Constraints, Acuity Measures, etc... Vision The WCW will remain the main window on inpatient activity and management, up to and including discharge. The aim is for WCW to provide greater communication of information within the acute sector and also between primary and acute healthcare. Examples include enhancement of the Discharge Letter functionality and expansion of the clinical note and Clinician Handover function.

Service delivery benefits • Improvements in bed on-line management • Improvements in accessibility of bed state data over time (BI) • Leaner, more efficient and cost effective administrative processes


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Next Steps Further roll out of discharge letter functionality requiring closer integration with the Generic Letters function. Production of the ‘Dr Handover’ functionality. 77..33..44 EEUU WWoorrkkssttaattiioonn ((EEmmeerrggeennccyy UUnniitt WWoorrkkssttaattiioonn)) Current Status EU Workstation is a major module of the PMS infrastructure providing a real time view on patients to the Emergency Unit as well as Medical and Surgical Assessment Units. Like WCW it is linked to all other modules within the PMS infrastructure including WCW and the Bed Management System. It provides for real time management of EU Patients and their data. It enables the capture and real time monitoring of activity with EU – including those elements associated with Breach Avoidance and Management. It additionally provides clinical functionality including for example (but not exclusively) clinical notes maintenance and management of reports as well as Theory of Constraints etc.. Vision The EU Workstation will remain the main window on Emergency Patient activity and management, up to and including admission to the hospital or discharge from EU. The aim is for EU Workstation to evolve with the changing central and local demands associated with patient care within the Emergency Unit and reporting of central returns to NHS Wales. Next Steps A review of current change requirements is currently underway. A number of approaches are being considered including (for example) letter production techniques, RTT clock adjustments, etc..

Service delivery benefits

• Reduction in time between discharge and availability of information to primary care teams

• Reduction in letter production costs. • Reduction in Clinician admin time • Closer to goal of fully electronic patient record • Enhanced audit on patient care.


• Improved patient movement within the EU improving patient care • Accurate management of patient data allowing greater breach avoidance. • Reduction in letter production costs. • Reduction in Clinician admin time • Closer to goal of fully electronic patient record • Enhanced audit on patient care.


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77..33..55 CCoommmmuunniiccaattiioonnss HHuubb ((CCoommmmss HHuubb)) Current Status The Comms hub is currently providing services for GMS out of hours for Cardiff and Vale. It also provides services for dental out of hours covering Cardiff and Vale. In the daytime the Comms Hub provide a district nurse booking services and a 24/7 dental helpline, again covering Cardiff and the vale. The dental helpline in particular is a new venture, previously there were six numbers for patients to call asking for emergency treatment so bringing the service in-house allowed us to provide the services utilising a single number. The current services which the Comms Hub has in house amount to in excess of 250,000 per year. Vision The initial vision is to improve and modernise the out of hour’s services, focusing on how the service links in with daytime primary care, supports the EU, and contributes to shifting care into the community. For the Comms hub in general, the vision is to act a single point of contact for unscheduled health and social care services and to support the transfer of care into the community. It will also support the development and formation of locality based services. Next steps For out of hour’s services, over the coming months an audit will be undertaken of all staff working for the service, the aim of the audit is to improve clinical audit and effectiveness. Based on the outcome of the audit a remodelling of the out of hour’s service will be undertaken to meet the challenges of the shift of Citizen well being and treatment focused within the community. Work is also currently underway to transfer CRC services from secondary care into primary care. A pilot project sponsored by NWIS is about to commence which will enable GPs to electronically send referrals via WCCG to the Comms hub to request District Nursing services.


• The benefits of a newly modelled out of hours service should improve integration between in and out of hours, support the transfer of care into the community, and improve working relations with EU.

• The transfer of the CRC to the Comms hub will help the UHB manage referral criteria and it will also help in the transfer of care into the community.

• Having one number for a range of unscheduled care services will improve communication between services and access to patients.

• As PSBA is installed within the hub, this allows access to any NHS system which allows potential growth of services.


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77..33..66 MMeeddiiccaall RReeccoorrddss DDiiggiittiissaattiioonn Current Status The NHS has been delivering care facilitated by a paper clinical record since its inception. Whilst this has proved an effective mechanism for managing the care that is provided, there is a need to exploit opportunities to modernise the systems by which we manage the clinical record. Such action enables the Health Board to continually improve the management systems which support clinicians in their decision making for our patients, thereby improving the quality of patient care.

There are a number of services within the NHS and this Health Board which use different types of Health Records ranging from Paper Light to a full electronic record. CAV recognises that within NHS Wales there is a national programme which is responsible for the strategy of IT systems and ultimately the strategy for an electronic patient record. As such it is important that this Health Board reviews options that are congruent with the current and potential future strategy of NHS Wales.

Benchmarking other Health Boards, both internal and external to NHS Wales, has identified that a move to a paper light system currently provides the greatest opportunity for improvement. Vision To move Medical Records to a Paper Light System within Cardiff and Vale UHB The following definition of a paper light system is used:

“Replication of the current paper record in e-format which is easily accessible by clinicians through the clinical portal or similar electronic infrastructure”

In practice, this will mean that the historical record for all active patients will be scanned and made available through the PC and software infrastructure. New notes will be completed electronically where possible. Where this is not possible, the resultant paper note will be scanned and added to the electronic record. Next Steps The process is planned to complete within the financial year 2012/13. During this period a review of available software solutions will be completed. Funding presumed, the hardware and software will be implemented within this same overall period. As noted, hardware infrastructure will need to be purchased to support the solution. This includes the appropriate storage solution as well as PC's to facilitate access at points of care. The IT department has advised on the necessary specification and associated cost for the procurement of the Hardware to facilitate the implementation of a Medical Records document Management Solution. The relevant hardware will be purchased within 2011 – 2012 financial year with a view to be installed within spring 2012. The Service will investigate the ‘best of breed’ digitisation systems available on the market within 2012 – 2013.


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The Medical Records services, as part of their business case submission, have identified the following benefits of introducing a Medical records document management solution: 77..33..77 MMeennttaall HHeeaalltthh aanndd CCoommmmuunniittyy SSyysstteemm ((PPAARRIISS)) Current Status The Health Boards highly successful Electronic Patient Record deployment for Community services and Mental Health, is providing a solution for clinical record sharing, clinical risk management, care-planning, case-note creation/storage, reporting to Welsh Government, uHB, Service, Teams and individuals, and a mechanism to service manage on the evidence of shop floor, electronic clinical data entry. The system, which is re-fashioned to suit the needs of each, often diverse, clinical team by the UHB’s small dedicated implementation team, provides both the traditional PAS functionality (Demographics, Waiting List Management, Appointments, Referral Management) alongside a full clinical record facility within Mental Health Acute, Mental Health Community Teams, Mental Health Addictions Service, District Nursing Core Service, District Nursing Specialist Teams, Health Visiting Core, Community Child Health and Specialist teams. also provides a traditional PAS role for the Community Podiatry service, as they prepare for their full clinical rollout to in 2012. Vision It provides the Cardiff and Vale UHB and its partner agencies in Cardiff and Vale Councils the opportunity to deliver truly joined up services in the community and Mental Health arenas. Already the High profile Flying Start Programmes within Cardiff and Vale Councils have identified a joint record, facilitated by as their strategic goal, as have the Adult Community Mental Health teams across Cardiff and Vale. When conjoined with the National path-finding ‘Mobile Working’ initiative (a rollout of 500 3G net-books) rolled out by the project team during 2011, the ‘solution’ can begin to be seen as a template for community service delivery elsewhere in Wales. Next Steps • The solution to be advanced as an option for Wales in the Community Health and Social Care

arena via the National Community Informatics Board. • Design and build of the Flying Start solution for Social Care commenced in January 2012,

targeting all programme delivery by the end of 2012-13 • Support for parts 2 and 3 of the Welsh Mental Health measure (including the National MH Care

Plan) will be delivered by April 2012 in line with National targets.

Service delivery benefits: • Improved access to patient records improving quality of care delivered • Cost savings within the health board through the introduction of a paper light system • Reduced costs for future support from Health records for additional clinic activity • Reduced number of lost clinic slots due to the increased availability of the Health Record • Improved efficiency elsewhere within the organisation through the availability of the

Health records electronically


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• The development of a cross organisational Mental Health solution for the Health Board and its partners in Cardiff and Vale councils for the Adult Community Mental Health arena will continue progress in 2012.

• Continued delivery of an increasingly rich and functional EPR to the current scope of 161 clinical teams, and c2500 daily staff users.

77..33..88 OOpphhtthhaallmmoollooggyy OOppeenn EEyyeess AApppplliiccaattiioonn Current Status The use of retinal (etc) images for diagnosis and treatment of eye diseases and disorders is becoming increasingly important for ophthalmology clinicians. As such it is increasingly important that access to such images and related patient clinical data be maintained in an easily accessible and co-joined Electronic Patient Record (EPR). Vision The Open-Eyes is a multi-disciplinary open source development that aims to provide just such functionality and is constructed and maintained by a UK wide federation of NHS and University organisations. Next Steps The Ophthalmology Department supported by the infrastructure arms of the IM&T Department is part of this federation and expects to undertake a phased implementation and enhancement of the Open-Eyes system in the coming months.

Service delivery benefits • Retired over a dozen incumbent information systems within scoped services. • Removed the burden of the clinically un-productive and onerous, ‘end of month paper based

activity returns’ from over 2500 clinicians. • Improved safety for both staff and patients and provided access to real-time information. • Improved communication across services inc. Social Services, Police and voluntary. • Improved ability to manage services and staff. • The clinical usage of is ever expanding, currently greater than 100,000 full clinical

assessments are being written up annually, alongside greater than 1.4 million annual case-note entries. Greater than 4500 uHB staff (70%+ clinical) have become users of since rollout began in 2005, with greater than 2000 staff using as their daily record keeping solution by July 2011.

• Allows for the safe storage and availability of patient clinical records on a 24*7*365 basis across community and acute sites.

• Cardiff and Vale uHB’s rollout of has been internationally recognised as an NHS leading initiative, hosting visits from a dozen English PCT’s and Canadian Health regions, becoming a development partner of Civica for Health And Social Care IT

• Awarded a ‘Highly Commended’ CPAA award for support of the CPA process in 2011.


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Additionally, the project will undertake (in a phased approach) to provide integration of patient demographics with the central PMS System and cross loading of images from existing and long standing imaging devices (10+ years of existing data) 77..33..99 OOrraaccllee FFiinnaanncciiaall SSyysstteemm Current Status

There is a detailed work programme of activities scheduled for 2012-13, some requiring final funding approval. The work programme should help consolidate the present Oracle Application and better align the use of the service to support NWSSP. The four key initiatives being planned for the next 18 months are the migration to the next version of Oracle (release 12), the introduction of a Business Intelligence solution, the hardware refresh planned for the Oracle service and finally the initiatives to enhance the standardisation of good practice processes (systems and business processes)

Vision

The aim is to grow the use of the Oracle Finance and Procurement solutions across the NHS with the use of new technologies such as OCR Scanning and electronic trading solutions.

The vision to support NWSSP includes extending the use of the Oracle service across the wider public sector

Next Steps

Discussions held with Cardiff Data Centre on any additional rack space requirements we may have

The outline work programme has already been discussed and agreed through the Oracle Strategy Board

Final funding for some of the strategic initiatives still pending Work has commenced on phase 2 of our Common Operating Model (service

standardisation) All benefits and business case justifications reviewed at the Oracle Strategy Board and

signed off by Directors of Finance


• Improved patient care through time correlated images and data associated with individual patients.

• Improved treatment through clinical and business analysis of data over multiple patients over time • Improved security of data from imaging devices. • Contributes to the evolving electronic patient record thereby providing accessibility, accuracy and

security of patient data.


All benefits and business case justifications reviewed at the Oracle Strategy Board and signed off by Directors of Finance


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77..33..1100 EElleeccttrroonniicc SSttaaffff RReeccoorrdd ((EESSRR))

Current Status The Electronic Staff Record (ESR) is an integrated payroll and workforce information system used in the NHS throughout most of Wales and England. The system has been in place since November 2006. It is used to record workforce information and payroll information. ESR is a ‘live’ system so changes to information have an impact of the data held on the system including payroll information. Within Wales, the priorities for the development and implementation of ESR functionality have been set by the All Wales Workforce Information Systems Board for the last two years. During 2011/2012, these priorities primarily related to the roll out of the Manager/Employee Self Service/Organisational Learning (MSS/ESS/OLM ) modules of ESR within the Finance, IM&T and Workforce and Organisational Development Functions of UHB's . Additionally, the Cardiff and Vale UHB opted to roll out (MSS/ESS/OLM) to the Dental Division. Aside from being a payroll and workforce information system, there exist a number of third party systems such as e-rostering, e -expenses, GMC and NMC registration checking and e-expenses, which interface with ESR and facilitate the transfer of workforce and payroll information in and out of ESR. These are increasingly being used within the UHB and are bringing significant benefits to the UHB (see below). For example to use of e-rostering system which is interfaced with ESR will facilitate the provision of real time sickness information for wards by end September 2012. Vision The national contract with current provider is due for renewal in 2014 and there is currently work ongoing nationally to develop ESR's specification and functionality (ESR2) in preparation for this tendering process . There will undoubtedly a significant impact on the UHB in terms of training etc when roll out of ESR 2 commences . Next Steps Within the UHB , the priorities over the next twelve months are as follows

• roll out of phase two of MSS/ESS/OLM

• Implementation of third party interfaces with ESR (including HPC and other Registrtaion bodies)


• Cost savings – direct & Indirect

• Empowerment of Managers

• Improved workforce intelligence (more real time data)

• Empowerment of staff re completion and validation of personal data

• Reduced data input by payroll

• Standardised learners' processes

• Managers/staff able to book training on line.


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77..33..1111 EE--EExxppeennsseess Current Status NHS Wales Shared Services Partnership is currently in the process of managing the procurement on an e-Expenses System for eight Organisations across Wales. Over the last few months, Suppliers have been invited to tender for this contract through the OJEU Competitive Dialogue process. The procurement of this system has been undertaken by Cardiff & Vale University Local Health Board. Competitive Dialogue meetings have now taken place with seven Suppliers, five of which have been short listed through to the next phase. The procurement phase is expected to be completed in March 2012 the two pilot areas are expected to commence implementation of the system in April 2012. One of the pilot areas is the Dental Division based in the Cardiff and Vale UHB. Vision Roll out of e-expenses system across the UHB and ongoing maintenance. Next Steps

• Within the UHB , the priorities over the next twelve months are as follows

• Implementation of e-expenses system in the Dental Division and evaluation of pilot scheme

• Rollout to other areas within the UHB (yet to be confirmed). Likely to commence in third quarter of 2011/2012.

77..33..1122 RRoosstteerrpprroo CCeennttrraall

Current Status Rosterpro is a rostering and workforce information system supplied by HMT Systems Ltd. HMT have recently been taken over by Smart Human Logistics Plc (Smart) who are McKesson’s preferred supplier for e-rostering software. RosterPro allows service areas to compute rosters electronically. Planned shifts can then be updated to record actual changes thereby facilitating electronic timesheets and accurate reporting of shifts and staff absences. Timesheet data is then interfaced into the ESR payroll system eliminating manual or spreadsheet based timesheets. Within the NHS, Rosterpro has mainly been used as an electronic rostering system for nursing staff inpatient wards. Cardiff and Vale UHB have used the system for six years and are one of the primary implementers of system in the United Kingdom. In May last year, the UHB approved a business case to upgrade the e-rostering system from Rosterpro to Rosterpro Central and to integrate the two parallel ward and bank e-rostering systems. The integration of the ward and bank systems have now been completed and roll out of RPC to inpatient areas ongoing and scheduled to be completed by the end of September 2011.


• Cost savings

• Standardised /leaner processes


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The system has the capacity to provide timesheet information which can be electronically transferred to payroll and uploaded onto ESR Currently 85% of areas utilising Rosterpro or RPC submit their payroll information via the uploading of electronic transfer of timesheet information. Vision To extend e-rostering to all areas who work 24/7 or shift working is predominant Next Step • Complete roll out of RPC to nursing areas

• Extend rollout of RPC to Patient Experience, Labatories, Estates

• To pilot RPC Medical Staffing Modules in 2 Directorates.

Service delivery benefits: • Increase UHB's ability./capacity to electronically transfer of time sheet information • Real time sickness reporting • Less overpayments • senior staff having more direct time caring for patients • Cost efficiencies within payroll • implementation and monitoring of limits on working hours (as per the Working Time

Directive) for staff on RosterPro which will include substantive, overtime and bank hours)


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77..44 EEnnaabblliinngg IImmpprroovveedd AAcccceessss ttoo IITT SSyysstteemmss // AApppplliiccaattiioonnss ffoorr CCiittiizzeennss aanndd SSttaaffff

The UHB as part of its strategy is actively seeking to deploy technologies which will provide further access opportunities to systems, applications and services for staff, patients and the public. The UHB is at the forefront of promoting this agenda across Wales. Timelines are outlined below. The programme is aimed at facilitating a way forward which will allow the UHB to take on these initiatives either as a package or individually. Some will have no or minimal revenue impact and some are to be determined. 77..44..11 EEnnaabblliinngg cciittiizzeenn AAcccceessss The citizen will shift to become the centre of care as a result of the global revolution in telecommunications. We will work with NWIS on this Strategy to revise our privacy and security models to enable citizens to use their network connection and devices to communicate with public service; this will drive the change in the technology we use. This change will also enable the carers and third sector to be included in the communications and circle of care from which our previous technology excluded them. 77..44..22 SSmmaarrttpphhoonnee CCoonnnneeccttiivviittyy PPrroojjeecctt -- BBrriinngg YYoouurr OOwwnn DDeevviiccee ((BBYYOODD)) SSttaaffff The UHB is working with NWIS in the development of a national solution that will enable staff to access Clinical and Business applications from their smartphone devices. It is anticipated that the national solution will not be a “single product” but a number of options that will be aligned to the UHB’s infrastructure design. It will facilitate BYOD access for staff to applications such as email, intranet and clinical portal as appropriate. 77..44..33 IInntteerrnneett SSeerrvviicceess The UHB plays a key role in the design team for NHS Wales that is currently investigating how each Health Board within Wales will have and adequate internet link to support its clinical and business users. The national design will ensure that each organisation has the ability to prioritise and manage the various types of internet traffic such as Social Media sites. The Internet Circuit has been increased from 100Mb to 300Mb in April 2012. A Task and Finish Group is being set-up to look at how every Health Board can have a 100Mb Internet Circuit design that can be expandable with minimal impact on NHS Wales. It is projected that that the Internet growth to support NHS Wales will increase by 50% annually. 77..44..44 SSoocciiaall MMeeddiiaa SSiitteess The ability to fully utilise Social Media sites is linked to being able to provide the appropriate bandwidth and agreement on policy within NWIS. The NHS Wales internet circuit has been increased from 100mb to 300mb in April 2012. A task and finish group has been established in NWIS to determine how every UHB can have a 100mb internet circuit design that can be expandable with minimal impact. This will facilitate the usage of everyday internet tools such as Facebook and Twitter in support of the delivery of Health Care in Cardiff and the Vale.


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77..44..55 EEdduurrooaamm ((UUKK AAccaaddeemmiiaa WWiirreelleessss NNeettwwoorrkk)) The UHB is currently in design discussions with technical colleagues from Cardiff University on the interfacing of Eduroam (UK academia wireless network) to our Wireless Local Area network (WLAN). The design work will be transferable to other Health Board. 77..44..66 IImmpprroovveedd 33GG SSiiggnnaall iinnttoo UUHHBB HHoossppiittaallss With the major change in mobile technology driven by Smartphone Technology and the ever improving 3G soon to be 4G signals the UHB is looking into the installation of Pico Cells to improve mobile phone access within its premises. The design work will be transferable to other Health Board. 77..44..77 BBrriinngg YYoouurr OOwwnn DDeevviiccee ((BBYYOODD)) ffoorr PPaattiieennttss // PPuubblliicc The UHB has invested heavily its in Wireless (WLAN) and will be tendering in 2012 for a solution that will enable its patients and guests secure access to the internet. The design work will be transferable to other Health Board. 77..44..88 MMoobbiillee WWoorrkkiinngg The UHB already offers extensive home working facilities providing off site access to applications to over 1200 staff. This included the mobile working project using netbooks and 3G which have been provided to District nurses and Health visitors. Options for further rollout are under review, further investment will need to be funded by improvements in productivity. 77..44..99 TTiimmeessccaalleess All of these enabling programmes are being driven by the UHB’s local strategy. The following diagram shows the timescales for implementation

Enab

ling

Impr

oved

Acc

ess

to IT

App

licat

ions

/ Sy

stem

s

Current Status

Phase 1

Phase 2

Phase 3 and onwards

Internal Projects

SmartPhone Connectivity

2012 / 13 2013 / 14

Internet Services

Social Media Access

EDUROAM

Improved 3G Signal into UHB Hospitals

Bring Your Own Device (BYOD) for Patients / Public

Mobile Working

Citizen Based Access


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77..55 MMaaiinnttaaiinniinngg aa SSuussttaaiinnaabbllee IInnffrraassttrruuccttuurree

Current Status The Health Board is facing some significant challenges in relation to the sustainability of its underlying IT infrastructure over the next 3 years. Significant investment is required in the IT network, PC’s, servers and storage infrastructure to ensure the continued high availability of clinical applications. 77..55..11 NNeettwwoorrkk Current Status The informatics service operates an extensive data network both within and between all of the UHB sites. The network supports nearly 10,000 connected devices and is fundamental to the delivery of critical applications and services to the point of delivery. Vision To continue to support maintain and upgrade when required the extensive data network of all the UHB sites to ensure delivery of access to critical application and services ensuring appropriate data resilience where possible. 77..55..22 PPCC’’ss aanndd DDeesskkttoopp SSooffttwwaarree Current Status The IT Department currently supports over 7500 PCs, laptops and desktops across the Health Board. The Health Board has not regularly committed to a rolling programme of replacement of these devices, with the result that many of these are becoming unfit for purpose due to processor and memory constraints, and this slows down applications with the resulting loss of productivity. It is best practice to plan for a maximum 4 year life from a desktop / laptop, as is not economically viable to upgrade memory or processors on a regular basis. The Health Board has recently undertaken an extensive evaluation working with Microsoft, Dell and its incumbent desktop provider Stone. This was carried out to determine whether the current Health

The underlying technology of the network contains significant quantities of equipment which will become end of life in the next 3 years and will require a technology refresh in order to maintain technical currency and sustainability. The total estimated cost of this refresh within the next 3 years is £2.7M Inc Vat. The UHB will then need to budget for a rolling replacement of network infrastructure on a 3-5 year lifecycle to ensure future sustainability at a value of £750k per annum.


Provide access to critical applications and services to the point of delivery. Improved access speed to systems within the Health Board Provide resilience in order to maintain access to services


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Board ‘Fat’ Technology deployment or ‘Thin’ Technology alternatives deliver the best solution in terms of quality of service and value for money. The following issues were considered in this evaluation:

• The availability of High Bandwidth connectivity within the Health Board • The number of occasions the Health Board undertakes a large software licensing upgrade

o XP to Windows 7 o MsOffice 2003 to MsOffice 20xx

• The current sizing of the NHS Wales Internet link to support MsOffice365 and its annual revenue implications

• The hardware and licensing costs of “thin technology” • The hardware costs of “fat technology” • A 5 year costing evaluation was also undertaken

The outcome of the joint review was to continue to use fat Client technology in those Health Board locations that have the appropriate bandwidth. Vision To deliver a sustainable desktop infrastructure replacement programme based on provision of appropriate levels of capital investment. The increase in the use of personal devices to connect to Business and Clinical applications will supplement this programme. The programme should be based on the following principles:

• The PC Hardware to be replaced on a four year programme • The Operating Software and Office Software to be one release away from the latest release

Next steps Develop a cost model to support a sustainable replacement programme within the Health Board. Continue with a replacement PC programme of oldest PCs being replaced first. Ensure that clinical areas have sufficient PCs to support various initiatives being progress such as WCP and HeRS dependant on availability of funding.

Taking a 4 year rolling replacement lifecycle for these devices, and assuming an office software refresh at the same point, requires an annual budget of £1.43M Inc VAT


Provide access to clinical and business applications to staff in their relevant work areas

Allow access to clinical and business applications in a timely manner to support new initiatives being introduced within the Health Board such as digitisation of Medical Records, WCP, HeRs and MTED

Ensure latest software is available to staff Provide resilience in order to maintain access to services


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77..55..33 SSeerrvveerr IInnffrraassttrruuccttuurree Current Status The Heath Board maintains more than two hundred data servers. A number of these servers contribute to the underlying general user access and function requirements (logons, eMail, Intra/Internet, etc...) including connectivity to NHS Wales in general. The majority of these however maintain the large number of clinical and business critical applications and their data. Each of these systems are essential to the Health Board for patient treatment and care and the management of this care. The net replacement value of these servers is circa £4M with additional demand for increasing numbers of servers as technologies evolve into newer business and clinical areas. It is important to note that financial restrictions and lack of investment have left the Health Board with a large number of servers whose age is well in excess of the advised three to five year lifespan. Some significant servers are in excess of eight years old and plans have not yet been identified by those departments to fund replacement. Vision The Health Board has begun to invest in Virtual Server Farms. Virtual Server Farms enable to joining of several high end servers into a single cluster capable of supporting significantly larger numbers of virtual server. This is in essence is 'Cloud' computing at the physical level. Importantly Virtual Server Farms, and the virtual servers they support, offer all of the functionality of physical servers with the additional clear advantages:

• Significantly reduced cost over all. A virtual server instance providing the same level of performance on average costs around half of that of a classic physical server.

• Increased resilience – virtual server farms provided significant enhancements to the security, robustness and failover capacity of servers.

Next Steps The Health Board will be continuing to invest, where possible in this advancing technology in order to provided securer, more cost effective servers for the HB services and departments. It is to be noted however that not all servers can be virtualised and realistic cost reductions are more typically 30% to 40%. Additionally, whilst virtual servers only convey advantages at the technical server level there are operational issues to address. Currently the Health Board costing model for servers is department based (departments pay for their own servers). Virtual server infrastructure requires a centralised costing model to enable upgrade and replacement as the farms age.

Taking a 4 year rolling replacement lifecycle for the server infrastructure, this requires an annual budget of circa £850K with a significant increase on this if virtual server farms are not progressed.


• The HB will provide for its server infrastructure requirements, improve resilience and performance as well as its ability to respond to major issues and at a lower level investment than would otherwise be possible.


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77..55..44 SSttoorraaggee IInnffrraassttrruuccttuurree Current Status The Health Board faces a continually expanding need for ever increasing storage as newer system technologies enable improvements in the quality of care via enhance data capture. Newer systems typically increase storage demands by orders of magnitude. Classic (but not exclusive) examples of such changes include the ever increasing media capture facilities of systems such as Cardiology, Medical Physics, Radiology, etc…. It is to be further noted that business/clinical critical data storage must be stored in highly available and resilient disk arrays which by nature are extremely expensive. Vision The Health Board's storage needs will simply continue to increase year on year. This requires a consistent plan of investment. The IT department will simply seek to ensure that best balanced storage methods are utilised. Storage capabilities and costs range from expensive 'highly available' (very resilient and fast to access) to less expensive 'available' (slower access and lower resiliency). This range is multi-tiered and typically described (in order) as Near, Far and Deep Storage. Near costs between £15K and £20K per TByte and Deep around £4K per TByte. Future storage requirements must be viewed in this tiered manner and will require investment in software and hardware technology to implement this capability. Current expansion levels are of the order of 30TBytes per year and continuing to increase. Next Steps Investigation and investment in tiered storage.

77..55..55 BBaacckkuupp IInnffrraassttrruuccttuurree Current Status Business and clinical data is critical to the Health Boards business and patient care needs and robust backups of all data must be maintained. The Health Board currently pays in excess of £40,000 per year for the tapes necessary to backup its critical data. Several departments have recently implemented image based systems which together will treble the volume of data requiring secure backup over the next two to three years. Additionally, the Health Board is seeking to implement Health Record digitisation. Discussions are currently in place but this in turn will create further increased demand on the backup.

Storage infrastructure must be invested in year on year. This requires an annual budget of £350K Inc VAT


• The HB will support its continued need for storage at a reduced investment cost year on year compared to non tiered storage.


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Vision Standard tape centred backup technology is no longer the method of choice for large volume backup. It comes at a high cost and has the further disadvantage that eventually there will not be enough hours in the day to complete the backup without significant investment in tape drives. Costs can be reduced by investment in a block level backup technology such as the software based ComVault or hardware based HP iBrix technology. Such technologies can reduce the tape requirement to 10% for areas where data is essentially unchanging. Whilst business systems are largely unaffected by this methodology, almost all clinical systems fall into this category. Next Steps The Health Board will need to investigate and invest in this technology if it is to continue to maintain backup's of its critical data. Alternatively the Health Board will need to maintain existing and increasing investment in current tape technology in order to keep its data safe.

77..66 TTeelleeccoommmmuunniiccaattiioonnss aanndd VVooiiccee SSeerrvviicceess

In 2005, the Cardiff and Vale NHS Trust (the predecessor to Cardiff and Vale University Health Board) retained 4C Strategies Limited to assist with the development of a Telecommunications strategy. The resultant strategy was published in September 2005. The Strategy set out a number of key recommendations to enable the Trust to secure its telephony services (in the context of the fact the system at University Hospital Wales was obsolete) and to commence the implementation of emerging telecommunications technologies. Having completed the replacement of the UHW system, and the implementation of a significant number of the additional recommendations, a review and update to the Telecommunications Strategy was undertaken in 2011. Below is a summary of the key elements from the revised Telecommunications Strategy. Current Position The Health Board has made considerable progress in relation to implementation of the strategy over the past 5 years. The key achievements are summarised below.

Backup infrastructure requires a minimum 4 year rolling replacement lifecycle. Failure to do so will leave the Health Board incapable of maintaining backups. This requires an annual budget of £200K Inc VAT plus an additional cost for media tapes used. The tape cost will reach circa £150K within the next 4 years but can be reduced if block level technology is invested in. Exact reductions cannot be identified without the investment but could reduce tape costs by between 50% and 75%


• The HB will support its continued need for backup of critical Clinical and Business data at a reduced investment cost year on year compared to non legacy backup methods.


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Achievements

• Completion of an OJEU compliant tender process which resulted in the selection of Damovo to supply and install Ericsson (now Aastra) IP telephony products to meet the needs of the Trust.

• Replacement of the obsolete telephone systems at UHW and CRI with an Aastra MX-One IP based solution delivering additional resilience and business continuity.

• Installation of MX-One gateways at other key sites to facilitate IP based networking between locations and deliver savings by ceasing legacy TDM circuits.

• Roll-out of MX-One based solutions supported by EBN survivable gateways to a number of smaller locations.

• Implementation of a separate system at UHW for Business Continuity (BC) purposes - on-loan from Damovo / Aastra pending installation or release 5.x on MX-One systems.

• Deployment and roll-out of a voice messaging solution tightly integrated to the MX-One systems.

• Deployment of an audio-conferencing solution.

• Deployment of a contact centre solution (Solidus) to support the Appointments Booking Centre, Telecoms, IT and Facilities help desks.

• Deployment of Vocera wireless technology to support cordless telephony for the Emergency Unit (withdrawn 2011), Women’s Unit and peripatetic IT and Facilities staff.

• Centralisation of the Health Board switchboard facilities at all sites into a single centralised facility at UHW.

• Integration of the Telecoms Support team into IT.

• Review and renewal of carrier services and mobile contracts (with Virgin Media Business and Orange respectively).

• Procurement and deployment of a new on-site paging (bleep) system (Multitone) at all major locations to remove dependency upon obsolete systems and introduce cross-site paging.

• Introduction of Rotawatch Directory to facilitate self-service updates.

• Establishment of a regular forum to discuss operational and developmental matters. (Telecoms is a standard agenda item on the IRG).

Vision In parallel with the main telephone system replacements, a number of enhanced telephony services have been strategically deployed to varying scale in selected departments and locations. It is envisaged that the following facilities and enhancements will be available to be deployed (where appropriate) to virtually all UHB staff irrespective of location:

• An equable telephone service to include: o A common set of extension facilities – Group Hunting, Diverts, Call Pick-up,

Manager/Secretary Working, Abbreviated Dialling, etc. o Enhanced Voice Mail via common and centrally managed platform. o Enhanced Auto-Attendant and Call Queuing capability.


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• A change to 5-Digit Extension numbering across all locations. This will facilitate the complete removal of the existing confusing intra-UHB numbering plans (72 xxxx, 73 xxxx, 0 1873 xxxx, etc.).

• A new Direct Dialling In (DDI) numbering plan across all main UHB locations to compliment the 5-Digit Extension numbering.

• SMS messaging from Desktop. • DNA Reminders to Patients (delivered via Telecoms Platform). • Major incident automated staff alerting application. • Access to cheaper call tariffs at all locations. • Enhanced call logging and proactive usage monitoring with appropriate reports automatically

generated and made available to departmental managers. • Fixed IP Telephony where practicable (new builds, re-furbishments, etc.). • Mobile telephony which is complementary to the fixed telephony infrastructure, utilising Wi-Fi

(Vocera, SIP handsets) and/or public GSM (Mobile) networks. Potential for BYOD (bring your own device) for certain UHB colleagues.

• Unified Messaging. • Speech Recognition Auto-Attendant (Automated Operator). • Contact Centre technology for departments with significant incoming Telephone traffic.

There are many examples of best practice in neighbouring and similar NHS organisations throughout the UK where it can be proven that tangible benefits for all telephony users are achievable through the proper adoption of many of the enhancements and facilities available via the new MX-One infrastructure. Next Steps Many activities are planned by the Telecoms Team over the next 2-5 years including:

• Installation of MX-One telephony system at Llandough Hospital to replace existing obsolete Meridian Telephone and to meet increased capacity requirement (MHSOP & planned new M.H. Hospital).

• Expansion of existing MX-One Gateways located at Whitchurch and Lansdowne Hospitals to accommodate all Telephony requirements at these locations.

• Migration of all MX-One sites to a new 5 digit numbering scheme which will facilitate simplified dialling, overcome numbering restrictions and enable roll-out of facilities (e.g. voicemail) to additional sites.

• Introduction of new 16,000 number integrated DDI range to complement 5 digit numbering scheme. This will also address the current shortage of DDI numbers available at the UHW and offer the UHB a better corporate identity as all main locations will share a common DDI number range.

• Upgrade of MX-One systems and its applications to the latest software release.

• Expansion of existing Business Continuity (BC) solution to include further UHB locations.

• Continued roll-out of MX-One / EBN solutions to small sites.

• Continued review of telecoms contracts to ensure best value for money.

• Continued roll-out of Vocera (subject to funding).

• Strategic roll-out of Mobility and Unified Messaging applications – these will be co-ordinated with, and/or complimentary to, parallel UHB IT and National NWIS strategies.


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77..77 AAlltteerrnnaattiivvee OOppttiioonnss

77..77..11 CClloouudd TTeecchhnnoollooggyy The UHB’s IT Department has carefully considered the benefits, risks and costs associated with the various levels of Cloud technology available. These considerations take into account the needs and opportunities of the UHB as a single Clinical Business unit and also as part of the Welsh NHS as whole (with associated National Strategy).

Potential advantages to small businesses of external cloud technology are not to be confused with the requirements of larger businesses such as the Health Board. It is clear that the most cost and resource efficient approach for the UHB is to utilise virtual server farm technology within the Health Board’s own network geography. This approach, whilst clearly less expensive than both physical and external offerings, also improves rather than compromises security and resilience of systems. It will also be consistent with the National Strategy which will provide access to All Wales National Systems utilising an identical approach to ‘Cloud Technology’ from the National data centres.


• Simply put, all envisaged and/or proposed Telephony enhancements have the sole aim of improving the efficiency and/or effectiveness of all voice communications involving UHB colleagues. Studies have proven that in many cases up to 10% of a working day can be lost to poor communications – this is in addition to the detrimental effect that poor communications have upon Patient perceptions of the UHB.

• The intended total revamp of the UHB’s extension numbering plan will result in a more consistent means to dial between all main UHB locations (at no cost) by taking advantage of the existing network links.

• The removal of duplicate extension numbers (within the UHB) will result in further associated benefits; including maximising the potential of the new Multitone internal pager/bleep system and improving the robustness of the emergency call procedures (Crash - x2222 / Emergency - x3333).

• The numbering changes along with the new on-line directory will offer significant improvements to the general efficiency of the UHB Switchboard Operators as well as general extension users.

• The introduction of the speech recognition automated operator will further reduce the existing operator work-load and offer a more consistent service to the bulk of our callers – while still retaining the option of a ‘human’ operator where preferred.

• Mobility and Unified Messaging applications will enable much better communication with peripatetic colleagues.

• The successful introduction of the Solidus Contact Centre application into a number of departments including the ABC has proven that high volumes of calls can be handled much more professionally and efficiently with appropriate management and staffing. Many other departments where high call volumes exist would benefit from adopting the same technology. These include non-ABC managed Out-Patients appointment booking (e.g. Physio, I.S.H., Eye Clinic), S.S.S.U., Pharmacy, IVF Wales, etc.).


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77..77..22 OOffffiiccee 336655 The UHB will be undertaking a review of its Microsoft Desktop applications to identify best value for money in respect of “cloud licensing” against desktop licensing. It is however recognised that the UHB will need to invest heavily in a licence model in 2014 and will be working with NWIS in the development of our strategy Preliminary costings for Microsoft’s Cloud based Office 365 offering for 7500 devices would equate to £1.3m per annum recurring therefore making it an unlikely option. 77..77..33 NNaattiioonnaall DDaattaa CCeennttrree The UHB will work with NWIS throughout the strategic programme and where appropriate systems and servers will be accessed from the National Data Centre. 77..77..44 SShhaarreeppooiinntt The UHB will explore options to implement sharepoint which could provide business and potential clinical benefits in terms of the sharing and secure storage of documents within the Health Board. Provision of such a service will require the following:

• Implementation of virtualised server cluster (can be managed within the current infrastructure)

• Allocation of storage (can be managed within the current infrastructure for year one only. Will requirement investment in storage for years 2 onwards)

• Purchase of server licences for O/S, sharepoint and backup requirements - £48K • Purchase of user licences – cost dependant on number of users 1 x WTE Server

Administrator, Note that this is a significant system and will require additional resource to manage the database.

Physical to Virtual

Physical Optimisation

Virtual Optimisation

Server Optimisation – C&V Virtualisation (Cloud) approach

Physical to virtual Migration delivers Efficiencies in areassuch as server counts, power, cooling and Space

Virtual optimisation allowing rapid provisioning, targetedWorkloads simplified management

Local Systems Resilience and availability

National Systems


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88 BBUUSSIINNEESSSS IINNFFOORRMMAATTIICCSS SSTTRRAATTEEGGIICC WWOORRKK PPRROOGGRRAAMMMMEE


The NHS Wales Annual Quality Framework (AQF) for 2011-12, more recently complemented by the NHS Wales Delivery Framework, sets out a 5-year vision with the key aims to: • do more to protect and improve health for all, linked to the priority areas in Our Healthy Future

(OHF) and concentrating efforts on the specific key outcomes identified from the Prevention and Promotion National Programme;

• create integrated services across primary, community care and social care services, delivering against the priorities identified within Setting the Direction;

• modernise what the NHS does so that it has systems that deliver and sustain excellent services to meet the needs of patients and maximise clinical outcomes.

All support services will need to devise work programmes that align with these overall key aims, whilst at the same time delivering on service specific deliverables specified within the Delivery Framework. in the form of core targets. These core targets fall into two distinct groups: Tier 1: Key priorities where either immediate improvement is necessary or where performance at defined target levels must be sustained. Tier 2: Priorities that are subject to longer term delivery trajectories or in some cases may be subject to regular local monitoring. Above all, for both groups, the strategic importance of prevention and health promotion is critical and the areas within each tier are as follows: Tier 1: Setting the Direction Dignity in Care Quality in Care Mortality Rates Access

Unscheduled Care Cancer Stroke Efficiency & Productivity Resource Utilisation

Tier 2: Child Poverty Targets Prevention and Health Promotion Primary Care Unscheduled Care Mental Health End of Life Care Clinical Leadership Corporate Requirements


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In the case of ICT, the next five years will require collaborative working and pooling of resources across all organisations in order to deliver on common all-Wales Information services that will support the two tiers of target delivery, as well as addressing specific Corporate Requirements within Tier 2 such as:

Delivery of the key areas of the all Wales information services EMPI, NADEX, IHR, WCP, MHOL, WCCG

Utilise ICT to improve delivery of high quality clinical services In addition, the UHB will contribute to the development and use of National reporting tools and systems for efficient collection and reporting. Responsibility for data quality will rest with the provider and this will be critical in supporting the move towards an outcome focussed NHS.

88..22 DDaattaa WWaarreehhoouussee

The UHB’s Data Warehouse is a fully integrated data repository providing a powerful platform for information reporting. It is under continuous development but currently houses the following data from core operational systems. • Acute Patient Management (PMS) • Mental Health and Community System • Accident & Emergency • Radiology • Pharmacy • Pathology • Theatres • Prosthetics • Patient Level Costing

88..33 BBuussiinneessss IInntteelllliiggeennccee SSyysstteemm

The UHB has the most advanced business intelligence system (BIS) in Wales providing comprehensive BI analysis and reporting capabilities. The system is designed to enable UHB staff to access a single source of trusted information on a self-service basis in a safe and intuitive environment. Currently there are over 400 users of the system and demand for increased access is high. The BI System is complimented by a fully integrated Data Warehouse which contains data from all core UHB operational systems providing a rich source of secondary uses data for operational and performance management including patient level costing.


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One Trusted Information SourceData

WarehouseData Entry

Other Data Sources

Departmental Systems (EPR) Business Intelligence

SystemDashboards & Scorecards

Reporting

Self-ServiceAnalysis

Clinicians

Board

Managers

Information Professionals

Since the initial deployment a number of notable developments have provided clinical and operational benefits to the organisation. The most high profile of these being the provision of self-service analysis and reporting functionality to support the management of elective pathways, in line with the Welsh Government referral to treatment time targets. In more recent times the development of a Ward Team Dashboard containing a variety of performance indicators including those pertaining to quality and safety has been released to ward sisters and charge nurses across the acute section of the UHB. Other notable developments recently delivered include: • Patient Level Costing - aims to allocate actual costs to UHB patient activity through

incorporating the wide range of data stored in the Data Warehouse • Discharge Planning - a reporting solution to support the patient discharge planning process,

which is being deployed within acute and community settings. • Theatre Productivity Tool - designed to support improved efficiency and productivity of all the

UHB’s theatre facilities. • Divisional Scorecards - designed to support the delivery and promotion of performance

improvement within the UHB in order to meet both Welsh Government and local targets. • Emergency Unit Dashboard – designed to provide a view of the departments compliance

against key performance indicators refreshed every 30 minutes These developments have added an extra dimension to the services now being provided by the UHB Business Intelligence Team The Business Intelligence System also provides opportunities for improving the efficiency of the corporate information production process.

88..44 TToopp HHoossppiittaall AAssppiirraattiioonn

The UHB ambition is to be within the Top Hospital group as defined by CHKS. The UHB has subscribed to CHKS for a number of years, which requires the support of IM&T in particular regarding data flows and interpretation and also in terms of the access to the CHKS system via the IT infrastructure. This collaborative work will continue in the years to come.


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88..55 FFuuttuurree DDeevveellooppmmeennttss

Whilst the organisation has come a long way in the use of its Business Intelligence system, still more can be done over the coming years. To date the focus of development has been in support of the acute services and while that will continue to form part of the future of the systems development path, it is recognised that Business Intelligence support in the areas of Mental Health, Community and Primary Care need to be progressed. To consolidate on the achievements to date, the UHB will: • review and rationalise the existing system as an enabler to upgrading the system to the latest

industry standard, which will include statistical analysis • increase the frequency of data feeds so that weekly updates will become daily updates and

daily updates will become hourly • support the expanding self-service user base through enhanced training and analytical support • increase further the number of data feeds into the Data Warehouse e.g. departmental systems

such as Oracle Financials , Rosta Pro and Bluespier • Support the full roll-out of Patient Level Costing beyond its pilot phase • Continued to de3velop and deploy Business Intelligence products in support of the

organisation such as dashboards, scorecards, reports and cubes. • Investigate tools for modelling and forecasting as a core part of the BI function Collaborative working will be essential in order for the UHB to consider the population health perspective as per Our Healthy Future. The UHB will require the support of the Public Health Observatory: • as a source of health intelligence • in the development of a Shared Public Health indicator set • to provide routine flows of public health information into the UHB • in looking at a medium to long term development that would incorporate public health data

sets into the UHB Data Warehouse Integration of services across sectors is essential in order to deliver the UHB capacity plan, in particular the utilisation of inpatient beds. The successful implementation of the capacity plan is critical to delivering the key Access targets for 2011/12, improving the efficiency of the organisation and improving resource utilisation. The development of key performance indicators for capacity utilisation across all sectors is a priority, building on the Business Intelligence developments to date for utilisation of acute capacity. The UHB is unique in Wales in having a system that is deployable in a range of healthcare sectors that can support the priorities identified within Setting the Direction. The UHB has recently completed a project to ensure that data is housed within the UHB’s Data Warehouse, which will provide a robust reporting platform for community and mental health services and the wider community. As with all LHB’s, the Primary Care Information infrastructure is supported by NWIS and whilst this will continue, this will need to be complemented by developments within the UHB to facilitate and support the integration of services across Primary and Secondary care sectors. The focus will continue on key priority areas associated with access to NHS care and the Business Intelligence developments implemented to date within the UHB to support elective and unscheduled access will be consolidated and further developed as required. Collaborative working will be essential in order to make the necessary changes to the national CaNISC system required to support the delivery of the cancer access targets.


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In addition there will a focus on the following areas: • Stroke – where there will be element of collaborative working with NLIAH • Cardiac services • Trauma • Mortality rates – making use of both local developments and CHKS • Mental Health – in particular, full compliance with CPA, supported through which has recently

received an award for its CPA functionality The quality and safety agenda will require renewed focus on objectives such as eliminating pressure sores and reducing healthcare associated infections, which will be underpinned by existing and ongoing Business Intelligence developments, specifically the Ward Team Dashboard. Whilst the implementation and maintenance of the 9 nationally agreed focus on pathways can no longer be supported by the Map of Medicine, they are essential deliverables for both improved efficiency of services and better outcomes for patients. This is further demonstrated through the national mandated requirement to develop 3 elective care pathways and 3 unscheduled care pathways as part of the GMS Quality and Outcomes Framework within each LHB. Existing UHB information systems are already being deployed at a locality level to support the integration of primary and secondary care services and this will continue, together with collaborative working with NWIS to in particular develop alternatives to Map of Medicine. Future developments requested of the BI system are varied and exciting and would provide the UHB with ground breaking levels of business intelligence data. However the ability to deliver these in an acceptable timescale will depend on whether additional resource (staff and funding) can be identified. The chart below reflects what is possible with the current resource and what could be achieved if this were increased.

PLC( PARIS, EU, Exec Reports Theatres Ward Dashboards APC ( Inpatient management frequent feed for Discharge Management)Business Reporting

LIMS

RADIS II

2012/13 2013/14 2014/15

BI Work Plan 2012 - 2015

Info

rmat

ics

/ Bus

ines

s In

telli

genc

e Pl

an

Current Status

Phase 1

Phase 2

Phase 3 onwards


Business Reporting Business Reporting

Outpatient Activity (increase feed clinical management)BluespeirClinical Information Repository Real time Bed ManagementHRG4 Mental Health BI Module

Finance Commissioning

Outpatient Activity (increase feed clinical management)Clinical Information RepositoryHRG4 Divisional Analysis support & Education

Additional Resource

Finance CommissioningDivisional Analysis support & Education

Business Reporting

Divisional Analysis support & Education


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88..55..11 PPaattiieenntt LLeevveell CCoossttiinngg Vision: Patient Level Costing (PLC) allocates actual costs to UHB patient activity using the UHB's integrated Data Warehouse which has been expanded to include , Pharmacy, Radiology, Pathology, Theatres, Accident & Emergency and Prosthetics in addition to Patient Management System data. The Warehouse has an established data feed to the UHB’s Patient Level Costing System (Synergy) which assigns detailed costs to activity and passes the cost back to the warehouse for analysis and reporting through the Business Intelligence System. Its use across the organisation by finance, managers and clinicians will increase understanding of service income and expenditure. Current Position A pilot in three specialties has been completed and over 50 users of the Business Intelligence System have been trained to use the new PLC module. The finance department continues to quality assure the PLC methodology and to support and encourage its use at divisional level. The Service Line Reporting Group chaired by the Director of Finance is responsible for steering the future rollout and use of Patient Level Costing across the UHB. Next Steps To fully integrate Accident & Emergency and PARIS into the PLC data feed enabling all elements to be costed. Feedback from the pilot confirmed that self-service use of such a varied and rich data source is challenging and time consuming. Therefore current development is focusing on building a suite of directional and exception reports to help users focus on areas of interest that may warrant further analysis.

88..55..22 DDiisscchhaarrggee PPllaannnniinngg Vision The discharge planning work stream led by the Innovation & Improvement Directorate required a reporting solution to support the patient discharge planning process. In particular, the e-solution needs to ensure that ward staff, locality managers and senior Divisional staff are aware of any problems in facilitating discharge, especially where the patients are complex in nature e.g. requiring support in the community on discharge, being discharged to residential/nursing homes or transitional care units.


• Ensuring that finance and use of resources are integral to the delivery of efficient and high quality services

• Empowering teams to be accountable for their use of resources • Understanding income, expenditure and contribution at patient and service level • Bringing decision making closer to the patient • Improved use of resource


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Current Position A suite of individually tailored reports is generated automatically by the Business Intelligence System and sent to key nursing staff in both the acute and locality sectors. These reports identify patients who are being managed under the discharge or choice protocols and are used to facilitate the weekly Super Tuesday meetings. The reports ensure that all senor nursing staff have access to the same information prior to and during key operational meetings. Notes and actions agreed at the Super Tuesday meetings are recorded on Ward Workstation, and are in turn extracted and included in the following weeks generated reports, providing a log of actions and progress. Next Steps Increase of the frequency of loading current inpatient data from PMS into the Data Warehouse from nightly Monday to Friday to hourly seven days per week. This would enable reports to be run self-service throughout the day and at weekends.

88..55..33 WWaarrdd // NNuurrssiinngg DDaasshhbbooaarrdd Vision The UHB is required to participate in the definition and development of an all Wales Nursing Dashboard. In addition a local dashboard has been developed to provide ward sisters and senior nursing staff with a cohesive view of their wards performance in areas such as quality and safety, patient experience and use of resources. Current Position The ward level team dashboard has been rolled out to the University Hospital of Wales and University Hospital Llandough. It is available on-line to ward sisters and charge nurses on a self-service basis. Next Steps The further rollout to Mental Health Division The development of a high level view of the ward team dashboard is underway. It aims to provide UHB wide information and exception reporting for use at executive and divisional nurse level. The development of a Mental Health and Maternity version of the ward team dashboard


• Early indication of patients whose discharge has the potential to be complex or where a known delay or constraint has been recorded

• Monitoring of patients managed under the Choice protocol • Highlighting patients who are medically fit but have no planned discharge date • Enables analysis retrospectively of performance against key targets such as compliance

with planned discharge dates and with the noon discharge target. • Ultimately to improve patient flow, thereby facilitating the delivery of the UHB’s Capacity

Plan


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Development of additional data feeds and indicators such as cleaning scores, hand hygiene and Rosta Pro Information 88..55..44 CCoommmmuunniittyy aanndd MMeennttaall HHeeaalltthh IInnffoorrmmaattiioonn Vision The solution is a pervasive implementation of a full electronic patient record system into both the Community and Mental Health sectors. The UHB is unique in Wales in having such a system implemented in Community Services. It is essential that this rich data source is incorporated into the UHB’s Business Intelligence System and fully loaded and integrated into the Data Warehouse. This will bring the vision of one corporate business reporting solution across all services a step closer. Current Position Data is fully loaded and integrated into the Data Warehouse. Next Steps A suite of reports have been identified by the PARIS team for redevelopment in the Business Intelligence System. The Corporate Information Team will be working on the development of these reports during the next financial year as resources allow. Now that data is available in the Data Warehouse it will be possible to build a module in the Business Intelligence System to provide the same self-service solution to the Mental Health and Community division as that already in use by Acute Hospital Services. This will include cubes, report, dashboards and scorecards and will require a significant analysis and development resource from the BI Team. In addition an estimate of at least 50 users will need to be trained to use the system at division and directorate level.

Service delivery benefits • Provide a robust Business Intelligence Reporting solution to users and the wider UHB

community. • Improve the understanding and reporting of elective pathways that require input from

therapy services.


• Enables ward sisters and senior nurses to view trend data on key performance indicators all in one place such as pressure damage, medication errors, infection rates and complaints, to recognise exceptions and to facilitate improvements where necessary.

• Enables ward sisters to drill down through trends to greater detail including incident and patient information.

• Highlights ward compliance with UHB targets such as discharging before noon and planned discharge dates, thereby facilitating the delivery of the UHB’s Capacity Plan.


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88..55..55 TThheeaattrree IImmpprroovveemmeenntt PPrrooggrraammmmee Vision Theatre data is now fully integrated into the UHB’s Data Warehouse and is therefore available for the development of dashboards and reports. Having the data integrated into the main warehouse facilitates reporting across areas such as theatres, waiting lists and activity including clinical coding. Current Position Some products have already been developed such as the Theatre Productivity Tool (TPT) which was originally designed and developed by DSU and NLIAH as a stand alone tool to improve the efficiency and productivity of theatre facilities across Wales. However unlike the national product, the UHB’s version of the TPT is fully integrated into its Business Intelligence Solution. The TPT is available to service users along with supplementary performance dashboards including key performance indicators such as theatre utilisation, late starts, early finishes, turnaround time etc. Next Steps Additional reporting and dashboard requirements have been identified and will be scheduled for development in March/April 2012. The additional reports are aimed at making Theatre performance information more accessible to directorate managers across the UHB. Two new OLAP Theatre cubes have been developed and following testing will be released for self-service analysis 88..55..66 DDiivviissiioonnaall SSccoorreeccaarrddss Vision The Divisional Scorecards are designed to support the delivery and promotion of performance improvement rather than just deliver performance reporting. The first phase of the project focused on the acute hospital divisions, with diagnostic and therapy and Mental Health services included in the next phase. The score carding philosophy is to automate the strategy management process, enabling organisations to monitor, measure and manage their key business metrics against their strategic and operational objectives. Current Position The current phase of the scorecard development has been rolled out to acute divisions and summary reports have been developed to further support regular performance meetings.


• Improved understanding of the use of theatres • Highlight areas requiring further investigation based on performance against both

national and local targets • Ultimately improved and more efficient use of theatre facilities


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Next Steps To define, develop and rollout Diagnostic and Therapy and Mental Health versions of the scorecard. Work with Divisional managers to encourage use of the scorecards in their directorates and to develop local indicators as required

88..55..77 HHeeaalltthhccaarree RReessoouurrccee GGrroouuppss –– VV44 Vision Healthcare Resource Groups version 4 has been implemented centrally in Wales and provides greater detail than version 3 currently in use locally in the UHB. Having the ability to group and store HRG4 against activity in the UHB’s Data Warehouse would provide an additional level of granularity and detail to Patient Level Costing and for wider casemix analysis. The Finance Department and specifically the Patient Level Costing lead has requested that the Grouping of HRGs within the data warehouse be investigated and costed. Current Position The UHB’s Data Warehouse 3rd party supplier, who develops the warehouse schema along with the Business Intelligence Team, has successfully implemented grouping of HRGs in another NHS organisation. A quote can be requested for the work to be replicated at Cardiff and Vale. Next Steps The commissioning of this development will be discussed and if agreed prioritised at the Information Requirements Group.


• Information currently only available at a national level would be available locally for casemix analysis and reporting.

• HRG4 would be available within the Patient Level Costing module of the Business Intelligence System

• The UHB would be in a position to comply with the submission of HRG version 4 codes in its national dataset submissions if this were to become mandatory in future


• To facilitate and enable improved performance against key national and local targets • The adoption of a common performance improvement framework across the whole

organisation • Ensure that key business metrics are reported at both Divisional and Corporate level • Track and trend performance against key performance indicators • Assign a primary owner for every metric to clearly identify accountability


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88..55..88 EExxeeccuuttiivvee DDaasshhbbooaarrdd aanndd EExxcceeppttiioonn RReeppoorrttiinngg Vision The Business Intelligence System offers exceptional levels of access to information and flexibility in analysis and reporting. However the system has grown in size and complexity over the last two years and this has in turn brought challenges in terms of how to make important and relevant information stand out to managers who are already extremely busy. A need for exception reporting has been identified to ‘push’ important performance information out to users. Current Position Project initiation stage. Next Steps Work with divisional managers to identify priority areas when exception reporting could be of most value. Redevelop the Executive Dashboard to include exception reporting Develop automated exception reporting for divisions and directorates 88..55..99 OOuuttppaattiieenntt DDaattaa AAvvaaiillaabbiilliittyy RReeffeerrrraallss aanndd WWoorrkkffllooww IInnffoorrmmaattiioonn Vision Outpatient activity and clinic utilisation is currently reported via the Business Intelligence System on a weekly basis. It has recently been highlighted by Acute Hospital Services that the data needs to be updated on a daily basis to facilitate the effective management of clinic utilisation. A proportion of referrals are now being received by the UHB via the WCCG (e-referrals) and as they are managed through the on-line workflow module additional information is recorded. A development is required to ensure all referrals both electronic and manually recorded are passed into the Data Warehouse for reporting. The additional workflow information collected could also be included in the feed. Current Position Project initiation stage. Outpatient activity and clinic utilisation data is currently passed from PMS to the Data Warehouse by the running of dated extracts, which have been in place since the warehouse was first implemented.


• Provision of targeted reporting to highlight performance exceptions to operational managers

• A high level dashboard for Executives to highlight exceptions and key trends • Ultimately enabling a quick response to service areas heading away from local or

national targets


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These extracts would need to be replaced by event or trigger based data feeds that would enable movement of the minimum amount of data required rather than bulk updates. It is recognised that the development of additional extracts cannot be undertaken until new PMS infrastructure is in place. Next Steps Specification to be agreed for the migration of the current outpatient activity and clinic utilisation feeds to a more efficient method of data transfer from PMS. Specification to be written for the feed of referrals and workflow data into the Data Warehouse. Quote to be requested from the UHB’s Data Warehouse Supplier to receive and load the data specified into the warehouse schema.


• More frequent clinic utilisation reporting as requested by Acute Hospital Services • All referrals available for reporting via the Business Intelligence System • Reporting of electronic referrals and associated workflow information distinct from

manual referrals in support of the WCCG implementation project


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99 BBEENNEEFFIITTSS AANNDD RREETTUURRNN OONN IINNVVEESSTTMMEENNTT ((RROOII))

This section of the strategy outlines some of the benefits that can be achieved by the implementation of the National programme and also the continued developments of internal projects which support the potential for process change arrangements for ‘back office’ administration, such as medical records. In these challenging times, it is also necessary to ensure that the strategy is linked with the requirements of Turnaround to Transformation (T2T) and Transforming Admin Pathways programmes as well as exploiting opportunities emerging from new initiatives such as connectivity of “smart” devices and mobile working. Benefits and return on investment are vital. Some benefit opportunities are illustrated below. Delivery of benefits and return on investment are an essential component of this strategy. One example is Digitisation of Health Records and is expected to deliver recurring savings increasing to £1.9 million per annum by 2015. Other areas are outlined in the table below and are set out in more detail in section 8 of the strategy. Any benefits/savings from implementation of the strategy will be assessed and factored into Divisional and service line budgets.

99..11 DDeelliivveerriinngg tthhee NNaattiioonnaall aanndd LLooccaall PPrrooggrraammmmeess

The national and local development programmes are critical to the achievement of the Health Boards strategic objectives. All developments are related to a set of strategic benefits defined by NWIS:

The table below shows the set of strategic benefits defined, with examples of some generic types of outcomes and benefits that the Programme is delivering to support them:

Examples of types of outcomes & benefits:

Patient safety increased Increased timeliness and availability of relevant clinical information decreased transcription errors & increases safety.

Positive patient outcomes increased

Easy access to relevant clinical information increases speed and relevance of diagnosis, care, treatment plan and onward referral.

Convenience of care increased

Improved availability of information make the location, timeliness or method of access for patients more convenient

Patient confidence increased

The availability and targeting of accurate and relevant information at the patient’s point of contact increases confidence in service

Legal/policy compliance maintained Requirement to comply with policy or UK/EC legislation is met.

Health system efficiency increased

Processes are faster, or wasteful processes can be reduced to improve productivity.

Overall health system costs decreased

Informatics improvements eliminate wasteful processes and reduce expenditure.

In order to help ensure the effective delivery of these benefits the UHB should invest appropriately in business process change, systems and services aimed at auditing and realising potential benefits. This investment to appropriately deliver the benefits using IT tools should involve the Innovation and Improvement department (I&I), Workforce and Organisation Development (WOD), Clinical and Divisional management.


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99..22 BBaacckk OOffffiiccee SSyysstteemm RReevviieeww –– LLiinnkkss ttoo WWoorrkkffoorrccee MMooddeerrnniissaattiioonn PPrrooggrraammmmee

The IM&T strategy is to review all administrative systems over a period of time to assess the scope for implementation of technology to improve the effectiveness and efficiency of those systems. Technology will underpin the workforce modernisation programme moving from a paper driven system to an electronic process which has the potential to release significant efficiencies and savings however, implementation will be constrained by available funding and WG Invest to Save finance will need to be accessed. The current review timetable is set out in the following table: System 2012/13 2013/14 2014/15 Health records * Electronic coding * ESR * E-leave * E-expenses * Datix * Telemedicine * Rosta Pro * Digital Dictation * Electronic Admin Pathways * Communications Hub *

99..33 TTrraannssffoorrmmaattiioonn ooff AAddmmiinniissttrraattiivvee PPaatthhwwaayyss –– PPootteennttiiaall BBeenneeffiittss

The potential for benefits and ROI in the implementation of key national and local initiatives in terms of Back Office savings and the Administrative Pathway cannot be understated. Some potential Admin pathway benefits that can accrue from these initiatives are outlined below. It is important to ensure that the T2T programme and the Admin pathway programme are joined up to help achieve these benefits. e-Referrals It has been agreed at a National level that electronic referrals (e-Referrals) from GP practices to outpatients will be delivered to hospitals through the Welsh Clinical Communications Gateway (WCCG) utilising clinical designs that have been endorsed by the National Architecture Design Board (NADB). It has been further recognised that there is considerable benefit in continuing the electronic ‘flow’ of the referral beyond initial receipt by hospitals, and to this end, e-Referrals will be received and managed using Hospital e-Referrals (“HeRs” – formerly Hospital Workflow). HeRs development has been led by Cardiff and Vale University Health Board and it is passing through the NADB approvals process. Current HeRs functionality (known as “Phase 1”) allows e-Referrals to be managed up to the point that they need to be transferred to clinicians for prioritisation, and includes addition of the patient to the outpatient waiting list. Phase 2 will increase the scope of the system to allow e-Referrals to be transferred to clinicians for on-line prioritisation. Phase 2 will be delivered to clinicians as part of the Welsh Clinical Portal (WCP).


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Potential Impact: GP Secretaries and other GP practice admin staff

• Reduced filing/retrieving of specialty/clinic-specific referral templates, as on-line referring guidance will be used to complete the WCCG generic template, or bespoke templates will be held within WCCG

• In some cases, no need to type up, edit, confirm sign off, or send the referral letter as primary care clinicians may create and send this on the WCCG

• In some cases, where admin continue to type up, edit, confirm sign off, or send the referral letter, need to do this using the WCCG

• In the majority of cases, no longer need to print, address, and post or fax the referral letter, as this will be sent electronically via the WCCG in real time.

• In some cases, such as where the target specialty cannot receive e-Referrals, or failure of the WCCG system, need to revert to paper systems to create/send the referral letter

• Reduced made phone calls regarding referral progress, appointment booking, and reasons for rejection, as status updates will be provided in real time

• Reduced received phone calls/reprocessing work relating to resending lost referrals • Reduced received phone calls/reprocessing work relating to transcribing/legibility issues

Practice managers, GP Secretaries, and other GP practice admin staff

• May need to manage WCCG work lists, checking that draft e-Referrals are completed and

successfully sent, and requests for information are processed • May need to use WCCG to monitor sent e-Referral status in case of delays or rejections

Courier/Hospital Post Room Staff

• Reduced amount of paper letters to be delivered to Health Records and other initial

recipients of referrals

Health Records (including Clinical Referrals Centre) staff, and admin staff in areas where responsibility for managing referrals is devolved from Health Records

• Reduced amount of paper letters received, opened filed with the patient paper record or

scanned to the electronic record (including fax) • Reduced received phone calls regarding referral progress, appointment booking, and

reasons for rejection, as status updates will be provided in real time • Reduced made phone calls/reprocessing work relating to resending lost referrals • Reduced made phone calls/reprocessing work relating to transcribing / legibility issues • Reduced work locating or requesting required data within letters, due to generic template • Reduced requirement to transcribe from paper or one system to another • In most cases, will need to use HeRs system to process e-Referrals • In some cases, will need to use both HeRs system and PAS system, such as new patients,

duplicates, expedites, etc. • Reduced amount of paper letters to be transferred onwards within admin areas or to clinical

areas/clinicians • In majority of cases, will need to use HeRs system to target recipients of e-Referrals • In some cases, may use HeRs system to manage availability of receiving clinicians


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Hospital Medical Secretaries • Significant reduction in the amount of paper letters to be received and managed within

clinical areas and transferred back to or via admin areas • Reduced made phone calls/reprocessing work relating to transcribing / legibility issues • Reduced work locating or requesting required data within letters, due to generic template • In some cases, may use HeRs system to manage availability of receiving clinicians • Reduced management of communications to and from GP practices, to request further

information or to explain reasons for rejection

eDischarge

• It has been agreed at a National level that electronic discharge (eDischarge) will be delivered through the Welsh Clinical Portal (WCP) utilising clinical designs that have been endorsed by the National Architecture Design Board (NADB).

• It is important to note that central to the success of eDischarge will be the inclusion of medicines information/data. This will be achieved through the development of a WCP component called Medicines Transcribing and e-Discharge (MTED). Cardiff and Vale University Health Board developers are prime builders of this component contributing directly to this NHS Wales Informatics Service (NWIS) led development.

• It was recognised that the Electronic Medicines Transcribing development requirement would impact on how quickly the full eDischarge could be achieved and hence an interim solution was implemented. This interim solution delivers electronic copies of the current paper based discharge documents to primary care via the national Welsh Clinical Communications Gateway (WCCG).

Potential Impact: Both the Interim and the National solution would impact on Admin Staff as follows: Hospital Medical Secretaries:

• Will no longer need to type up the Discharge Advice Letter (DAL) as this will be created on

the WCP by medics and pharmacy staff. • In some cases where local processes (consultants) dictate they will need to be edit and/or

sign off and send the DAL electronically • In the majority of cases they will no longer need to print, address the envelope and post the

DAL to the GP Practice as this will be sent electronically via the WCCG in real time. • In some cases, where the DAL status reports ‘failed to deliver electronically’ they will need to

print, address the envelope and post the DAL to the GP Practice.

Hospital Post Room Staff • There will be a significant reduction in the amount of paper letters to be delivered to GP

Practices GP Secretaries

• There will be a significant reduction in the amount of paper letters received, opened filed with

the patient paper record or scanned to the electronic record.


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• Reduction in phone calls regarding the patients stay in hospital as DALs will be provided real time eg between 1-3 days from discharge, taking into account weekends.

Communication Hub The UHB have ceased the contract with Primecare for the provision of Out of Hours (OOH) services to the Vale of Glamorgan from 1st April 2011 and Cwm Taff supporting Cardiff from 1st October 2011. The new service will be located in the Vale of Glamorgan Call Centre located in the Barry Leisure Centre. This will represent the foundations to build an integrated service between our service partners and the voluntary sector enabling the patient, citizen and victim in the future access to services via a “single access point” (SAP). Currently the service provides:

• Vale call centre premises secured to operate services on a SLA covering 5 years. • We have capacity for +100 desks out of hours and in excess of 60 in hours, meaning the

centre is future proof for services which will be delivered through the hub. • PSBA installed within the hub, allowing access to any NHS system. • PARIS installed as a FAT Client allowing for greater resilience and flexibility • Vale OOH service repatriated on 1st April and now being delivered through the hub. • Daytime dental helpline live on 1st July, first phase on a planned service which will bring a

one number solution for dental queries within Cardiff and Vale. • Patient experience telephone surveys being conducted for those patients being discharged

via the new St John’s stream, this will set the ground for further patient experience work over time.

• Discussions held with outpatients and therapies on the hub helping provide some telephony based services.

Potential Impact: The Communications Hub model provides the Service and Technology infrastructure for pooling of manpower virtually or physically which in turn will provide economies of scale in service provision in the future.


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Benefits of the full IM&T Programme The following table illustrates the potential benefit and return on investment of the Strategic IM&T work programme: Project Service Benefits Welsh Clinical Portal (WCP)

• Implementation of the WCP will result in increased timeliness and availability of relevant clinical information

• The production and administration of paper results will be reduced or eliminated

• The transcription of pathology and radiology orders will be reduced or eliminated

• The ordering of unnecessary tests will be decreased, resulting in reduced costs to the organisation

• Telephone transcription of urgent results will be reduced or eliminated

• Implementation of the WCP will contribute significantly to the evolving electronic patient record supporting accessibility, accuracy and security of patient data

Medicines Transcribing and Electronic Discharge (MTED)

• The implementation of MTED will reduce medication transcription errors

• Compliance with the formulary will be increased • The effectiveness of medicines reconciliation will be increased • An electronic discharge letter will be produced which will result

in fast transmission of structured and complete data to primary care.

• GPs will have an up to date medication list for their patients Hospital E-Referrals Project

HeRs contributes significantly to patient safety, patient treatment processes and business processes in the following ways:

• Safe, secure and fast electronic transmission of patient data between clinicians, health records and administrative staff

• Reduction in the time taken to add patients to a waiting list and, ultimately, a reduction in the time taken to initiate appointment booking

• Integration with the Welsh Clinical Communications Gateway (WCCG)

• Integration with the UHB’s Patient Administration System (PMS)

• Multi-user workflow functionality for processing referrals in medical records department(s) / patient appointment centres / administration teams (before clinical review and prioritisation of referral)

• Flexibility – referrals can be processed by staff in devolved or other areas that are away from the main Health Records Department

• Significant reduction in turn around time between admin and clinical functions

• Improved security of referral – ie referrals will not be lost or mislaid

• Contributes significantly to the evolving electronic patient record thereby providing accessibility, accuracy and security of patient data.

• Improved Primary/Secondary Care communications on current


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patient state • Improved clinical triage management • Improved data accuracy. • Lean efficient and cost effective administrative processes • Online viewing and prioritisation by clinicians • Ordering of tests and investigations at point of clinical

prioritisation • Messaging back to primary care

Welsh Clinical Communications Gateway (WCCG)

• The implementation of WCCG has resulted in a decrease in the manual handling of referrals

• Faster transfer of referral documents to the receiving site • A decrease in the cost of referral administration e.g. reduced

telephone calls • An Increase in the relevance and completeness of patient

clinical data within the referral due the introduction of a structured template

• Knowledge of referral status is shared amongst clinicians in primary and secondary care

• E-discharge letter can be sent to GP practice as soon as a patient is discharged, benefiting both patient and GP who has the latest information about the patient’s stay in hospital

• Full audit capability E-Communication

• WCCG could be used to send a range of electronic messages to GPs to improve efficiency, release resources and improve patient safety.

• Primary care clinicians would receive timely and complete information about their patients to support their ongoing care

Individual Health Record (IHR)

• Clinicians report that access to the IHR supports diagnosis in urgent situations

• The speed and accuracy of medicines reconciliation is increased

• Errors in treatment management are decreased • Speed of treatment initiation is increased • Reliance on the patient for medical history is decreased • Knowledge of clinical intolerances is increased • Opportunity to provide patient education is increased

Radiology Management System (RADIS2)

• All health boards will have a common platform from which they can move to a new All Wales Radiology Management System (RMS)

• Radis2 will be improved to allow functions such as desktop integration with picture archiving and communications systems (PACS),

• Radis2 is will support clinical governance, operational

efficiency, demand management and forward planning

Laboratory Information System (LIMS)

• Decrease in likelihood of lost/mislaid tests between organisations, leading to less frequent duplicate testing.

• Single pathology record for each patient • Improved audit trails



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• External user access to look up and referral of specialist tests • Transfer of tests for investigation from outside UHB will not

require double entry • Blood stock can be monitored and tracked more efficiently

leading to less waste and improved safety of blood transfusion • Key enabler for the electronic patient record in Wales which

will lead to more efficient and effective patient care with reduction in costs for medical records and avoidance of duplication.

• Delivery of standardised information across Wales • New and better analytical business tools for improved

management. • Opportunities for better cross departmental working between

sub specialties in laboratory medicine • Consistent application of the All-Wales Pathology Handbook

will be increased Cancer Histopathology Reporting Project (CHIRP)

• To replace the current manual data collecting and coding systems with an electronic solution

• To develop a system to enable maximum functionality and flexibility to meet required standards

• To improve standardisation of processes in Histopathology departments by introducing data capture templates for the reporting of cancer cases

My Health Online (MHOL) • By using the MHOL service patients will not have to wait on

the phone to get through to their GP surgery to make an appointment, order a repeat prescription or update their details

• Patient will have convenient access to GP services from home or work — or anywhere with internet access

• There will be a reduction in administration workload for the GP practice staff

Enterprise Master Patient Index (EMPI)

• Support for patient safety initiatives by ensuring that patients are identified correctly

• Identification and linking of duplicate records • Support for the 1000 Lives Campaign • Support for operational processes • A gold standard patient record • Support for the implementation of national systems e.g. WCP, LIMS

National Active Directory and Exchange (NADEX)

• Support for the implementation of national systems e.g. WCP, LIMS

• Migration of all users to a National Active Directory. • Single address book to support health professionals in the

sharing diaries across organisations within NHS Wales Encryption

• All portable computers, mobile devices and removable media will be encrypted

• This will ensure person identifiable information is kept secure • It will also ensure NHS organisation are protected from

prosecution resulting from the loss of personal data Patient Management System (PMS)

• Demand for continued additional functionality PMS will be addressed by the new hardware.


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• Greater storage and processor performance will enhance options both within PMS and the Data Warehouse based BI system.

• Required enhancements to the many sub-modules of PMS can progress providing greater clinical and administrative functionality without further impact on current services and functions.

• Continued deployment and enhancement of clinical communications (correspondence and direct data interlinks) will also be a significant part of this move forward.

Bed Management

• Improvements in bed on-line management • Improvements in accessibility of bed state data over time (BI) • Leaner, more efficient and cost effective administrative processes

Ward Clinical Workstation (WCW)

• Reduction in time between discharge and availability of information to primary care teams


EU Workstation (Emergency Unit Workstation)

• Improved patient movement within the EU improving patient care

• Accurate management of patient data allowing greater breach avoidance.


Communications Hub (Comms Hub)

• The benefits of a newly modelled out of hours service should improve integration between in and out of hours, support the transfer of care into the community, and improve working relations with EU.

• The transfer of the CRC to the Comms hub will help the UHB manage referral criteria and it will also help in the transfer of care into the community.

• Having one number for a range of unscheduled care services will improve communication between services and access to patients.

• As PSBA is installed within the hub, this allows access to any NHS system which allows potential growth of services.

Medical Records Digitisation

• Improved access to patient records improving quality of care delivered

• Cost savings within the health board through the introduction of a paper light system

• Reduced costs for future support from Health records for additional clinic activity

• Reduced number of lost clinic slots due to the increased availability of the Health Record

• Improved efficiency elsewhere within the organisation through the availability of the Health records electronically


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Mental Health and Community Systems (PARIS)

• has retired over a dozen incumbent information systems within scoped services.

• has removed the burden of the clinically un-productive and onerous, ‘end of month paper based activity returns’ from over 2500 clinicians.

• Improved safety for both staff and patients and provided access to real-time information.

• Improved communication across services inc. Social Services, Police and voluntary.

• Improved ability to manage services and staff. • The clinical usage of is ever expanding, currently greater than

100,000 full clinical assessments are being written up annually, alongside greater than 1.4 million annual case-note entries. Greater than 4500 uHB staff (70%+ clinical) have become users of since rollout began in 2005, with greater than 2000 staff using as their daily record keeping solution by July 2011.

• Allows for the safe storage and availability of patient clinical records on a 24*7*365 basis across community and acute sites.

• Cardiff and Vale uHB’s rollout of has been internationally recognised as an NHS leading initiative, hosting visits from a dozen English PCTs and Canadian Health regions, becoming a development partner of Civica for Health And Social Care IT

• Awarded a ‘Highly Commended’ CPAA award for support of the CPA process in 2011.

Ophthalmology Open-Eyes Application

• Improved patient care through time correlated images and data associated with individual patients.

• Improved treatment through clinical and business analysis of data over multiple patients over time

• Improved security of data from imaging devices. • Contributes to the evolving electronic patient record thereby

providing accessibility, accuracy and security of patient data.

Electronic Staff Record (ESR) • Cost savings – direct & Indirect

• Empowerment of Managers

• Improved workforce intelligence (more real time data)

• Empowerment of staff re completion and validation of personal data

• Reduced data input by payroll

• Standardised learners' processes

• Managers/staff able to book training on line.

E-Expenses • Cost savings


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• Standardised /leaner processes

RosterPro Central • Increase UHB's ability./capacity to electronically transfer of time sheet information

• Real time sickness reporting • Less overpayments • senior staff having more direct time caring for patients • Cost efficiencies within payroll • implementation and monitoring of limits on working hours (as

per the Working Time Directive) for staff on RosterPro which will include substantive, overtime and bank hours)

Maintaining a Sustainable Infrastructure

• Provide access to critical applications and services to the point of delivery.

• Improved access speed to systems within the Health Board • Provide resilience in order to maintain access to services

PC’s and Desktop Software • Provide access to critical and business applications to staff in

their relevant work areas • Allow access to critical and business applications in a timely

manner to support new initiatives being introduce within the health board such as digitisation of Medical Records, WCP, HERs and MTED

• Ensure latest software is available to staff • Provide resilience in order to maintain access to services

Server Infrastructure

• The HB will provide for its server infrastructure requirements, improve resilience and performance as well as its ability to respond to major issues and at a lower level investment than would otherwise be possible.

• The HB will support its continued need for storage at a reduced investment cost year on year compared to non tiered storage.

• The HB will support its continued need for backup of critical Clinical and Business data at a reduced investment cost year on year compared to non legacy backup methods.

Telecommunications and Voice Services

• Simply put, all envisaged and/or proposed Telephony enhancements have the sole aim of improving the efficiency and/or effectiveness of all voice communications involving UHB colleagues. Studies have proven that in many cases up to 10% of a working day can be lost to poor communications – this is in addition to the detrimental effect that poor communications have upon Patient perceptions of the UHB.

• The intended total revamp of the UHB’s extension numbering plan will result in a more consistent means to dial between all main UHB locations (at no cost) by taking advantage of the existing network links.

• The removal of duplicate extension numbers (within the UHB) will result in further associated benefits; including maximising the potential of the new Multitone internal pager/bleep system and improving the robustness of the emergency call


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procedures (Crash - x2222 / Emergency - x3333). • The numbering changes along with the new on-line directory

will offer significant improvements to the general efficiency of the UHB Switchboard Operators as well as general extension users.

• The introduction of the speech recognition automated operator will further reduce the existing operator work-load and offer a more consistent service to the bulk of our callers – while still retaining the option of a ‘human’ operator where preferred.

• Mobility and Unified Messaging applications will enable much better communication with peripatetic colleagues.

• The successful introduction of the Solidus Contact Centre application into a number of departments including the ABC has proven that high volumes of calls can be handled much more professionally and efficiently with appropriate management and staffing. Many other departments where high call volumes exist would benefit from adopting the same technology. These include non-ABC managed Out-Patients appointment booking (e.g. Physio, I.S.H., Eye Clinic), S.S.S.U., Pharmacy, IVF Wales, etc.).

Patient Level Costing

• Ensuring that finance and use of resources are integral to the delivery of efficient and high quality services

• Empowering teams to be accountable for their use of resources

• Understanding income, expenditure and contribution at patient and service level

• Bringing decision making closer to the patient • Improved use of resource

Discharge Planning

• Early indication of patients whose discharge has the potential to be complex or where a known delay or constraint has been recorded

• Monitoring of patients managed under the Choice protocol • Highlighting patients who are medically fit but have no

planned discharge date • Enables analysis retrospectively of performance against key

targets such as compliance with planned discharge dates and with the noon discharge target.

• Ultimately to improve patient flow, thereby facilitating the delivery of the UHB’s Capacity Plan

Ward/Nursing Dashboard

• Enables ward sisters and senior nurses to view trend data on key performance indicators all in one place such as pressure damage, medication errors, infection rates and complaints, to recognise exceptions and to facilitate improvements where necessary.

• Enables ward sisters to drill down through trends to greater detail including incident and patient information.

• Highlights ward compliance with UHB targets such as discharging before noon and planned discharge dates, thereby facilitating the delivery of the UHB’s Capacity Plan.


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Community and Mental Health Information

• Provide a robust Business Intelligence Reporting solution to users and the wider UHB community.

• Improve the understanding and reporting of elective pathways that require input from therapy services.

Theatre Improvement Programme

• Improved understanding of the use of theatres • Highlight areas requiring further investigation based on

performance against both national and local targets • Ultimately improved and more efficient use of theatre facilities

Divisional Scorecards

• To facilitate and enable improved performance against key national and local targets

• The adoption of a common performance improvement framework across the whole organisation

• Ensure that key business metrics are reported at both Divisional and Corporate level

• Track and trend performance against key performance indicators

• Assign a primary owner for every metric to clearly identify accountability

Healthcare Resource Groups V4

• Information currently only available at a national level would be available locally for case mix analysis and reporting.

• HRG4 would be available within the Patient Level Costing module of the Business Intelligence System

• The UHB would be in a position to comply with the submission of HRG version 4 codes in its national dataset submissions if this were to become mandatory in future

Executive Dashboard and Exception Reporting

• Provision of targeted reporting to highlight performance exceptions to operational managers

• A high level dashboard for Executives to highlight exceptions and key trends

• Ultimately enabling a quick response to service areas heading away from local or national targets

Outpatient Data Availability, Referrals and Workflow Information

• More frequent clinic utilisation reporting as requested by Acute Hospital Services

• All referrals available for reporting via the Business Intelligence System

• Reporting of electronic referrals and associated workflow information distinct from manual referrals in support of the WCCG implementation project


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1100 PPAARRTTNNEERRSSHHIIPPSS

The IM&T strategic programme will in particular exploit the opportunities to be gained from working with partners. The UHB will explore innovative solutions working with public and private sector partners to improve efficiency, delivering mutual capacity improvements and provide additional combined benefits. The respective IM&T Departments of the UHB and Cardiff University are currently working together on a range of initiatives including mobile working, wireless connectivity, and connection to non NHS sites and with non NHS devices. The UHB is also at the forefront of working with other partners in relation to joint IM&T initiatives and are currently exploring all possible opportunities to champion the proposal for joined up working with Social Service Departments with the potential to explore the usage of one ICT system for both. In addition the IM&T Department is working collaboratively with other public sector partners both regionally and nationally under the auspices of the Office of the Chief Information Officer (OCIO) for Wales to explore the potential for working collectively across the public sector. It is through this group, in conjunction with NWIS, that strategies for the delivery of future Cloud computing solutions, servers, back up infrastructure and email procurements will be taken forward in line with the ICT Strategy for the Public Sector in Wales. The UHB currently has in excess of 100 users connecting from non UHB desktop PCs located in both Cardiff Council and the Vale of Glamorgan premises. Staff connect to the PARIS and UHB business applications which enable the provision of an integrated Flying Start service to its residents. The Mental Health service in Cardiff has recently been integrated into a single service combining staff from both Cardiff Council and the UHB. The technical design for the management of this service has been agreed, all staff will use PARIS as the single Citizen focussed system. The PSBA- Extranet when fully operational will provide the technical solution to provide a Gateway Service for staff from both organisations to access their required systems including PARIS or their relevant business systems such as email in a seamless manner. It is also planned that the Wyn Project technical design will also replicate the business model implemented by Mental Health integrated services. The UHB is working with Cardiff University in the integration of our Wireless Local Area Network (WLAN) to Eduoroam (university’s wireless solution) which will enable university staff access to their academic resources whilst on the UHB estate. Providing such services as access to our WLAN and NHS Wales roaming will provide staff availability to their business and clinical system and patients and guest access to the internet, which will aid in the UHB obtaining ROI on the purchase of the WLAN.


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1111 FFIINNAANNCCEE AANNDD RREESSOOUURRCCEESS

1111..11 WWhhyy IIMM&&TT iiss iimmppoorrttaanntt

IM&T now underpins every aspect of healthcare delivery within the UHB and is critical to virtually every patient engagement. We have:

• Over 7,500 desktop computers or other devices

• Nearly 10,000 devices connected to our network

• Over 8,000 email users

• Over 200 applications used by all staff, provided from our data centres.

There is rightly an expectation that these systems will be available 24 hours a day, seven days a week, to support our clinical services

1111..22 DDeemmaanndd ffoorr IIMM&&TT RReessoouurrcceess

The information requirements of the newly established Health Board have resulted in a, to be expected, increase in demand for IM&T resources. The period since the establishment of the Health Board has seen a significant increase in requirements for System and Information developments. There has also been a significant increase in IT infrastructure utilised to support Health Board requirements. This increase has come at a time of reducing resources devoted to IM&T. Despite these increasing demands IM&T within Cardiff and Vale has a significant record of achievement at both a local and national level

1111..33 CCuurrrreenntt PPoossiittiioonn SSuummmmaarryy

The current position regarding financing and resources for IM&T is summarised below. 1111..33..11 FFiinnaannccee For 2011 / 2012 the IM&T revenue budget before CRP was £3.3M. This represents between 0.3% and 0.4% of the UHB revenue budget. The IM&T discretionary capital allocation for the year was £435,000.

Revenue funding of IM&T at Cardiff and Vale is 25-50% of funding in equivalent organisations.

Recent years have seen a three fold increase in the number of PC’s and connected devices, with no increase in the resources to support it all. Continued growth in both connected devices and applications is expected over the next 3 years.


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1111..33..22 RReessoouurrcceess IM&T currently has 102 WTE staff (including vacancies). This represents 0.6% of the total UHB staff. IM&T staff are currently allocated as follows: Informatics WTE Total (n) Programming and Development 16% Training and Implementation 8% Corporate Information Services 10% Information Modernisation 8% Operational Information Analysis 6% Network and Server Management and Support 16% IT and Web Support 16% Programme / Project Management 12% Telecomm and IT Security 8% 100%

80% of IM&T resources are committed to maintaining and supporting current systems and applications, with only 20% available for the implementation of the local and NWIS development programmes. IM&T is not currently resourced to deliver the agreed local and national programmes as scheduled.


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1111..44 CCoommppaarraattiivvee FFiinnaanncciiaall PPoossiittiioonn

The following sections set out the comparative resources position for IM&T at Cardiff and Vale and other like organisations. 1111..44..11 IIMM&&TT RReevveennuuee BBuuddggeett AAllllooccaattiioonn

2008/09-2010/11 LHB Informatics Spend as a % of Total LHB Revenue Allocation

Source – NWIS analysis of financial and manpower data for LHB’s It can be seen that the national average for LHB’s is 0.9%, with C&V averaging below 0.6% for the last 3 years. As further context for where this places us: • The Wanless report recommended that 3% of revenues should be spent on IM&T. • In leading non NHS organisations 6% of revenue is typically spent on IM&T

For 2011 / 2012 the IM&T budget was £3.3M, with the UHB turnover exceeding £1.1bn, the allocation to IM&T has fallen below 0.35%.


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1111..44..22 IIMM&&TT CCaappiittaall BBuuddggeett AAllllooccaattiioonn

2008/09-2010/11 Total ICT Spend as a % of Discretionary Capital Allocation (LHBs)

Source – NWIS analysis of financial and manpower data for LHB’s 1111..44..33 IIMM&&TT RReessoouurrcceess The Informatics service currently has a total of 102 WTE staff, including vacancies and those staff working on NWIS national projects. The following chart shows this in the national context

For 2011 / 2012 the IM&T discretionary capital allocation for IM&T was £435,000. Cardiff and Vale UHB is consistently at the lowest measure of investment in IM&T using this metric.


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2010/11 Informatics WTE Staff as a % of all WTE (by Organisation)

Source – NWIS analysis of financial and manpower data for LHB’s Within C&V 80% of staff resources are allocated to maintaining and supporting the current systems and services 1111..44..44 CCoommppaarraabbllee OOrrggaanniissaattiioonnss The Leeds Teaching Hospitals NHS Trust is one the largest health organisations in England. In 2010/11 the Trusts total income was £910M. The Informatics department, including ICT and Information, had a revenue budget for this year of £15.5M, or about 1.7% of turnover. The department has a total staff complement of 320. The ICT only budget (excluding Information, Medical Records, Libraries etc) was £8m, or about 0.88% of turnover. In 2010/11 the capital spend on ICT was £4M.

Within the UHB, informatics staff as a % of all staff (0.6%) is less than half of any other LHB


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1111..55 CCoosstt ooff IImmpplleemmeennttiinngg tthhee SSttrraatteeggyy

1111..55..11 GGaapp AAnnaallyyssiiss A detailed resource plan is available which shows the shortfall in resources available to achieve the Strategic Infrastructure and IM&T Programme. The following section however details the estimated requirements to address the Infrastructure gap and to increase IM&T revenue resources closer to the national average. 1111..55..22 IIMM&&TT IInnffrraassttrruuccttuurree SSuussttaaiinnaabbiilliittyy The required infrastructure funding over the next three years is shown in the following table. The costs are the estimated requirements for replacement in line with normal infrastructure life expectancy. The UHB, because of historic failure to invest in infrastructure refresh, faces the dilemma of having one of the most extensive ICT footprints in support of clinical care at risk of collapse if routine funded replacements are not undertaken. The revenue costs shown are the maintenance and SLA costs within IM&T budget for core systems such as network, PMS Etc. There is little scope for capital funding for IM&T in 2012/13, therefore it is unlikely that these requirements will be met, significantly increasing the risk of infrastructure failure. A schedule of absolute priorities for investment to mitigate this risk as far as possible is set out in section 1.14 of the Executive Summary. Infrastructure/Cost 2012/13 2012/13 2013/14 2013/14 2014/15 2014/15 Cap £k Rev £k Cap £k Rev £k Cap £k Rev £k Network 200 500 750 PCs and desktop Infrastructure

380 872 1090

Desktop Software 2700 Server 200 750 750 eMail system upgrade 108 Storage 75 350 350 Backup 75 225 350 Telecommunications 0 100 100 Maintenance / SLAs 792 792 792 Total £1038 £792 £2797 £792 £6090 £792 Infrastructure refresh and replacement normally comes under the definition of capital expenditure, however recognising the constraints of a limited capital programme all revenue based options are currently being explored particularly in relation to PCs. 1111..55..33 IIMM&&TT RReevveennuuee RReeqquuiirreemmeennttss The current revenue allocation of 0.4% of the Health Board budget is not a sustainable position taking into account the increasing demands on the IM&T service.The strategy recommends that the Health Board should set an objective to match the average LHB funding of 0.9% by the end of the 3 year period.


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1111..55..44 IInnvveessttmmeenntt PPrriioorriittiieess It can be seen from the analysis of ICT infrastructure and requirements for staffing the IM&T strategic programme that significant capital and revenue investment is required by the UHB to reduce risk of infrastructure collapse, deliver the EPR programme and improve clinical service delivery. Taking into account the UHB financial position this year there are a number of key investment priorities which will remove some of the highest risks and deliver some key priority immediate benefits as set out in the rest of this section. Infrastructure Infrastructure requires significant investment but the following list could deliver immediate benefits and remove some of the highest risks: PC Infrastructure: The UHB is currently replacing 1100 PCs on the basis of clinical need and age, in line with funding received from discretionary capital and Welsh Government in 2011/12. An investment in a further 700 PC replacements would remove the entire stock of the most aging 6+ years old Eversham PCs providing a massive increase in performance for users. Cost: £380K This could potentially be a revenue investment as outlined earlier. Email Infrastructure: As described earlier the email infrastructure could be upgraded providing a very significant increase in mailbox size to all users. Cost: £108K Server Infrastructure: As described earlier out of the 200+ servers the UHB supports, there are 20+ that can be categorised as high risk. Following the recent risk assessment these require virtualisation or replacement. Cost: £80K Network Infrastructure: As described earlier large elements of the network infrastructure will be end of life within 3 years. Addressing the priority risk areas as described below will mitigate the highest risks. Network Edge The UHB has over 200 Network switches that are over 8 years old and have been End of Life for some time. We require 50 of these switches replacing each year as well as their associated fibre-optic interfaces. This will support the increase in Network speed to key locations such as X-Ray to enable faster and more reliable data services. Cost: £100K ICT Support The UHB is currently operating a support structure well below accepted staffing levels to maintain its infrastructure effectively. An investment of 3 WTEs would help to address some of the highest priority support risks. Cost £80K


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Summary of critical infrastructure investment priorities Project COST PC Infrastructure £380K Email Infrastructure £108K Network Infrastructure £100K Server Infrastructure £80K ICT Support £80K EPR Priorities The UHB, as has been mentioned previously is at the forefront of the development and delivery of the EPR strategy for Wales. In order to deliver in line with requirements and outlined timescales investment will required as described however priority areas with earlier benefits could be addressed with the investment outlined below: HeRS (Hospital e-Referrals System) The HeRS (Hospital e-Referrals System) is a national development project for which C&V are the main developer and project management site. Additionally C&V will be the pilot site for this fully electronic referrals system which will provide significant clinical benefit as well as clear business benefits. There is a high level of Clinical anticipation and acceptance for HeRS phase 2 and a pressing demand to deliver this product within the current financial year. The addition of 3 x WTE development resources will provide a realistic opportunity for the Health Board to meet this timescale. Cost: £128K Medicine e-Transcribing and Discharge system Similarly the implementation of the national Medicine e-Transcribing and Discharge system (MTeD) will provide significant clinical and business improvements both within the acute and primary care arms of the Health Board. Phase 1 of this project is due to start beta-implementation in the near future. The Health Board has a need to address phase 2 developments in order to fully realise the benefits of this system. Initial estimates are that this will require 2 x WTE developers to take forward. Cost: £85K Integration of BI and EPR Systems The Business Intelligence system has an increasing data foot print both in terms of dashboards and general reporting. Limitations in the processing power within source data systems have introduced a significant delay in BI advance. Provision of 2 WTE developers will enable this backlog to be addressed to more realistic timescales. Costs: EPR based systems agreed for deployment within the Health Board requires increased integration resources. Agreed examples (not exclusive) include, Community, Orthopaedic, Neurophysiology, Cardiology and Ophthalmology systems. These demands cannot be met to aspired timescales without additional integration resource of 1 x WTE. Cost: £128K EPR implementation, training and project management Successful EPR implementation will require appropriate training, project management and implementation leads. – 3 WTE Cost £100K


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Summary of investment priorities for quicker implementation of EPR Project WTE (band 7s) COST HERS 3 £128K MTeD 2 £85K PMS BI Integration 2 £85K PARIS – PMS Integration .5 £21K Bluespeir Integration .5 £21K EPR implementation 3 £100K PARIS The UHB leads Wales in the development and deployment of a Mental Health and Community EPR. On a daily basis the PARIS system supports over 2000 UHB staff, across 159 teams and 4 service divisions in their recording of patient care delivery. The system has grown since inception in 2005 from a user base of 50 to a user community of 3200 UHB staff members. Resource to work on the system has not however kept pace with this growth, and indeed the UHB funded project resource has remained static from 2005 to 2012. The project resource covers project management, development, reporting, training, application management/support, business analysis and system helpdesk. The UHB PARIS solution has won both National and International recognition in recent years, including a UK CPA award for ‘best support from IT’ and the hosting of 14 connections for Health (cFH) or northern Ireland Health and Social Care visits. The development resource of 1 WTE and reporting resource of 1 WTE have implemented 1000 system enhancements since 2005, at a rate of approximately 1 LIVE change every 2 days, however, as a consequence of the projects demonstrable delivery to its scoped services, and PARIS’ role as the UHB’s default tool of choice in the Mental Health, Community and PC&IC arenas, an increasing ‘bow wave’ of over 300 initiatives/changes is now faced. The project is critically under resourced to respond and deliver to the UHB’s 2012-15 change agenda Clearly the UHB requires a facility in the Mental Health, Community and PC&IC areas, which is able to respond and deliver to the National Community and integrated Health and Social Care agenda in 2012-15. To support this, the UHB’s PARIS project must be appropriately resourced. The following prioritised resource and deliverables matrix allows for this: Summary of investment priorities for PARIS Project WTE COST SPOE (addictions single point of entry) and CAVERS (CaV electronic record for substance misuse) implementation System Developer/Reporting resource

1

£35K

PC&IC System Development/reporting Resource to deliver the PC&IC change agenda (CRT, cross PC&IC community teams, data links to acute record stores)

1

£35K

PC&IC Business Analyst/Service Lead for 2012-15 developments

1

£35K

WYN Campaign Business Analyst/Developer to support this implementation

1

£35K

BI Reporting Information analyst to deliver PARIS data to the corporate BI team.

0.5

£17K

System Support Officer To provide support function for existing 159 team (this is currently supported by a single 0.6WTE system manager)

1 £29K


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Business Intelligence Priorities The UHB like other NHS organisations is incredibly data rich and the Business Intelligence System provides huge opportunities to turn that data into real intelligence and knowledge whenever and wherever it’s needed. However while the system is deployed widely and is an essential part of the organisations operational and performance management structures, its full potential has not yet been realised. Some key development requests made by the UHB cannot be delivered within the aspired timescales without additional resource – examples below. Summary of investment priorities for BI Project WTE COST Bluespier Data Warehouse Integration & BI module 0.5 £17K Clinical Information Repository Data Warehouse Integration & BI module

1 £35K

Finance Data Warehouse Integration & BI module 1 £35K Commissioning BI module 1 £29K BI and Informatics analysis and support for divisions 1 £29K Mental Health BI Module 1 £29K Theatres BI Module 0.5 £17K


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1122 HHOORRIIZZOONN SSCCAANNNNIINNGG AANNDD EEMMEERRGGIINNGG TTEECCHHNNOOLLOOGGIIEESS

The Health Board will continue to be at the forefront of exploring the potential opportunities to utilise emerging technologies. Wherever possible the Health Board will attempt to drive the agenda just as it has done with the delivery of a solution to securely link non NHS owned smart phone and tablet style devices to the NHS network. This section looks at the potential opportunities that current and emerging technologies could bring to clinical and administrative services within Cardiff & Vale Health Board over the coming years.

1122..11 MMoobbiillee TTeecchhnnoollooggyy

The recent success of the mobile working project has highlighted the potential benefits of mobilising the workforce. As it becomes feasible to securely connect smartphones and tablet devices to the network and to securely access applications, further opportunities will arise to deliver information to the mobile workforce. This will relate not just to staff who work in the community, but to staff who are mobile within the acute environment. In many commercial organisations the concept of staff using their own devices (BYOD – Bring Your Own Device) to securely access corporate applications is becoming increasingly popular.

1122..22 DDiiggiittiissaattiioonn ooff MMeeddiiccaall RReeccoorrddss

The NHS has been delivering care facilitated by a paper clinical record since its inception. Whilst this has proved an effective mechanism for managing the care that is provided, there is a need to exploit opportunities to modernise the systems by which we manage the clinical record. Such action enables the Health Board to continually improve the management systems which support clinicians in their decision making for our patients, thereby improving the quality of patient care.

There are a number of services within the NHS and this Health Board which use different types of Health Records ranging from Paper Light to a full electronic record. CAV recognises that within NHS Wales there is a national programme which is responsible for the strategy of IT systems and ultimately the strategy for an electronic patient record. As such it is important that this Health Board reviews options that are congruent with the current and potential future strategy of NHS Wales.

Benchmarking other Health Boards, both internal and external to NHS Wales, has identified that a move to a paper light system currently provides the greatest opportunity for improvement.

1122..33 DDiiggiittaall DDiiccttaattiioonn

The Health Board will seek to explore the opportunities afforded by new Technologies of Speech recognition and Digital Dictation to improve services and modernise back office functions.

1122..44 DDiiggii--PPeennss

The Health Board will explore the benefits of the use of Digi-Pens in appropriate settings. initial deployments could include Maternity and Clinical Coding.


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1122..55 TTeelleeccoommmmuunniiccaattiioonnss iinniittiiaattiivveess

The Health Board will evaluate the potential for further exploiting its modern telecommunications infrastructure. In parallel with the main telephone system replacements, a number of enhanced telephony services have been strategically deployed to varying scale in selected departments and locations. It is envisaged that the following facilities and enhancements will be available to be deployed (where appropriate) to virtually all UHB staff irrespective of location:

• An equable telephone service to include: o A common set of extension facilities – Group Hunting, Diverts, Call Pick-up,

Manager/Secretary Working, Abbreviated Dialling, etc. o Enhanced Voice Mail via common and centrally managed platform. o Enhanced Auto-Attendant and Call Queuing capability.

• A change to 5-Digit Extension numbering across all locations. This will facilitate the complete removal of the existing confusing intra-UHB numbering plans (72 xxxx, 73 xxxx, 0 1873 xxxx, etc.).

• A new Direct Dialling In (DDI) numbering plan across all main UHB locations to compliment the 5-Digit Extension numbering.

• SMS messaging from Desktop. • DNA Reminders to Patients (delivered via Telecoms Platform). • Major incident automated staff alerting application. • Access to cheaper call tariffs at all locations. • Enhanced call logging and proactive usage monitoring with appropriate reports automatically

generated and made available to departmental managers. • Fixed IP Telephony where practicable (new builds, re-furbishments, etc.). • Mobile telephony which is complementary to the fixed telephony infrastructure, utilising Wi-Fi

(Vocera, SIP handsets) and/or public GSM (Mobile) networks. Potential for BYOD (bring your own device) for certain UHB colleagues.

• Unified Messaging. • Speech Recognition Auto-Attendant (Automated Operator). • Contact Centre technology for departments with significant incoming Telephone traffic.

1122..66 EEvviiddeennccee--bbaasseedd IInnffoorrmmaattiioonn

The availability of both internal and external web based information targeted at aiding clinicians is continually increasing. These sites are easily accessed and the numbers and volume of information can be overwhelming. Additionally, the sites themselves may not be best information sources and in some cases may be suspect. There is a need therefore to consider certification of such sites based on professional clinician input.

1122..77 PPaattiieenntt SSeellff--MMoonniittoorriinngg

Patients are increasingly cared for in their homes with a focus on shortening hospital stays. As such there is the demand on patient safety to allow patients to monitor their own well-being, take responsibility for their own care and rely on good access to clinicians where their condition demands.


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This is especially true for immediate after-care following an inpatient episode or for patients with long term conditions. New technology can help in all these areas and will be seen as an invest-to-save opportunity by many as well as offering a better quality of life for the patient.

1122..88 TTeelleemmeeddiicciinnee

Where the patient is unable to monitor themselves in the home setting remote telemedicine can offer a suitable alternative. Phone video links now available can prove life-saving for many along with remote vital signs monitoring to provide a safe and responsive environment for the home based patient.

1122..99 SSppeeeecchh RReeccooggnniittiioonn

The vastly improved technology supporting voice recognition offers an alternative means of capturing text or data to complement existing systems. Offering hands-free data input for the busy clinician (e.g. radiologist when reporting) as well as an alternative for the slow or reluctant keyboard user. These same applications also offer an audio service which many are finding useful for keeping up to date with emails and other communications.

1122..1100 TThhee SSiinnggllee HHeeaalltthh && SSoocciiaall CCaarree RReeccoorrdd

Probably the most significant development towards improving the care of patients will be the merging of health and social care records. As well as improving discharge planning a single patient/client record will vastly enhance the quality of service that health professionals can offer.. With appropriate levels of access afforded to all involved in an individuals care it will ensure improved safety as well as a more responsive service for all. The restrictive factor is not the technology. A system is available today to satisfy the prime requirements of health and social care services. It is the concerns of confidentiality that delay the introduction of a service that will almost instantly improve the lives of many and continue to safeguard children through their formative years. Whilst a single health and social care system is available there are still problems sharing information between health services – primary care, acute hospitals, mental health services – again because of confidentiality matters which are often proving detrimental to the care of the individuals being protected. It is inevitable that this confusion about who-can-access-what will be cleared in time and it is of some disbelief to patients that such information is not readily available to people directly involved in their care. The Health Board is at the forefront of efforts to take forward the concept nationally on a Strategic basis.

1122..1111 CClloouudd CCoommppuuttiinngg

The Health Board continually monitors opportunities to use virtualised and non-direct technologies to provide software and hardware requirements - where these benefit the Board. 'Cloud Computing' concepts cover a wide range of technologies and associated approaches. The Health Board is confident that its current adoption of these technologies in for example virtualised environments provides the best value to the board at this time. The Health Board will continue to roll out these technologies where they continue to provide best value, highest resilience (for its critical data) and secure access (including high availability).


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1122..1122 SShhaarreedd SSeerrvviicceess

Public Sector organisations coming together to share scarce and expensive technical skills is increasingly popular and is seen as a major means to reduce costs of ICT services.

1122..1133 DDaattaa CCeennttrreess

NHS Wales is already developing plans to introduce national data centres to drastically reduce investment in such centres in each public sector organisation across the country. The business case appears compelling. Improved security, improved disaster recovery arrangements, enhanced back-ups of vital data, reduced costs all add up to an inevitable move to such future service provision. The potential Achilles heel in such scenarios is the Communications factor with the dependence on commercial providers ensuring that appropriate speed connections are always available and contingency plans in place for any break in service.

1122..1144 IInntteerrnneett aanndd IInnttrraanneett

The Internet for NHS Wales is currently a “gateway service” provided and managed by NWIS with a 100Mb circuit. The Internet will be increased in May 2012 to 300Mb, with each Health Board being allocated 30Mb extra to their current allocation. The Quality of Service (QOS) sub group of the national Technical Service Management Board (TSMB) and supported by colleagues are actively reviewing designs which would provide each Health Board with a 100Mb service linked to the PSBA via JANET (Academic Network). The Health Board Internet site is hosted and managed by NWIS, but the software is not currently able to support the integration of social networking and modern methods of communication with the citizens of our nation. Vision

• The ability for each Health Board and Trust to have a suitably sized “pipe” to support its Clinical and Business Users and reviewed and upgraded on demand.

• The integration of every day internet “tools” (Facebook, Twitter etc) used by the Citizens of Cardiff and the Vale of Glamorgan to access Clinical Systems. In addition the use of these tools to support the delivery of patient care and improved awareness to our citizens

• The success of these social networking sites proves that the general public will regularly use such means on a daily basis. In turn this drives a demand for important matters to use the same means of communication. As well as providing personalised health sites for patients there is likely to be a move towards using push technology to communicate directly with patients via their preferred social networking system. So appointment and medication reminders can easily be programmed to reach the patient at the appropriate time. Customised health information can also be directed to patients to help and support them. The range of opportunities is still to be recognised but will become increasingly important if the vision of ‘Driving efficiencies through increased use of self-care and lifestyle management techniques’ is to be realised

• Next Steps

• The need for NHS Wales to ensure the “sizing” of the Internet service provided by NWIS is able to support the needs of the Health Board today and flexible to support tomorrow.

• The need to agree with NWIS how the Health Board is able to develop full and rich content, which embraces such novelties as “video” and more engaging and interactive content.


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• Benefits

• Greatly improved communication to/from the citizens • Technologies the citizens are used to using • Sustainability • Improved patient care

1111..1155 WWiirreelleessss LLooccaall AArreeaa NNeettwwoorrkk ((WWLLAANN))

Current Status The Health Board has invested heavily in its Cisco WLAN and is operational in the UHW and UHL Wards and main Corridors, but not fully pervasive throughout the building. All new building such as Mental Health Services for Older people (MHSOP) has a pervasive WLAN design. The WLAN has a “Guest” network however because of the current supplier of Patient Entertainment Services (Hospedia) and National Policies this is not operational. The Health Board has a direct “outward bound only” connection to Cardiff University to support the Positron Emersion Technology (PET) Scanner located in the UHW. Vision The WLAN to be configured to enable access from

• Non NHS Devices (direct linkage to the Use of Personal Devices to Connect to Business and Clinical Applications)

• Patients, Visitors and Staff (direct linkage to the Patient Entertainment Programme) • Health Board staff to connected to training resources in Cardiff University

Next Steps • The Health Board are currently in discussion with Cardiff University and working with

Damovo UK to enable its WLAN to be accessed via Eduroam • Review the Microsoft licensing impacts of connectivity to an Academic Network.

Benefits • Medical Staff able to connect to training resources to support their development plans • Greater access to Business and Clinical application by staff using personal devices to

access the network •

1122..1166 PPaattiieenntt EEnntteerrttaaiinnmmeenntt

The Health Board will continue to review options for the provision of modern bedside communications and patient entertainment services whilst evaluating the feasibility of such devices being additionally utilised for Clinical access. 1122..1177 UUssee ooff PPeerrssoonnaall DDeevviicceess

Use of Personal Devices to Connect to Business and Clinical Applications Current Status The Health Board working with NWIS are evaluating secure software which enables staff using their personal smartphone and tablet devices eg iPAD, iPhone, Android etc connectivity to Business and Clinical Applications. The secure software creates an encrypted bubble on the user’s personal device and connects to the Health Board Business and Clinical application via their 3G. This model provides a sustainable hardware platform with the Health Board only responsible for the funding of the software.


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Vision

• The provision of a connectivity solution to facilitate connection of non NHS owned mobile devices to the NHS network.

• Increase in the number of staff being able to access to Business and Clinical Applications • A “marked” decrease in the purchase of Health Board Laptops • The Health Board Blackberry server to be accessed by personal devices •

Next Steps

• The procurement of a national solution. • The review of the Health Board Microsoft Licensing which is currently “device” based (each

device requires a licence) to a “mixed” licence model that includes “user” licensing (a users can have a number of devices)

• Benefits Health Board employees are able to

• Use their personal devices to connect to Business and Clinical Applications • Make and receive calls to/from their mobile phone • Charge their personal devices

Junior Doctors are able to • Use their personal devices to connect to Health Board Business and Clinical Applications • Access the Internet • Access training resources in Cardiff University • Make and receive calls to/from their mobile phone • Charge their personal devices

1122..1188 PPuubblliicc SSeerrvviiccee BBrrooaaddbbaanndd AAggggrreeggaattiioonn ((PPSSBBAA))

Current Status The Health Board currently has a “point to point” network provided by BT and Virginmedia and managed by IM&T Department The Health Board has agreed with the Welsh Government to migrate from its current network design to the PSBA over the next two years as contracts with our incumbent suppliers cease. The Health Board has already agreed with Cardiff Council sites such as the UHW would only be supported by a single data link into the PSBA to support both organisations. Vision

• The migration to the PSBA will be the “platform” enabling the Health Board to share services with other Welsh Government organisations.

• The ability to create a “virtual call-centre(s) from within the Health Board estate connected back to the Communications Hub “hosted” in the Vale of Glamorgan VoG) County Council.

• The reduction in circuit costs funded by various government organisations in the Cardiff and vale of Glamorgan area into a single supplier Wide Area Network.

• The creation of a single network in Cardiff and the Vale of Glamorgan to support its patients and citizens


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Next Steps

• The integration of the Health Board to the VoG Mitel telephone switchboard that supports the Communications Hub

• The integration of the Community Mental Health Teams with both Cardiff Council and the Vale of Glamorgan County Council.

Benefits

• The reduction in wide area network costs • Increased bandwidth • A sustainable cost platform • The enabling platform for service re-engineering between Health, Unitary Authorities and the

Third Sector. •

1122..1199 SSoocciiaall NNeettwwoorrkkiinngg

The success of social networking sites such as Facebook and Twitter proves that the general public will regularly use such means on a daily basis. This in turn drives a demand for important matters to be disseminated and discussed using the same means of communication. As well as providing personalised health sites for patients there is likely to be a move towards using such technology to communicate directly with patients via their preferred social networking system. For example, appointment and medication reminders could be programmed to reach the patient at the appropriate time. Customised health information could also be directed to patients to help and support them. The range of opportunities is still to be recognised but will become increasingly important if the vision of ‘Driving efficiencies through increased use of self-care and lifestyle management techniques’ is to be realised.


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1133 GGOOVVEERRNNAANNCCEE

1133..11 IInnffoorrmmaattiioonn RReeqquuiirreemmeennttss GGrroouupp ((IIRRGG))

Within the National and Local context , as outlined in previous sections, the UHB is faced with a challenging list of development and implementation requirements to ensure the organisation has the systems and information necessary to support new ways of working and the modernisation agenda. It will be necessary to ensure that there is an appropriate prioritisation mechanism to determine which initiatives move ahead and when. It will also be crucial to ensure that initiatives are resourced appropriately so that they can deliver anticipated benefits The IM&T Department work plan is managed via the Information Requirements Group who have overall responsibility for the resource commitments and prioritisation of the current work plan and any new project / development requests that are submitted. The IRG has representation from both Clinical and Divisional Management. The IRG has the following responsibilities within the Health Board:

• To determine, direct and manage the implementation of the Cardiff and Vale Health Board IM&T Strategy ensuring that the plan is aligned with the UHB’s Operational Plan/Annual Operating Framework and the NHS Wales IM&T Strategy ‘Informing Healthcare’.

• Agree an Information Strategy Implementation Plan, to support delivery of the agreed UHB Information Strategy.

• Establish an annual detailed Implementation Plan, prioritising projects against available resources, identifying deliverables and key milestones.

• Agree the Information requirements for the UHB and ensure they are kept aligned to the UHB’s key operational deliverables recognising the extended portfolio of services within the UHB’s remit.

• Manage the implementation of the UHB’s eHealth Strategy within the context of the NHS Wales IM&T Strategy ‘Informing Healthcare’ and the UHB’s operational and business objectives.

• Manage the on-going development and rollout of the UHB’s Business Intelligence System within the context of the UHB’s operational and business objectives encompassing new Services being delivered within the UHB.

• To assess the compatibility, feasibility, viability and priority of any new IM&T proposals (whether free-standing, or part of other business case proposals), and to advise on investment priorities, financial viability and business benefit.

• To assess the compatibility, feasibility, viability, priority and impact of any new Information requirements arising either as a result of WAG directives or operational need and to advise on priorities and business benefit.

• To monitor and assess the UHB’s compliance against National ICT standards • Manage the implementation and deliverables of the National Welsh Informatics Services

(NWIS). • To monitor the progress of the agreed Implementation Plan and agree changes where

appropriate. • Ensure that a Programme Management approach is adopted. • To advise and report on Information Strategy implementation progress against the agreed

Implementation Plan. • To advise and report on relevant Project Boards constituted to deliver the IM&T Strategic

Programme. • To review realisation of benefits arising from Information Strategy implementation.


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• Information Requirements Group will advise and report to the Strategic Planning and Performance Committee (SPPC) on the above matters.

• Information Requirement Group will advise and report on relevant Project Boards constituted to deliver the IM&T Strategic Programme. Reporting Structure:

1133..22 CChhaannggee MMaannaaggeemmeenntt

Implementation projects should be seen as change projects enabled by I.T. They will have a technical component, and require support from information and I.T. specialists. However they should not be seen as I.T. projects, and they should not be led by I.T. It is recommended that all projects are service-led to ensure that there is a visible commitment to deliver the full range of envisaged benefits. Without the will and means to introduce change, the benefits of all these investments will be diluted by a lack of commitment to facilitate and drive the changes to working practices that are necessary to deliver the identified benefits. This is the single biggest challenge to delivering the strategy and is vital to the success of the programme.

1133..33 PPoosstt--IImmpplleemmeennttaattiioonn RReevviieewwss

It is important to ensure that value for money is realised from all approved investments. It is therefore necessary to introduce a Post-Implementation Review process within the normal implementation programme. This will cover areas regarding completeness of implementation, lessons learnt, budget performance and most importantly check that all the envisaged benefits listed in the original business case have been realised.

1133..44 IIMM&&TT IInnffrraassttrruuccttuurree MMaattuurriittyy MMaattrriixx RReevviieeww

To aid the understanding of the state of readiness of the organisation to undertake any project it is recommended that a NIMMs (NHS Infrastructure Maturity Model) analysis be undertaken. This is a


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self-assessment toolset which can be used repeatedly to measure and assist NHS organisations in justifying and prioritising their infrastructure investment priorities. It covers the technology and business readiness of the I.T. infrastructure and is outlined in the diagram below.


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1144 CCOONNCCLLUUSSIIOONN

The 3 year strategic programme as described will provide the UHB with a platform to deliver an ICT strategic infrastructure, EPR programme and BI programme appropriate for a billion pound Health Care organisation. Working with NWIS it will also begin to deliver a the paradigm shift in the way we will use information services to put the Citizen at the centre of integrated care systems as a result of the global revolution in telecommunications. In addition it will provide the baseline for the UHB to take forward a programme of modernisation and transformation. Appropriate investment levels will enable the timely delivery of the programme, achievement of benefits and return on investment envisaged. Failure to invest will result in risk and delay. Crucially however this programme should not be seen as IM&T led but rather as a modernisation programme for the UHB taken forward by the services with the involvement of stakeholders and supported by Innovation and Improvement.


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AAPPPPEENNDDIIXX II NNWWIISS PPRROOGGRRAAMMMMEE PPLLAANN

APPENDIX 1 – NWIS PROGRAMME PLAN


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Cardiff and Vale UHB NWIS Programme PlanIssued: 14/02/2012

◊ Go LiveTranche 1 Tranche 2 Tranche 3 Tranche 4

2010 2011 End 2012 End End EndOct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14

NADEX

Encryption Laptops/At Risk Devices

Encryption Remainder

Radis 2

EMPI

WCCG (e-Referrals)

Hospital e-Referrals (HeRs)(LOCAL)

Hospital e-Referrals (HeRs)NATIONAL PROJECT

Hospital e-Referrals Phase 2Local & National

WCP

IHR - Cardiff

IHR - Vale

IHR Other Settings e.g. EU

LIMS

GP Test Requesting

My Health On Line

CHIRP

PSBA2

All Wales PACS & RMS

NADEXReadiness

Radis2Readiness

WCCG Readiness& Training

IHR OOH Other Settings

Readiness

NADEXImplementationPilot

EncryptionReadiness

IHR OOH CardiffReadiness

LIMSImplementa

MHOLReadiness

MHOLImplementation

NADEXReview

◊ Encryption - At Risk/Laptops

IHR OOH ValeReadiness

IHR OOH ValeImplementation

EMPI Phase 2 - Other systems (TBC)Readiness

WCP Readiness

IHR OOH Cardiff Implementation

LIMSReadiness

IHR OOH Other SettingsImplementation

WCCG INPS & EMISImplementation

EMPIReadiness - PMS,

Radis2 ImplementationRFC 317 refers

EMPI

Implementation - PMSAwaiting Programme Note from NWIS

Go live

Hospital e-Referrals Phase 1Implementation & Enhancements

Hospital e-Referrals Phase 1Readiness

Hospital e-Referrals Phase 2 - C&V + All Health BoardsReadiness

Hospital e-Referrals Phase 2Implementation

NEW DATE TO BE AGREED - RFC

WCCG iSoftImplementation

Hospital e-Referrals Phase 1 - Other Health BoardsReadiness

Hospital e-Refferals Phase 1 - Other Health BoardsImplementation -

EA ABMU (Myrddin) from March 2012

CHIRPReadiness

All Wales PACS & Radiology Management System

EMPI Phase 2 - Other systems (TBC)Implementation

Hospital e-Referrals Phase 1 - C&V projectFurther Implementation - Devolved Areas & Excluded Specialties

EncryptionRemainder

PSBA 2implementation

PSBA 2Readiness

IHR OOH Cardiff & Vale

iSoft

WCP 1st 1mplementation including MTED

GP Test RequestingReadiness

GP Test RequestingImplementation

CHIRPImplementation


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AAPPPPEENNDDIIXX 22 UUHHBB PPRROOGGRRAAMMMMEE PPLLAANN

APPENDIX 2 – UHB PROGRAMME PLAN


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Cardiff and Vale University Health Board UHB INTERNAL PROGRAMME 2012 -2014

UHB Programme2011 2012 End 2013 End End

Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14

PMS PROGRAMME

PMS Server Replacement

PMS General Support(inc EU & Ward Clinical Work Station )

PMS Developments

RTT Reporting Enhancements

RTT Development Enhancements

RTT Systems Interoperability

IM&T 001Outpatients Booking System Redesign

Data Warehouse - High Frequency Dashboard Extracts

Bed Management Developments - Phase 2

Discharge and Transfer Developments

Admin Module

John Pathy Appointment Booking

Appointment (Re-occurrence)

E-Referrals

Other E Comms Projects to Primary Care (Clinical Lettes - Shared Discharge Notifications)

Ward Clinical workstation integration with WCCG / Bed Management

Clinical Portal - ISEC Requirements

Gateway Services Integration with PMS/WCP

Clinical Information Repository (CIR)

Medical Record Digitisation (MRD)

General Support

Design / Build / Test / Implement



General Developments ( change requests )





Design / Build / Test / Implement Design / Build / Test /

Implement





Research Procurement Installation & Transfer

Develop Specification Build Modules




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MHCS - PARIS PROGRAMME

Mental Health & Community Systems (PARIS)

MHCS/PMS EBI Interface (Support RTT)

MHCS Mobile Working

New Modules - Phase one

New Modules - Phase two

GP DN referral Pilot using WCCG & Comms Hub Phase 1

Interface WCCG into PARIS - Phase 2

NETWORK PROGRAMME

PSBA Migration

PSBA Extranet

Wireless Networking Expansion

IM&T L111Transfer CAG / Citrix Users & PSBA Extranet Project

TELECOMMS PROGRAMME

Telecoms Support

Various Capital Schemes e.g. Llandough,MHSOP, CRI

Expansion of UHW BC System

5 digit numbering Project

Upgrade to Version 4 Switchboard Software

Small Site Switchboard Implementation

Barry Hospital & Rookwood Switchboard Upgrade

Whitchurch & Lansdowne replacement systems

Replacement of Llandough Switchboard

Llandough Business Cont. System

Replacement of Park View Switch Board

Replacement of Roayl Hamadrayd Switch Board

Unified Communication & Roll out of new applications

Design Specification

General Support

General Support

Business Case/ Pilot / Procurement Stage

Child Health Casenotes, Body Map Imaging etc..

New Central Index, MS Common User Interface Rollout etc...

Ongoing work

Barry Complete

Plan / Design

Design

Plan / Design

Ongoing installations

Roll out of Mobile Devices x 435

Develop Specification Implement Interface

Rookwood to be confirmed

Design

Set up and Run phase 1 of pilot

Review Technical Specification Build Interface

Procure Commision

Awaiting commission of Extranet Migrate

Migrate Phase 1 Migration Phase 2

Futher roll out (Flying Start) and ongoing support for mobile users

Rollout of Interface

Review Techincal Requirements with NWIS & Other HB's & LA Pilot Extranet Rollout Extranet

General Support

Review requirments

Implement - including Barry,Rookwood,etc

Implement

Ongoing Roll-out of additional IP phones.

Migration onto expanded MX-One


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BI, DATA WAREHOUSE & CORPORATE REPORTING PROGRAMME

Data Warehouse ongoing Support

Data Warehouse Developments

Patient Level Costing - Support & Analysis

Business Intelligence System Support

Business Intelligence System - Development & Analysis

Business Intelligence - Training

Radiology / Pathology / Pharmacy - BI Suite

National Nursing Metrics

Executive Level Dashboards and exception Reporting

Divisional Scorecard - Finance & HR Development

Implementation of SPSS (statistical software)

Diagnostic & Therapy BI Suite

Ward Dashboard - New feeds and KPI

Mental Health - Business Intelligence Suite

Primary Care / Community Directorates BI Suite

Information Reporting Services

Orthopaedic and Truama Care Pathways Pilot

Development of Data Source for SAIL Data Bank

IT INTERNAL PROGRAMME

Review New Technologies (Admin pathways)

Patient Entertainment

New Services supported in the Comms Hub

PACS Upgrade

Email Archiving

Bluespear

Design

Subject to NWIS

Procurement

General Support

Provision of Corporate and Service Informatics

POC Development

General Support

Implementation Trauma Board Specification

Develop and implement








General Support

General Support

General Support

General Support

Installation/ Commission / Rollout

Inpatients


Development

Review and investigate

Review and investigate

Review and implement


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Web Site Development & Support

Infrastructure Refresh Programme

WCP Stapling of other UHB Systems

Support of All Wales Finance System (ORACLE)

IM&T 003Develop Info System - Neuromuscular patients

IM&T 004Diabetes Inreach Team - WCW Data Collection Requirements

IM&T 005Non-Microsoft Device Connecting to Domain- Paperless Project Board Meetings Project

IM&T 007Stroke - Telecare National Project

IM&T 009ALAS - Mobile Working Project

IM&T L106Prison Health Project

IM&T L108ESR Self Service Project

IM&T 010Integrated Sexual Health System Upgrade

IM&T 016Access to Neruophysiology Results via Clinical Portal

IM&T 012PARIS Document Management

IM&T 013PARIS Prescribing Project

IM&T 014PARIS Linkage to IHR

IM&T L109Availability of UA - Complex Discharge

IM&T L110Dental - Development of a Website

General Support

General Support

General Support

Design / Develop

Review products

Design and Procurement

Review Requirments

Review Service Requirements

Submit to NADB Design Funnel - On Hold

Design

IT Pilot / Support implementation

On Hold (WG)

ON HOLD

Phase 1 Complete

Pilot with NWIS

Procurement Implement



Review of ongoing requirements via National Solution

Phase 2

Pilot

Implement

Implement

Review requirements


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AAPPPPEENNDDIIXX 33 UUHHBB SSYYSSTTEEMM LLIISSTT

APPENDIX 3 UHB System List


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Name H/W InstallH/W Type

H/W Status Risk

Win Install

Win Version

SQL Version

Backup Policy Total GB Reqd GB

CAV‐LMED01 Aug‐03 WVR DiskErr 10 Aug‐03 Win2K SQL2Ksp3 SQLSrv1 Pathology 130 125CAV‐ALA02 Mar‐05 JRR DiskErr 9 Mar‐05 Win2K3 SQL2Ksp4 FileSrv1 ALAC 272 230CAV‐DDF01 Jun‐06 JRR DiskErr 8 Jun‐06 Win2K3 FileSrv2 Dental/Radiology 272 180CAV‐PID01 Aug‐06 JRR DiskErr 8 Aug‐06 Win2K3 Revelation SQLSrv4 Poisons 272 17CAV‐MPHYS01 Nov‐06 JRR DiskErr 8 Dec‐06 Win2K3 SQL2Ksp4 SQLSrv1 MedPhys 304 260CAV‐CEN01 Aug‐03 WVR 6 Sep‐03 Win2K FileSrv1 MedPhys 32 10CAV‐CSD01 Aug‐03 WVR 6 Feb‐04 Win2K Cache SQLSrv3 Cardiac Services 130 40CAV‐EYE01 Apr‐04 WVR 5 Apr‐04 Win2K FileSrv1 MedIllus 272 200CAV‐EYE02 Apr‐04 WVR 5 May‐04 Win2K FileSrv1 MedIllus 272 220AWMGENS Jul‐06 JRR 5 Jul‐06 Win2K3 None MedGen 136 20UK‐PID01 Aug‐06 JRR 5 Aug‐06 Win2K3 Revelation Local Poisons

UK‐PID02 Aug‐06 JRR 5 Aug‐06 Win2K3 Revelation Local Poisons

CAV‐FNSN01 Apr‐05 HG 4 Apr‐05 Win2K SQL2K5 SQLSrv3 PayRoll 1120 620CAV‐TIX01 Apr‐05 JRR 4 Jun‐05 Win2K3 FileSrv1 ClinGov 136 5CAV‐TIX02 Apr‐05 JRR 4 Apr‐05 Win2K3 SQL2K SQLSrv1 ClinGov 480 17CAV‐TIX03 Apr‐05 JRR 4 Apr‐05 Win2K3 FileSrv1 ClinGov 547 65CAV‐PHARM01 Aug‐05 WVR 4 Aug‐05 Win2K SQL2Ksp3 SQLSrv1 Pharmacy 136 73CAV‐CH01 Nov‐05 JRR 3 Nov‐05 Win2K3 Oracle SQLSrv3 IT 542 130CAV‐LMED02 Nov‐05 WVR 3 Nov‐05 Win2K3 MySQL SQLSrv4 Pathology 136 77CAv‐POPPY01 Jan‐06 WVR 3 May‐06 Win2K3 SQL2K5 SQLSrv3 CAU 136 40CAV‐END01 Mar‐06 JRR 3 Mar‐06 Win2K3 InterBase SQLSrv3 Endoscopy 252 220CAV‐CAMH01 Jun‐06 JRR 3 Jun‐06 Win2K3 radox/FireB SQLSrv3 CAMHS 240 5CAV‐ELEARN01 Sep‐06 JRR 1 Sep‐06 Win2K3 SQL2Ksp4 SQLSrv1 ODT 556 90


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Service Service / Application System Supplier Name

CORE IT SERVICES

Child Health 2000 Database Server IT Development - Child Health Information - All-Wales Child Health Database offering services to LHBs in Wales

CP Live IT Development - Clinical Portal Services

Clinical Portal Web Server: MT01 DR IT Development - Clinical Portal Services

Clinical Portal IT Development - Clinical Portal Services

Data Warehouse Server IT Development - Data Warehouse Server providing key local and central reports and dashboards thereby enabling efficient management of clinical and business functions

Data Warehouse Server IT Development - Data Warehouse Server

BI System Servers IT Development - Data Warehouse Server

Cognos IT Development - Data Warehouse Server

Application Interface Server IT Development - Application Interface

Internet Live back end: Internet Live back end IT Development - Internet & Intranet Management

Intranet Live Infrastructure: Intra Live IT Development - Intranet Live Infrastructure: Intra Live

Patient Management System IT Development - LHB PMS Patient Administration System PMS application Server: Failsafe cluster node for PMS application production environment

IT Development - PMS application Server: Failsafe cluster node for PMS application production environment

PMS application Server: PMS application testing, training, and development environment

IT Development - PMS application Server: PMS application testing, training, and development environment

PMS application Server: Primary cluster node for PMS application production environment

IT Development - PMS application Server: Primary cluster node for PMS application production environment

IT Development - PMS SAN management server: Hot standby for PMS SAN management services

IT Development - PMS SAN management server: Hot standby for PMS SAN management services

IT Development - PMS SAN management server: Primary server for PMS SAN management services

IT Development - PMS SAN management server: Primary server for PMS SAN management services


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Welsh Clinical Portal Services IT Development - Welsh Clinical Portal Services for access across Wales

SERVICE SPECIFIC APPLICATIONS

Artificial Limb & Appliance Service ALAS System Management (All-Wales)

ALAS Application Server ALAS System Management (All-Wales)

Anaesthetics Patient Monitoring Anaesthetic Patient Monitoring

Audiology Patient Application Audiology Applications Auditdata, contact [email protected]

Cardiac Catheter Labs Cardiac Cath Labs Imaging (GE) GE

Cardiac Catheter Labs Imaging Cardiac Catheter Labs Imaging (GE) GE

Cardiac MUSE System Cardiac MUSE Imaging (GE) GE

Cardiology Services Directorate Server Cardiology - Dendrite Cardiology Information System Dendrite

Cardiobase Cardiology Paediatric Information System (Cardiobase) Magnus Medical Software

Cardiology Database Server - Excelera (Main) Echo Cardiology Xcelera Image Management Philips

Cardiology File Storage (NAS) - Excelera Echo Cardiology Xcelera Image Management NAS

Cardiology File Storage (NAS) - Excelera Echo Cardiology Xcelera Image Management NAS

Child & Adolescent Mental Health Server (Maisy) Child & Adolescent Mental Health Case Management (Maisy)

Clinical Engineering Clinical Engineering Equipment Management (Medusa) Softpro Solutions

Clinical Engineering Clinical Engineering Equipment Management (Sharepoint Microsoft

Clinical Engineering Medical Equipment App Server Clinical Engineering Medical Equipment App Server IM&T

Clin Gov Database Server Clinical Governance Citrix Applications

Critical Care Server CAV-WW01\WardWatcher Critical Care Audit Ltd


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Community & Mental Health Services PARIS - Community & Mental Health Services Civica

Dental Server Dental Imaging & Management Services MEDIATECH DENTAL EQUIPMENT & SERVICES LTD

Dental Photographic Server Dental Photographic Image Store Photoware (part of UHB media services see Paul Crompton )

Dental Hospital EDR SALUD TWOTEN

Community Dental EDR SOE Software of Excellence

Dental Laboratories Labtrac Labtrac Solutions Ltd (formerly Inventrix)

Dietetics File and Print server/Ely Heart Team Dietetics Management Applications

E-Learning Web and Database Server E-Learning Web and Database Server Learning Industries (LI) and Cardinus (Card)

EU Scanning Document Scanning System Emergency Unit Scanning - EU - Zylab Print Partnership

Endoscopy Departmental Server ADAM Endoscopy Gastro Imaging System Fujinon

Facilities Work Management Facilities - BactrakFM

Estates Website & Database Server Facilities - Estates System & Web Applications MiCAD Systems (UK) Ltd

Time Tracking Facilities - FingerPrint - Time Tracking

Rosterpro Staff rostering and Nurse Bank function Workforce - RosterPro Staff Rostering Application HMT Systems Ltd (part of

Smart)

Rota Management Facilities - RotaWatch Data Resolve Ltd


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Estates/Maintenance, Works Info management Server Facilities - Works Dept Job Management System

Fetal Medicine Server Fetal Medicine Imaging & Management System Healthnet Connections Asset Register Finance - Asset Management Real Asset Management

Patient Level Costing Application Synergy Patient Level Costing Application CACI

Finance SharePoint Microsoft SharePoint Server 2007 N/A

Finance Document Management Finance Document Management The Content Group Recruitment Server HR - Recruitment Applications

ESR ESR McKesson

e KSF OD&T

Intrepid (Deanery and access by HR)

Infection Control Infection Control - Ward Watcher

Cquip Community Staff

Acubase IVF/HFEA Information (Acubase) NSR Software Solutions

Maternity System Maternity Management System (PROTOS) iSoft

Special Baby unit Badgernet Clevermed

GUM TeleHealth Mills Mill Systems

Medical Genetics Database Server Medical Genetics LHB Applications (Shire, Clincal Pedgree, Ibase)

Genial Genetics (Shire), SHIRE Management Services (Clnical Pedigree), Wabalogic (iBase)


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Medical Genetics Service (All-Wales) Medical Genetics Services n/a (Used for file storage) FH Service Database Server FH Service Patient Management (PASS) PASS Software

Medical Physics SQL Server Medical Physics - Patient Services Management Applications Evesham

Isostock Application Medical Physics Trust-Wide Radioactive Waste Database Gillett Partnership

Neurophysiology Application Optima Medical Optima Medical

Neurophysiology Application Carefusion Carefusion

Neurophysiology Application Dianosys Dianosys

Neurophysiology Application Humphreys Humpherys Occupational Health Application Occupational Health - Cohort Patient Management

Glaucoma Treatment Ophthalmology - Glaucoma Service

Eye Clinic Server Opthalmology - Eye Clinic Imaging

Opthalmology MediSoft Database Opthalmology Patient Management Biochemistry Departmental File and Application Server

Pathology - Biochemistry Departmental File and Application Server

Biochemistry Pathology - Biochemistry Information Applications

Pathology Server Pathology - Lab Medicine Application Services Pathology Qpulse Document Management System

Pathology - Lab Medicine Qpulse Application (Histopathology) providing Quality Assurance Manegement solution

Mortuary Management Pathology - Mortuary - Management of data and functions within mortuary department

Pharmacy Application Server Pharmacy Departmental Application Services PICU PICUNET University of Leeds Poisons Information Database Server Poisons - All Wales Poisons Service

Poisons Poisons - Clinical Information System

Portering Services Application Server Portering - Ausped Job Management System Innovise


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RADIS Radiology - All-Wales RADIS

RADIS Server 2 Radiology - All-Wales RADIS

Radiology Services Radiology - PACS Imaging System

Radiology Results Radiology - Web1000

Digital Dictation Application Server Radiology G2 Speech Digital Dictation

Renal Application Server - Cardiff Renal Information System (VitalData)

Renal - Application Server (VitalData; although the former system [Proton] is still hosted because of lab links; UNIX server)

Vitapulse Ltd

Sterile Services Database Server Sterile Services Database Server

Telecomms Services Telecomms Management including Call Logging

Theatre Management Database Server Theatre Management System

Theatre Management Database Server Theatre Management System

Welsh External Quality Assurance Service WEQAS file system / Qpulse document control server in SAC

Oracle Finance Procurement System Oracle Finance Procurement System and OCR Scanning Service, Hosted by Cardiff and Vale LHB, Managed by Patech Solutions Limited

Patech Solutions Ltd


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AAPPPPEENNDDIIXX 44 IIMM&&TT RREESSOOUURRCCEE PPLLAANN

APPENDIX 4 IM&T Resource Plan


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SS Combined

Senior Mge Proj Mge Proj Supp

IM&T Security Helpdesk Network Dev Team

Imp & Train

Server Team Telecom

Corporate Team

Info Dept CT Mgt BI Team

BI Team Proj Mgt Proj Mgr

Proj Support Helpdesk Training

Info Support IM&T

PROJECT Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req Resource Req

Senior Management (NDL,GCB. PC) 3.00

SUPPORT POSITION:

IM&T Programme Management (SW) 1.00

Server Infrastructure Support 6.00

PMS Development & Support 3.00 3.50 1.50

PARIS Support including Mobile solution 0.70 1.65 2.00 2.00 0.50

Web Site Development & Support 1.00 0.10

Help Desk Support (14 staff) 13.30

Network Support (4 staff) 3.40

Telecoms Support 3.00

IT Security (3 staff) 3.00

Project Support (PC replacement, Home working, ESR, Oracle Finance, Rostapro, etc) 2.00

Support of All-Wales Finance System (Oracle) 0.04 0.20

Information Reporting Services 7.60 1.00

Business Intelligence System & Data Warehouse (Support & Maintenance) 1.50 0.25 2.00 1.00

Business Intelligence System (Training) 1.00

Reactive Business Intelligence Provision 2.00 0.50

Support Sub Total 67.74

INCREASED SUPPORT:

Increase in support in relation to Infrastructure expansion 0.40 0.00 0.30 0.30 2.00 0.52 0.69 0.53 1.19 0.45 0.38 0.05 0.25 0.08 0.11 0.25 0.30 0.30 0.08

PC's TeamGCB's Team Information Team MHCS Team


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UHB WORK PROGRAMME 2012-13

PMS PROGRAMME PMS New Developments (inc D&T) 4.75 3.10

Ward Clinical Workstation 0.50

EU Clinical Workstation 0.50 1.00

RTT Development Enhancements 1.00 1.00

RTT Systems Interoperability 0.50

Other eComms Developments to Primary Care (Letters)

Medical Record Digitisation (MRD) 0.50 1.00 1.00

MHCS - PARIS PROGRAMMEMHCS / PMS EBI Interface (Support RTT) 0.50

MHCS Mobile Working 0.01 0.10 0.70

New modules - Phase one

New modules - Phase two 0.20 2.30 0.50

GP to DN eRefferal pilot using WCCG and Comms Hub

Interface WCCG into PARIS eReferals Phase 2

NETWORK PROGRAMME PSBA Migration Programme 0.40

PSBA Extranet (UHB Staff Access to System from Local Authority Sites) CAG Migration 0.08 0.08

Wireless Networking Expansion 0.08

IM&T L111Transfer CAG / Citrix Users & PSBA Extranet Project

TELECOMMS PROGRAMME Small Site Switchboard implementation 0.12

Barry Hospital Upgrade Completion 0.02

Rookwood Switchboard Relocation 0.04

Expansion of UHW BC System 0.04

Various Capital Schemes (e.g. Tertiary Tower, Llandough MHSOP, CRI) 0.10 0.40 0.22

Replacement of Llandough Switchboard 0.06

Upgrade of Whitchurch Switchboard 0.04

Upgrade of Lansdowne Switchboard 0.04

Llandough Business Cont System 0.04

Replacement of Park View Switchboard 0.04

Replacement of Royal Hamadrayd Switchboard 0.04

Upgrade to Version 4 Switchboard Software 0.02

5 digit Numbering Project 0.02 0.06

Roll out new applications to UHB 0.20

Unified Communication 0.05


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BI,DATA WAREHOUSE & CORPORATE REPORTING PROGRAMME Business Inteligence System (ongoing dev. roll out) 2.50 2.00

Data Warehouse Development 0.25 1.00 0.50

Patient Level Costing (Development) 0.10 0.20 0.50 0.25

Patient Level Costing (Ongoing Support) 0.50 0.15

IT INTERNAL WORK PROGRAMME Review New Technologies (Admin Pathways)

Patient Entertainment

New Services Supported in the Comms Hub

PACS Upgrade 0.10 0.02

Email Archiving 2.40

Deaprtmental Moves (Helpdesk resource) 0.10

IVF System 0.06

Blue Spier) Orthopaedics System 0.45 0.25

Cancer Information Systems (CaNISC)

Patient Reminder System 0.30 0.20

IM&T 002 Cellma Database - Rheumatology 0.06

IM&T 003Develop Info System - Neuromuscular patients 0.01 0.01

IM&T 005Non-Microsoft Device Connecting to Domain- Paperless Project Board Meetings Project 0.25 0.02

IM&T 007Stroke - Telecare National Project 0.05 0.05

IM&T 009ALAS - Mobile Working Project

IM&T 010Integrated Sexual Health System Upgrade

IM&T 012PARIS Document Management

IM&T 013PARIS Prescribing Project

IM&T 014PARIS Linkage to IHR


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IM&T L104Duplicate Outpatient Referrals - PMS Flag Request

IM&T L105PARIS / Clinical Portal Link

IM&T L106Prison Health Project 0.04

IM&T L108ESR Self Service Project 0.05 0.03

IM&T L109Availability of UA - Complex Discharge

IM&T L110Dental - Development of a Website

UHB Project Sub Total 33.75

Total Resource Required 4.40 1.22 3.30 3.35 15.53 5.53 14.59 9.13 13.19 4.48 7.98 1.05 9.75 4.48 1.11 4.90 2.30 2.30 1.08 109.64Total Resource Available to Local Projects 4.00 1.00 3.00 3.00 14.00 4.00 7.00 3.15 5.90 3.00 8.00 1.00 8.00 2.00 1.00 4.00 2.00 2.00 1.00 77.05Resource Gap -0.40 -0.22 -0.30 -0.35 -1.53 -1.53 -7.59 -5.98 -7.29 -1.48 0.02 -0.05 -1.75 -2.48 -0.11 -0.90 -0.30 -0.30 -0.08 -32.59


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NWIS Programme Resource Requirements 2012-2013Resource Type IM&T Prog/Proj Management IM&T Imp Development Team Testing Server Team Network Team Helpdesk (local) Senior Manager IT Info Dept IM&T TotalResource Role - WTE Prog Proj PSO BCM Imp Man Train Dev Support SIT/OAT UAT Man Team Team Team SupportNadex 0.05 0.25 1.75 0.10 0.10 0.10

Encryption 0.05 0.10 0.10 0.10 0.03

Radis2 0.05 0.10 0.25 0.10 0.10

PACS Integration 0.05 0.10 0.10 0.05

WCCG 0.10 0.40 0.20 0.20 0.10 0.50 0.10 0.10

Hospital E-Referrals Local Ph1 0.10 0.40 0.20 0.20 0.20 0.05 0.20 0.50 0.50 0.10 0.10 0.10

WCP Implementation 0.40 2.00 0.40 1.00 0.20 0.10 2.00 0.50 0.50 0.50 0.05 0.20 0.10 0.10 0.20 0.10To include:WCP - Results Reporting + Core

WCP Pathology Test Req 0.10

WCP Radiology Requesting

WCP MTED 0.20 2.50 0.10

WCP Hospital E-Referrals Phase 2 3.00

EMPI 0.10 0.40 0.10 0.10 0.10 0.75 0.50 0.20 0.20 0.20 0.10 0.10 0.10 0.10

LIMS 0.10 0.25 0.20

CHIRP 0.05 0.10 0.10

My Health Online 0.05

GP Test Requesting 0.10 0.10 0.10

All-Wales PACS & RMS

Total Resource Required 1.20 3.30 1.10 1.20 0.60 0.45 2.40 7.10 2.00 0.70 0.70 0.50 2.60 0.40 0.70 1.08 0.40 26.43NWIS Funded 1.00 2.00 1.00 0.50 1.00 0.50 0.50 6.50UHB Resourced 0.50 0.60 0.45 2.40 7.00 2.00 0.20 0.20 0.50 2.60 0.40 0.70 1.08 0.40 19.03Resource Gap 0.20 1.30 0.10 0.20 0.00 0.00 0.00 0.00 -0.90 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.90

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