cheshire pioneer idcr project benefits realisation … · nhs vale royal ccg (vrccg) nhs eastern...

Cheshire Pioneer IDCR Project

Benefits Realisation Manager

Cheshire Pioneer IDCR

ToR Project & Benefits Manager v0.1

Contents

1 Introduction ........................................................................................................... 3

1.1 Purpose of this document ............................................................................... 3

2 Project Overview ................................................................................................... 3

1.1. Project Scope ................................................................................................. 3

1.2. Project Aim ..................................................................................................... 4

1.1. Geography ..................................................................................................... 4

1.2. The Partner Organisations ............................................................................. 4

1.3. The solution ................................................................................................... 4

3 Project Manager .................................................... Error! Bookmark not defined.

4 Benefits Manager .................................................................................................. 6

5 Terms .................................................................................................................... 3

6 Workstream Overviews ......................................................................................... 6

1.4. Technical Workstream ................................................................................... 6

1.4.1. Workstream Technical Products: 8

1.4.2. Workstream Membership 8

1.5. Benefits Workstream ...................................... Error! Bookmark not defined.

1.5.1. The Expected Benefits 9

1.5.2. Summary of Financial Benefits 9

1.5.3. Next Steps to identify benefits 10

1.5.4. Workstream Products: 11


1.6. Pilot Workstream ............................................ Error! Bookmark not defined.

1.6.1. Workstream Products: 13




1 Introduction

[email protected]

2 Project Overview

2.1 Project Scope

The Project scope is to provide an integrated digital care record (IDCR), which will provide a view of summary patient data that is read only and cannot be amended or added to by the users.

It will be for use by health and social care professionals to support direct patient care only.

The solution can be extended to include write functionality, mobile devices and patient access, but these options are outside of the scope of this Programme of work.

This document outlines the project and the core role and responsibilities of a Benefits Realisation Manager who is required to support the Cheshire Pioneer Integrated Digital Care Record (IDCR) project.

Terms The role will be for six months initially from May to Oct 2015 and will require between 2 to 5 days a week, with an expected average of 3 days a week worked over the period. Time will be paid in half or full day allocations and should be backed up with supporting timesheets including a high level description of the activities undertaken each day.

NHS Eastern Cheshire CCG will host the candidate and will need to be billed monthly in arrears.

Interested parties are asked to respond by 11th May 2015 and provide:

candidate CV

a description of how candidate skills meet the requirements of the role and project – max 1 page

daily rate

total proposal cost

Agencies are welcomed to submit details on behalf of candidates

Further information can be gained from and submission of details are to be sent to:

Marie Ward Transformation Project Manager NHS Eastern Cheshire Clinical Commissioning Group 01625 663485 07780 222 681 [email protected]

mailto:[email protected]

mailto:[email protected]



2.2 Project Aim

The project aim is to deliver a Cheshire IDCR for use by all health and social care organisations within the Cheshire Pioneer geographic area, to support effective decision making in relation to the delivery of high quality, safe, effective and efficient care and produces real benefits for clinical and social workflows and service design.

2.3 Geography

The Cheshire Pioneer geography covers both Cheshire East and Cheshire West Unitary authorities, serving a population of 750,000.

Within this geography there are four Clinical Commissioning Groups (CCG) who combined have 90 practices, and a number of provider organisations exist, who together provide a comprehensive range of acute, community and mental health services.

2.4 The Partner Organisations

The following organisations are participating in the Project:

Councils

Cheshire East Council (CEC)

Cheshire West & Chester Council (CWaC) Clinical Commissioning Groups

NHS South Cheshire CCG (SCCCG)

NHS Vale Royal CCG (VRCCG)

NHS Eastern Cheshire CCG (ECCCG)

NHS West Cheshire CCG (WCCCG) Provider

Mid Cheshire Hospitals NHS FT (MCHT)

East Cheshire NHS Trust (ECT)

The Christie NHS FT (CFT)

Clatterbridge Cancer Centre NHS T (CCCT)

Cheshire & Wirral Partnership NHS FT (CWP)

Countess of Chester NHS FT (CoCH) This Programme is endorsed by the Cheshire Pioneer Panel who have given assurances that they will oversee the provision of the funding for the project. In addition a successful bid was submitted to the NHS England Integrated Digital Care Fund (IDCR) (Tech Fund 2) to secure a proportion of the funding (£1.07m) required.

An approved business case is the first milestone required for monitoring purposes from NHS England.

2.5 The solution

The Project is to develop an IDCR incorporating data from all of the above partner organisations and linking to the existing West Cheshire Care Record, which already includes data from the following organisations:



Primary Care (37 GP Practices)

Acute Care (Countess of Chester Hospital NHS FT)

Mental Health (Cheshire and Cheshire Partnership NHS FT)

Community (Cheshire and Wirral Partnership NHS FT)

Social Care (Cheshire West and Cheshire Council)

Tertiary (Clatterbridge Cancer Centre NHS FT).

The IDCR will include:

Primary Care summary record;

Medications, diagnostic results and reports;

Procedure details for the acute Trusts;

Key contacts, allergies/alerts;

Clinical correspondence, summaries and assessments;

Appointment/event details (IP/OP/A&E);

Cancer summary and Mental health summary;

Summary social care records and details of care plans and service providers;

Community appointments and details of care plans and services provided.

The Cheshire organisations to be included and the sharing of data is shown below:



3 Benefits Realisation Manager

A Benefits Realisation Manager (BRM) will be required to oversee the delivery of the benefits work stream for the project as a whole across all partner organisations as identified in the workstream description below.

The BRM will be required to identify and quantify benefits across the IDCR Project and set up the mechanism to provide on-going benefits tracking. It is a requirement of the NHS England funding provision that a return of investment in excess of 1:1.5 is achieved and the BRM will lead in identifying how this can be achieved.

The BRM will report to the Programme Manager.

Specific responsibilities will include:

Ensuring that the Programme hits its overall target of a return on investment of 1:1.73 by identifying sufficient quantifiable benefits across all participating organisations

Reviewing the Statement of Planned Benefits derived from the West Cheshire Care Record Project and verifying these benefits

Identifying additional benefit areas through consultation with clinicians and service managers

Undertaking process reviews to identify areas where processes can be streamlined to save staff time and improve patient pathways

Categorising benefits as cash releasing, cash avoidance or qualitative

Working with Finance colleagues to calculate cash values for benefits wherever possible

Undertaking audits to establish a baseline position for all benefits identified

Identifying likely pilot areas in conjunction with the Programme Manager, that will maximise early benefits return

Reporting to the Programme Manager on benefits by completing the standard benefits tracking templates.

Skills required

Ideally the role would be undertaken by someone with good knowledge of the operational, clinical processes of an acute and community health provider, who knows typical patient pathways, such that they will be able to see where potential benefits arise, have good contacts within those areas and have sufficient authority to influence participating users to undertake audits etc. to quantify benefits.

A track record in benefits realisation in the NHS would be helpful, but not essential.

4 Workstream Overviews

4.1 Technical Workstream

The IDCR Project Manager will be responsible for the delivery of the Technical Workstream described below for Eastern Cheshire (EC)

This worksteam is responsible for the overall Project objective 1:



Objective 1: Cheshire IDCR record established and tested with secure read only, summary health social care data, presented and viewable in a useful format by September 30th 2015.

This workstream will identify the data items that can technically be provided from each source system for inclusion within the integrated record within the limitations of the timeframe of this Project e.g. delivery by September 30th 2015. It will determine the messaging format and standards for the agreed data items e.g. HL7 message, PDF output etc.

The Eastern Cheshire (EC) Technical Workstream will be developed by the Project Manager for their own data feeds. The Project Manager will provide their own PID describing the technical data feeds they propose to provide, the resources required and providing a detailed project plan for delivery. The timeline for each data feed will differ depending in the technical complexity of the data feed and to allow for staggered delivery of Graphnet’s contribution to create the Hub view of each data set within CareCentric.

Each Technical Workstream will deliver against the following more specific workstream objectives identified by the Project:

Objective 1: Identify the clinical requirements for the data items to be shared

by May 30th 2015.

Workshops will be help with clinical groups to demo the existing views within CareCentric and review:

Is the existing data useful?

Is it viewed appropriately?

Are additional data items and views required?

Objective 2: Develop the technical interfaces required by July 3 2015 for release 1 and 31 Sept 2015 for release 2.

The workstream will provide technical liaison between the participating organisations source system providers and Graphnet to enable the selected supplier can achieve the following:

Agree the data items to be shared and their format

Agree the extent that historic data will be provided

Provide the required data extracts

Transport the data extracts over N3 to the hosted environment with the CoCH

Test that the data sent and data received match and that the data is presented in a meaningful way to aid clinical decision making.

Objective 3: Provide embedded access to the CareCentric solution from each partner organisations source clinical system by 3 July 2015.

Graphnet will provide a specification for embedding the solution into core systems.

Embedding functionality already exists within EMIS, InPS, CareNotes, Silverlink and LiquidLogic. Development work will be required to achieve this for CSC iPM for East Cheshire Hospital and for System C or the Christie’s inhouse clinical system for cancer.



Embedded access will enable users to click on an icon from within a patient record within their source system, which will take them directly to the corresponding patient within CareCentric. This ensures that a legitimate relationship is achieved and prevents users from accessing patients inappropriately.

Objective 4: Test the availability of the total solution, including the data feeds, the transport mechanism, the data views and the embedded access to the solution by September 30th 2015.

The following testing phases will be adhered to:

Test the message content – each participating organisation

Test the message transfer mechanism – each participating organisation

Test the presentational views – each participating organisation

Test availability via the embedded icon– each participating organisation

End to end testing, including sampling of an agreed percentage of records – each participating organisation

Volumetrics testing – Graphnet

Penetration testing – CoCH.

Workstream Technical Products:

Technical specification for each data extract provided by source system suppliers including:

o data fields o demographics o parameters for inclusion e.g. all records, current episodes o what sent in each upload e.g. just amendments, full data replacement.

Technical specification of each of the Hub Views within CareCentric provided by Graphnet

Specification for embedding into core clinical desktop views– Graphnet

Schematic diagram of the message transfer mechanisms into the CoCH hosted environment

Testing plan

Test scrips

Record of testing undertaken

Issues log

Testing acceptance sign off.

Workstream Membership

Project Manager: To coordinate the input from all other members of the workstream and manage dependencies to ensure delivery to time.

Data feed Manager for each organisation: IM&T staff from the participating organisations who have knowledge about the technical interfaces already in place between systems within their organisation and relationships with their source system providers, such that they can facilitate the data extracts required and manage the liaison between suppliers to deliver the technical solution.

Supplier representation for each source system: a single point of contact from each impacted supplier to coordinate the technical development required and interface with their partner organisation.



Graphnet Technical Manager: To lead and coordinate the creation of the technical data feeds from Graphnet’s perspective.

4.2 Benefits Workstream

The BRM will be responsible for the delivery of the Benefits Workstream described below.

This workstream is responsible for the delivery of benefits as identified within the overall Project Objective 5:

Objective 5: Deliver a return on investment of 1.73 (Benefits of £5.3m over 4 years) as committed within the Tech Fund bid

The West Cheshire Care Record Project has already developed a Benefits Framework to govern the way in which benefits are identified, quantified and monitored. This adheres to the Memorandum of Understanding requirements of IDCF Tech Fund 2. The Cheshire Project will reuse this so that benefits are identified, monitored and reported in a consistent manner to NHS England.

The workstream will be responsible for:

Identifying the quantifiable financial benefits that the Project will deliver.

Identifying the clinical/societal benefits that the Project will deliver.

Determining the expected profiling of when benefits will accrue.

Establishing baseline calculations and measurement mechanisms for benefits.

The Expected Benefits Benefits will initially be considered for each Partner organisation in isolation and where feasible captured in accordance with NHS England’s categorisation as follows:

Staff efficiency savings (non- cash releasing) but enable more time to be spent on direct patient care.

Cash releasing benefits e.g. reduction in drug spend.

Societal benefits e.g. improved patient experience.

Once the benefits are better understood from an individual organisational perspective, further work will be done to consider the cross boundary impact of the IDCR.

Summary of Financial Benefits The quantification of benefits has been achieved by taking the benefits identification and baseline auditing undertaken within the West Cheshire Care Record Project and doubling them to reflect the size of the population of East Cheshire. This approach assures that the quantification of benefits is evidence based.

The details behind the calculation of the benefits that have been quantified for West Cheshire in the Statement of Planned Benefits.

The Project committed to NHS England that it would deliver circa £1.55m of benefits per annum. This equates to circa £222k per organisation per annum.

Benefits Realisation 2015/16 2016/17 2017/18 2018/19 Total



6 mths 12 mths 12 mths 12 mths

Acute

A&E nursing time efficiencies (10 hours per 24 hours = 1 hour x 10 nurses on EAU = 1.3 WTE at Band 5) 29,738 59,477 59,477 59,477 208,168

Bed days (discharge over 80s 3 hours earlier) 322,289 644,579 644,579 644,579 2,256,025

Additional Clinical Activity Costs 0

Failed to attend (day surgery) 0

Total Acute Care (CoCH) 352,028 704,055 704,055 704,055 2,464,193

Social Care (WCaC) 130,491 260,982 260,982 260,982 913,437

Primary Care - practice staff time saved 79,853 159,707 159,707 159,707 558,973

Mental Health and Community (CWP) 0

Ward nursing time efficiencies (4 hours a day = 1 hour x 4 nurses in 4 wards = 0.52 WTE at Band 5) 11,895 23,790 23,790 23,790 83,265

Bed days (discharge x 1 day earlier) 80,220 160,440 160,440 160,440 561,540

Community staff productivity savings (band 6 clinicians 30 minutes per day) 46,641 178,145 244,680 236,406 705,872

Total CWP 138,756 362,375 428,910 420,636 1,350,677

Total 701,128 1,487,118 1,553,654 1,545,380 5,287,279

Productivity 298,619 682,100 748,635 740,361 2,469,714

Cost savings 402,509 805,019 805,019 805,019 2,817,565

Total 701,128 1,487,118 1,553,654 1,545,380 5,287,279

Next Steps to identify benefits A significant amount of work is required to more accurately quantify the benefits identified to date and to find additional benefit areas as the Project progresses. To achieve this the following approach is proposed:



Operational use of the IDCR record should be contingent on the delivery of stated quantified benefits by each partner organisation before they are given access to the IDCR.

Roll out of the IDCR should target quantifiable, high value benefit areas first, to act as early adopters to trail the solution. Further quantification of the stated benefits should be done within the first few weeks of roll out to validate the stated benefits for the area.

This list is not exhaustive and is expected to be extended during Stage 1 of the benefits process.

To achieve this, the following more specific workstream objectives have been identified:

Objective 1: Identify the quantifiable financial benefits that the Project will deliver by 5 June 2015

These benefits should be subdivided in to cash releasing and non-cash releasing benefits. Whilst the Project anticipates making efficiency savings for staff it does not anticipate that these will be cash releasing. However it should improve the ratio of time that clinical staff spend providing patient care versus carrying out administrative tasks searching for and accessing records held by other organisations.

Objective 2: Identify the clinical benefits that the Project will deliver by 5 June 2015

Work should be undertaken to ascertain the clinical benefits of better sharing of integrated health and social records across Cheshire. This is probably best done by analysing a number of scenarios and determining the shortcomings that occur now and the gains that can be derived from improved and extended access to more timely data.

Objective 3: Determine the expected profiling of when benefits will accrue by 5 June 2015.

The expected delivery of benefits will be profiled across the four year term of the Project and will be expected to increase as the IDCR is used by more staff over time.

Objective 4: Establish baseline calculations and measurement mechanisms for benefits by 3 July 2015

It is anticipated that NHS England will want thorough reporting on the achievement of benefits that is evidence based and shows the baseline position, what has changed and what outcome this has led to.

4.2.1 Workstream Products:

Benefits Framework

Planned Statement of Benefits

Template to identify benefits

Template to baseline benefits

Template to quantify benefits.

Workstream Membership Each member of the team should be prepared to provide their time to undertake tasks to support the delivery of the workstream and act as the main liaison point to gather input from other staff within their organisation as needed to assist the Project.



Membership should comprise clinical staff who can provide real life examples of the frustrations of not effectively sharing health and social care records currently and the potential benefits to them of greater sharing in the future.

Members would ideally have some experience in working to define benefits on previous, ideally related projects, such as Electronic Patient Records or Electronic Document Management System projects or other initiatives to share care records.

4.3 Pilot Workstream

This workstream is responsible for the delivery of benefits as identified within the overall Project Objective 3:

Objective 3: Complete pilots in primary, acute, social, community and tertiary care to demonstrate the usability of the solution and deliver benefits to clinicians by December 31st 2015.

The pilot exercise should trial the viability of the system and measure:

Does the Cheshire Pioneer IDCR technical solution work as it is supposed to? Whilst user acceptance testing will have been completed on the solution, the pilots will provide the first opportunity to trial live operation of the solution and ensure that the functionality promised has been delivered.

Is the training sufficient? The pilot will provide an opportunity to test out the training for the solution, gauge how easy it is for end users to grasp and make amendments to make it more tailored and user friendly as required.

Are the processes in place to support operational use? The pilot will also test out the operational procedures for use both at the front end for users and to administer and support the system.

Is the Cheshire Pioneer IDCR being used effectively? The pilot will test out and review when users refer to the system, what data they are viewing and how useful it is.

Are the correct data items/documents being shared? Staff involved in the pilot will be asked to consider if the correct data items are being shared and make suggestions for new data to be added and data to be removed.

Does the consent model work? The pilot will provide the opportunity to consider the viability of seeking patient’s consent, how time consuming is it, do patients understand what is being asked and do they generally give consent.

Are the correct User Roles set up with access to appropriate documents? The roles can be reviewed and additional roles added if different access levels are needed.

Is the quantification of the benefits accurate?



The Benefits Work stream should baseline the benefits expected within the pilot area in advance of the pilot. The pilot should then verify the quantification of the benefits by assessing the extent that the time savings identified are being achieved. Mechanisms should be put in place to measure the benefits during the pilot, for example by repeating the audit undertaken to baseline the benefits, so that there is an exact before and after measure.

Pilots should run for a minimum of two weeks and should be preceded with baseline auditing of anticipated benefits. The benefits should be proven during piloting and a report written up to indicate the full extent of the benefits committed within the area and providing feedback of the success of the system, improvements required etc.

Workstream Products:

Pilot Plans

Pilot Outcomes Report

Workstream Membership The Project Manager within EC will be responsible for arranging their own pilots, supported by their Cheshire Pioneer IDCR Trainer and System Manager. A lead clinician should be identified to champion the Care Record and ensure staff use it.

cheshire pioneer idcr project benefits realisation … · nhs vale royal ccg (vrccg) nhs eastern...

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