Laurence Sutton What is NPfIT NPfIT is an organisation set up to implement projects vital to the NHS...

Laurence Sutton

What is NPfIT

• NPfIT is an organisation set up to implement projects vital to the NHS modernisation programme. It currently focuses on the four key developments which will make a significant difference to patients:

– integrated care record service

– electronic booking

– electronic transfer of prescriptions

– infrastructure

DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments!

Laurence Sutton

Aim

To deliver a 21st century health service throughthe efficient use of information technology

• To improve the quality and convenience of care by ensuring that those who receive care have the right information, at the right time

• To implement projects vital to the NHS modernisation programme using IT to directly improve the patient experience and clinical care

Laurence Sutton

Procurement

• NPfIT is one of the largest single IT procurement programmes in the world

• The National Programme aims to conduct procurement: – rapidly, with solutions that are responsive to

business needs – to provide value for money– to optimise the cost of participation in the

procurement by suppliers– following the process outlined in the Procurement

Approach document http:/www.doh.gov.uk/ipu/programme/ issued in January 2003

Laurence Sutton

• ICRS will facilitate the sharing of electronic patient records to provide clinical support across all care settings:

– providing a national set of standards and a national repository of information (NHS Spine)

– aiding delivery of patient-centred care

– facilitating the sharing of electronic patient records

– aiding clinical support


ICRS.

Laurence Sutton

BACKGROUND TO NPfIT AND ICRS

• ‘Information for Health’ document published in September 1988. A National Strategy for local Implementation.

• ‘Building the Information Core: Implementing the NHS Plan’ published in January 2001

• ‘Delivering 21st Century IT, Support for the NHS’ published June 2002

• NPfIT start October 2002

• National Service Frameworks. (Cancer, Heart disease).

• Modernisation Agency; Improving Radiology Services.


Laurence Sutton

• The Plan (PID)

• E-Booking functional December 2005

• ETP 50% national implementation December 2004 – 100% December 2007

• ICRS phase 1 December 2004 – phase 2 December 2006

• PACS 1/3 roll out by December 2004 – completed December 2006

• Infrastructure full connectivity March 2005


Laurence Sutton

INTEGRATED CARE RECORD SYSTEM

ICRS

PACS EPR RAD REPORTS

THE NATIONAL PACS PROGRAMME IS AN INTEGRAL

PART OF ICRS

Laurence Sutton

• Procurement levels.

– National infrastructure, N3, (NISPs).– Enabling continuity of NHSNet after the end of 2003

– National applications, (NASPs).– Data spine for the integrated care record service– The national electronic booking service

– Picture archiving and communications systems???

– Electronic transfer of prescriptions

– Local service providers. (LSPs).– Provide IT systems and services, in the five geographic clusters

dividing England – Ensure that the national applications can be delivered locally– Ensure that both national standards and local business needs are met


Laurence Sutton

National Infrastructure Service Provider (NISP)

• Will be contracted to deliver the new range of broadband connections for the NHS (known as N3) that will underpin the National Programme for IT:

– enabling continuity of NHSNet after the end of 2003

– meeting the NHS future increased bandwidth requirements

Laurence Sutton

National Application Service Providers (NASPs)

• Deliver nationwide applications such as:

– data spine for the Integrated Care Record Service

– the national Electronic Booking service

– Picture Archiving and Communications Systems ?????

– Electronic Transfer of Prescriptions

Laurence Sutton

Local Service Providers (LSPs)

• Provide IT systems and services, in the five geographic clusters dividing England

• Ensure that the national applications can be delivered locally

• Ensure that both national standards and local business needs are met

Laurence Sutton

The Five NPfIT Clusters (NPfIT’s geographic grouping of Strategic Health Authorities in England)

Laurence Sutton

DELIVERING PACS TO YOUR HOSPITALThe 5 Clusters.

Laurence Sutton

• An Evolving Process!

NPfIT Operational Management Team.NCAB To NPfIT.(PACS subgroup)

Modernisation Agency.NPfIT-PACS Board.

PACS NCAB.(RCR PACS SIG)Regional Clusters (5)

Local Service Providers (5)SHA (28)TRUSTS

Diagnostic Imaging Departments.PACS Project Teams.

YOU


The Organisations and Supporting Bodies.

TURMOIL

Laurence Sutton

• NPfIT Operational Management Team.

• STRATEGIC AND HIGH LEVEL OPERATIONAL FUNCTIONS.FUNDING.• PROCUREMENT

• NPfIT is an organisation set up to implement projects vital to the NHS modernisation programme. It currently focuses on the four key developments which will make a significant difference to patients:– integrated care record service– electronic booking– electronic transfer of prescriptions– infrastructure


Organisational Roles.

Laurence Sutton

• STRATEGIC AND HIGH LEVEL OPERATIONAL FUNCTIONS.

•Accredited Products.•2 Case Model Managerial, Financial

and Managerial.•Financial and OBC Templates.•No need for OJEC


Laurence Sutton

• NPfIT Operational Management Team.

• STRATEGIC AND HIGH LEVEL OPERATIONAL FUNCTIONS

• Streamlining of previously bureaucratic processes

• Integration of systems with scalability

• Identify additional resources.



NATIONAL CLINICAL ADVISORY BOARDTO NPfIT

PACS SUBGROUP(inc MA)

BENEFITS REALISATION

Laurence Sutton

Procurement

• The National Programme is following a structured procurement process to select preferred suppliers, which includes:

– issuing an advertisement in Official Journal of European Community (OJEC)

– developing and issuing the Output Based Specification (OBS)

– evaluating the response from the suppliers

– negotiating contractual arrangements with suppliers

Laurence Sutton

THE 5 CASE MODEL

•Strategic case – why is the procurement needed, what is the organisational context

•Economic case – the value for money arguments and evidence

•Financial case – can it be afforded?

•Commercial case – the contract and the procurement process

•Management case – delivering the project and its solution

Laurence Sutton

• NPfIT- PACS Board.

• OBS and PACS Specification.• Accreditation of PACS Products (Vendors).• Financial planning\Frameworks.• Test the robustness of proposed PACS

implementations against the National standard.

• Support PACS Implementations through Regional PACS Facilitators. (Business Case Planning)



Supported and Advised by the PACSClinical Advisory Board

RCR PACS and Tele-radiology SIG

Laurence Sutton

• REGIONAL CLUSTERS.TEAM

• Regional Implementation Director

• Regional PACS Facilitator

• Regional Clinical Lead for PACS.

• Will?



Ensure Implementation is consistent with the National Plan.Develop a cluster wide strategy for RIMS.

Co-ordinate the various SHA Business Cases. Prioritise these against other elements of ICRS

and the broader elements of the National Programme.Co-ordinate Funding.

Formulate\Negotiate\Award CONTRACT with the LSP.

Laurence Sutton

• Strategic Health Authority

• CIO

• NPfIT Implementation Director

• Clinical PACS Lead

• PACS Project Manager.

• Will?



Evaluate Implementation Plans for Health Care Economy.Collate Trust business Cases for RIMS.

Work with the RID to secure support and Funding.Implement and Manage Education and Change Management Programmes.

Eventually co-ordinate Community Wide PACS

Laurence Sutton

• The Trust• Chief executive

• Director of ICT• Director of Finance.

• Director of Diagnostic Imaging.

• Clinical PACS Lead

• PACS Project Manager.

• Will?



Form a Project Board TeamWork with the SHA PACS Team

And Regional Facilitator\Clinical LeadDevelop a HOSPITAL WIDE RIMS

Produce an Education ProgrammeAnd

Manage Change.

Laurence Sutton

THE LOCAL SERVICE PROVIDER

• Provide IT systems and services, in the five geographic clusters dividing England

• Ensure that the national applications can be

delivered locally

• Ensure that both national standards and local business needs are met



Laurence Sutton

• Ideal implementation would be a cluster wide, Large Health Economy.

• More realistically, SHA HE Wide. • ? Time scales.• Dependencies on other ICRS products• Geographical Scales, Big PACS depends on N3.• National View to balance the economies of scale

with the available funding streams AND:• The degree of Readiness of trusts, organisations to

assimilate new technology.ie to manage change.• Therefore expect relatively small incremental

changes not Tidal Waves!


THE LSP AND NATIONAL PERSPECTIVE

PACS 1/3 roll out by December 2004 – completed December 2006

Laurence Sutton


Procurement and Implementation

NATIONAL PROGRAMME

RID

SHATRUSTS LSP

Strategic PlanningContracts\funding

SERVICE DELIVERY

PROCUREMENT

LOCAL DELIVERY

ServiceRedesign

MA

TURMOIL

Laurence Sutton

• A National Framework for Service Improvement.

• Restructured Clinically Led Patient Focused Services.

• Workflow and Capacity Planning.

• Agenda for change and the four tier structure.

• Role of PACS, Radiology Management Systems to facilitate the above.

• Benefits Realisation.


Modernisation Agency.

Laurence Sutton

Products in the ICRS (Contract)

CORE

ADDITIONAL (PACS)

FUTURE

RING-FENCED FUNDING.

NOTHING TO DO WITH PRIORITY.


Laurence Sutton

Products in the ICRS, PACS.Contracting Issues.

• Core services. Programme can make firm orders for fixed prices.

• Additional. Programme requires a firm price. Programme reserves the right to place an order.

• Firm price means that some elements are fixed. Other prices are according to a rates schedule.

• For PACS, pricing schedules are being developed along with discussions around How PACS services will be delivered and the Nature of the contracts between the Vendors, the LSPs and the Programme.

• Sensitive Negotiations ongoing.


Laurence Sutton

What is in.

CRRADIOLOGY WORKSTATIONS.

STORAGE SYSTEMS

What is NOT

DR (Why Not)PC\Monitors Outside Radiology

LANEducation, Training.


The PACS Product.

Laurence Sutton

1) THE TRUST WILL FILL THE GAPWITH THEREFORE

CAPITALREVENUE CONSEQUENCES.

2) I.T. WILL CONTINUE TO PROVIDE AND MANAGE THE NETWORK AND PERIPHERALS.

3) CASH RELEASING BENEFITS(net of the above)WILL(?) GO BACK INTO THE NATIONAL PROGRAMME OR

THE TRUST?4)?CAPITAL CHARGES.

5) AFFORDABILTY GAP TO FUND.6) RIS IS NOT A HIGH PRIORITY PRODUCT IN THE ICRS

7) LSPs WILL PROVIDE SERVICES.


The PACS Product

Laurence Sutton

• Integrated Clinical Record Service. THE ICRS. Which includes RIS and PACS.

• STANDARDISATION of Clinical Systems.

• SCALABLE SYSTEMS


WHAT ARE WE SETTING OUTTO ACHIEVE?

Laurence Sutton


WHAT DOES THIS MEAN FORTHE LSP?

• Declare their modus operandi to achieve standardisation.

• Time Scales. (100% by 2006)

• Establish how they interact with the Clinical Community. Clinical Leadership.

• How will they Manage Change?

Laurence Sutton




• Two Routes • 1)

• Interface and customise (Eventually Integrate)• Fix up systems across the cluster• Some eventual convergence to the standard• Broad brush evolution with many ‘Legacy’

systems.• Variable Time Scales.• Lots of quick fixes but is this the best route

implementation wise to achieve success?

Evolution by customisationPoor Change Management

? Objectives achieved over theTime scale.

Laurence Sutton




• Two Routes • 2)• Select a group of early Implementers of a given

size of Health Care Economy.• Agree an acceptable implementation approach

(Partnership)• Pro-active approach to integration with a rapid

migration to a common enterprise architecture.• The perfected Exemplar is used to Role out across

the cluster.

Controlled REVOLUTIONBetter Change Management

Achieve Standardisation in an acknowledgedTime Frame

Easy to identify Lessons Learned.Share Best Practice

Role Out proportional to the abilityTo absorb Change

Laurence Sutton


WHAT DOES THIS MEAN FORUS?

• Become very aware of the NPfIT-PACS.• Provide the Clinical Leadership in the CONTEXT of

the ICRS Programme • Understand the Change Management required to

achieve the Standards.• Re-assure colleagues that this is an inclusive

process,bearing in mind that it us that create that environment.

• Try and tame the detractors.• Once in a Life Time Opportunity.

Laurence Sutton

• ORGANISE A PACS PROJECT TEAM.

• DISCOVER WHO YOUR REGIONAL PACS FACILITATOR IS

• HAVE A CLINICAL PACS LEAD IN THE TRUST.

• ENSURE THAT THERE IS AN SHA CLINICAL LEAD FOR PACS

• REMEMBER THAT THIS IS NOT JUST AN IT PROJECT!!


WHAT YOU NEED TO DO!

Laurence Sutton

• EMBRACE THE OPPORTUNITIES.

• GET WELL INVOLVED

• MAKE THE ORGANISATIONAL CHANGES

• SUCCESS NOW SUBSTANTIALLY DEPENDS ON YOU!

• ASK

• INVOLVE EVERYBODY.


WHAT YOU NEED TO DO!

Laurence Sutton

WHAT IS THE ROLE OF THECLINICAL LEAD FOR PACS?

• Make sense of the National Programme and the Cluster Strategy.

• Balance the processes of Procurement with the Needs of the Implementation Processes

• Work with the SHA and Trusts to engage in an implementation strategy.

• Seek the best possible solutions through the RID (Prioritisation)

• Ensure that all stakeholders are involved at all times.

• Feed back to the NCABs on issues on Implementation.

• Shape the PACS Implementation for the whole community.

• Involve all enthusiasts and Prime Movers.

Remove the Turmoil in the MindsOf the

Implementers

Laurence Sutton

PACS SYMPOSIUM.CALDERDALE ROYAL HOSPITAL.

SUCCESS IS A JOURNEY AND NOT A DESTINATION.

THANKYOU.

Everyone thinks of changing the world,but no oneThinks of changing himself.

Tolstoy

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Laurence Sutton What is NPfIT NPfIT is an organisation set up to implement projects vital to the NHS...

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