ict business plan 2015- · pdf fileict business plan 2015-2017 ... plan recognises that ict...

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ICT BUSINESS PLAN 2015-2017 A two year plan for IM&T in the Southern Health &

Social Care Trust

Performance & Reform January 2016

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INDEX

1.0 Statement of Purpose Page 3

2.0 ICT Governance Arrangements Page 4

3.0 Meeting the Quality Agenda Page 6

4.0 Resources Page 8

5.0 Summary of 2014/15 ICT Delivery Page 9

6.0 Expenditure 2014/15 Page 16

7.0 Regional E-Health Programme Page 17

8.0 Plans for 2015/16 & 2016/17 Page 19

9.0 Conclusion Page 36

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1.0 STATEMENT OF PURPOSE

The Southern Health and Social Care Trust employs over 13,000 staff, providing

services for more than 350,000 people across its region, as well as to the whole

of Northern Ireland.

The purpose and vision of the Southern Trust is to deliver safe, high quality health

and social care in a way that respects the needs, individuality and dignity of the

people who use its services. This purpose and vision is underpinned by the

following strategic priorities:

A. To provide safe, high quality care;

B. To maximise independence and choice;

C. To improve health and well-being;

D. To be a great place to work;

E. To make best use of its resources; and

F. To be a good social partner.

ICT plays a pivotal part in achieving these objectives by enabling growth, success

and delivery of service developments through robust technology provision. This

plan recognises that ICT could be used extensively to enable, support and

sustain change and drive efficiency. In this context, it will also help support a

culture of openness, transparency and comparability of information. The Trust is

committed to harnessing information and new technologies to achieve higher

quality care and improve outcomes for patients and service users. Informatics

objectives are as follows:

i. Provide and add value to the Trust business in a strategic and planned way;

ii. Make a real contribution to achieving the Trust objectives above;

iii. Deliver what we say, when we say we will and deliver it right first time; and

iv. Ensure services delivered are value for money.

v. Have secure, timely, resilient and accurate information at the point of care.

These objectives will be monitored through the following performance measures:

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Financial stability – providing services within budget;

Customer satisfaction;

Monthly monitoring of key performance indicators;

Project plans delivered on time and in budget;

Benchmarking performance with other Trusts; and

Well trained, competent and valued staff.

The purpose of this Business Plan is to identify the IT priorities for investment and

delivery in the financial years 2015/16 and 2016/17 and to agree and

communicate these with key stakeholders including Trust staff, HSC Board, BSO

and 3rd party suppliers This plan has therefore been developed in response to

local E-Health & Care Strategies and is aligned to the Trust TDP.

2.0 ICT GOVERNANCE ARRANGEMENTS

The Trust has established a Technology Enabled Change (TEC) Programme

Board with representation from all project managers who provide a bi-monthly

update on behalf of the SRO of each project. This group makes proposals

relating to ICT investment and these are submitted to SMT for approval in the

form of business cases. The Group reports to the Trust’s Senior Management

Team (SMT) through the Executive Director with responsibility for ICT (Director of

Performance & Reform). The TEC Project Board is responsible for ensuring that

ICT projects are delivered on time and on budget as well as monitoring of joint or

inter-organisational projects such as those Regionally funded. The TEC

Programme Board will assist in ensuring that the ICT Team responds to the

needs of the entire organisation and that investment is objectively prioritised. A

TEC update is provided to:

- Information Governance Forum which reports to Trust Governance Committee

(Quarterly)

- SMT (bi-monthly)

- HSC funded schemes are reported to HSC E-Health Programme Board

(quarterly)

In addition, a monthly Informatics Governance meeting is held to review risk, audit

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and incidents and any issues are escalated to the Performance & Reform risk

register when appropriate.

Figure 2.1 Informatics Governance Framework

2.2 Information Governance Assurance

The Information Governance agenda currently encompasses the following areas;-

Information Governance Best Practice and Management;

Confidentiality and Data Protection;

Information Security;

Secondary uses of information;

Clinical Information assurance; and

Corporate Information assurance such as FOI.

There is a new Controls Assurance Standard in Northern Ireland for Information

Directional & Representational Information Governance: Operational Information Governance:

Information Governance

Forum

AD Informatics

Head of Information Governance & Head of IT

(IT Security Officer)

Director of Performance & Reform (SIRO) &

Medical Director & Director of CYP (Personal Data Guardians)

Chief Executive Data Controller

Regional Information Governance

Advisory Group

Trust Board

t

SMT FORUM

Governance Committee

Records Management Committee & TEC Programme

Board

Data Protection Sub-Group, Informatics Governance Meeting, DQ Steering Group, Clinical Coding forum

HSC ICT Programme Board

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Management which is reported annually and monitored on a quarterly basis.

Substantive compliance against this standard is required. The Southern Trust

achieved this standard in 2014/15 and has an action plan to improve the overall

scores for the future.

Ultimate responsibility for Information Governance within the Trust lies with the

Trust Board. However, table 2.1 illustrates that there are personal Data

Guardians and a Senior Information Risk Officers (SIRO) at Board level. The

SIRO acts as an advocate for Information Risk Management on the Board and

provides written assurance to the Department of Health & Social Services in

Northern Ireland on an annual basis. The SIRO is responsible for developing and

encouraging good information handling practice amongst all members of staff

employed or contracted by the Trust.

In summary, the structure & governance arrangements in place in the Southern

Trust comply with the requirements of relevant Controls Assurance Standards

and Audit recommendations.

3.0 MEETING THE QUALITY AGENDA

The Southern Trust places a strong emphasis on quality improvement. Within the

Informatics Division it is recognised that there is a growing appetite with most

staff to embrace technology and use it to improve their working practice; quality of

care given; or help address some of the challenges that they face. Added to that,

there is paramount importance placed on Data Quality and completeness and

timely recording of information to support service delivery and manage clinical

risk. There is also a growing importance on communication and information

sharing between the Trust and all stakeholders in care, including external

partners in Health & Social Care delivery. The NIECR is an excellent example of

how Regionally, information is being shared safely and securely.

Within the Informatics Division the following objectives for improving and

maintaining quality are paramount:

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Use of PRINCE methodology in project implementation to ensure that project are

delivered on time and within budget;

An emphasis on developing baseline information and benefits methodology so

that the benefits of IT implementation can be clearly identified during post project

evaluations (PPEs) or at the end of pilots to establish the benefits to be gained

from further implementation; and

Improved collaborative working across HSC Northern Ireland and a ‘once for all’

approach to IT solutions for HSCNI.

The Informatics Division in the Southern Trust is also proud to have been winners

of 3 Regional awards in 2014/15. These were for E-Discharge implementation,

PARIS use across an integrated pathway and video conferencing use by Speech

and Language Therapists for patient therapy following stroke.

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4.0 RESOURCES

The Informatics structure in the Southern Trust is as follows:

Table 4.1 Informatics Structure

There is a total of 112 WTE staff employed in the Informatics Division. This

includes permanent, temporary and capitalised postholders. There are no

agency staff employed.

Personal Secretary Assistant Director of Informatics

Head of IT

Server & Infrastructure

Support

IT Service Desk Support

Network & Security Support

IT Contracts Manager

Head of Information Governance

FOI/DPA

Information Governance

Closed Records Storage

Head of Information & Data Quality

Clinical Coding Services

Information Analysis

Data Quality

Head of IM&T Project

Management

Business Case

Implementation

PPE

ICT Traininig

Head of PARIS Implementation

IT Innovation

e.g. PARIS Mobile, NIECR Integration

Reporting Development

PARIS Implementation

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5.0 SUMMARY OF 2014/15 ICT DELIVERY & ACHIEVEMENTS

The table below provides a summary of what was achieved in the last financial

year.

Table 5.1 Summary of ICT Delivery in 2014/15

Infrastructure & Governance

Build new Cisco Infrastructure to improve resilience of network.

Replacement of Core Network in DHH.

Resilient new ether connect link from CAH to DHH.

Installation of Wireless Controllers in Data Centres.

Microsoft Enterprise Agreement for licencing.

Upgrade of Digital Dictation

Latest Anti-Virus Protection and upgrade of firewall as best practice security risk reduction

Monitored and certified destruction processes for old hard drives to government standards.

Replaced all PCs that were more than 4 years old (750 PCs).

Use of Bit Locker and Mobile Device management to secure and control portable devices.

VDI (Virtual Desktop Infrastructure) & iPads.

Medical Devices Business Continuity.

Provision of One View Infrastructure

Replacement of Email Archive

Extension of Storage in Data Centres

Communications

Bedside Entertainment, Mandeville Unit

Rollout of 20 additional VC Units.

Paperless Board (Minute Pad).

Introduction of ‘Skype’ Virtual Patient/Client treatments using Video conferencing.

Voice recognition pilot in Paediatrics.

Roll out of Flow Bed Management electronic whiteboards.

Savience Self Check-In across acute services including language translation.

Wi-Fi in Community Sites (43 sites).

Replacement of Computers on Wheels on wards and additional units to increase ward access to IT.

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Clinical Systems

Cleanliness Audit system Implementation of 2 way PAS on Flow and allow admissions, discharges and transfers to take place by nurses using the whiteboard

Single Sign-On extension and enhancement.

Endoscopy on-line survey. Anaesthetics Electronic Record.

PARIS continued roll out

Bi-Pacs Digital Breast Screening.

E-rostering implementation in 3 wards

PARIS Mobile.

Regional Systems

BSTP. HRPTS. NIECR maximisation

Table 5.1 provides a very high level summary of the Infrastructure and

Governance elements of the ICT Infrastructure in the Southern Trust which were

upgraded or enhanced in 2014/15. It also provides a very high level summary of

the improvements in Digital Communication in the Trust, as well as the Clinical

Systems that were delivered or upgraded.

The table does not in any way reflect the amount of time, money or resources

involved (in collaboration with suppliers), to deliver this. Some examples of the

tangible achievements are as follows:

5.2 Digital Dictation

Digital Dictation is now the methodology of choice for drafting Clinical Letters in

the Trust. In December 2013 there were around 11,000 digital dictations per

month. This has now grown to over 24,000 dictations per month. This system

not only improves the sound quality for the staff typing the letters but it also gives

a clear indication to managers of where there are dictation backlogs and where

resources need to be diverted to ensure timely communication with GPs.

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5.3 NIECR Implementation

In December 2013 the Southern Trust had just over 600 NIECR Users. This has

grown to over 3,000 users who collectively access NIECR over 50,000 times per

month.

5.4 Single Sign On

At the commencement of Single Sign-On in February 2014, there were 400 users

of the system who accessed just over 2,000 times per month. There are now

7,760 users of Single Sign-On and on a monthly basis, 400,000 access to

systems are made per month using SSO, minimising the need to remember

passwords for multiple systems. All information systems are now available using

Single Sign on

5.5 Community Information System

Since December 2013, the number of Paris users has grown from 46 to 1,300,

which is around one third of the total planned. There are 100 PARIS Mobile

users who can access a ‘briefcase’ version of PARIS when they are in Patients or

Clients own homes, or outside a Trust facility. Some services, such as

continence, are now completely paperless and have managed to increase clinic

capacity and share admin resources as a result of this. Some PARIS Mobile

users have indicated that they are saving around 40 miles per week in travel cost

and time since the introduction of PARIS Mobile.

5.6 ICT Training

The small (5 WTE) ICT training team continue to provide training for existing

Information Systems in the Trust such as PAS, ED, Theatre systems, for newly

appointed staff to the Trust. As well as existing system support, the Training

team are also involved in the training for new system implementations such as

the Community Information System (PARIS).

Training is delivered using a variety of learning methods such as drop in

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sessions, classroom training, video clips as well as floor walking to support users

when they first start using the new system in their daily work. In the past 12

months the team have also successfully implemented the NHS skills pathway

solution which is an e-learning solution for the Microsoft suite of products, Word,

Excel, Power Point, Outlook and OneNote. This has been extremely successful

and has resulted in the Southern Trust being the highest user of this product

across the NHS in the UK.

The team continue to investigate innovative training solutions such as short video

clips, virtual classrooms as well as e-learning to support the increasing use of

technology across the Trust and provide the flexibility of learning approaches to

suit the needs of staff. As and when available and required, non-recurrent

funding is used to buy-in additional training sessions, such as basic ICT, to

facilitate HRPTS and BSTP implementation.

The diagram overleaf illustrates the journey of ICT achievements in the Southern

Trust over the past 18 months.

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Figure 5.7 - The Journey of ICT Achievements in SHSCT 2014 & 2015.

Robotics

Touch Screen

Technology (Flow)

Patient Self Check-In

Single Sign-On

VDI (Virtual Desktop

Infrastructure) iPads

NIECR Portal

(Regional)

Digital Dictation &

Voice Recognition

Virtual Clinics using

Video Conference

Paperless Board

Employee Self-Management (Regional

HRPTS, BSTP, E-Rostering)

PARIS Electronic integrated H&CC

record in community based services and

acute mental health.

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5.8 Accomplishment of ‘Technology Enabled Change’ (TEC) 3 Year Strategy

These achievements are tangible outcomes from the objectives of the Trusts ICT

Strategy - Technology Enabled Change, (TEC) which requires renewal in April

2016. In summary, the accomplishments against TEC have been:

More real time data entry and employee self-service into Regional systems such

as HRPTS, BSTP and local systems such as E-Rostering, E-Discharge and

PARIS.

Paperless or Paper Light working, particularly in community based services

through the implementation of PARIS and excellent pilots of scanning paper

document into the electronic records e.g. Home Treatment Crisis Response

Team.

Improved medical and nursing handover through use of the Regional NIECR

Portal and local systems such as Clinical Noting and Flow.

Greater emphasis on information systems providing patient care and supporting

clinical processes, such as the implementation of the Anaesthetics system.

Greater emphasis on integration of systems such as bi-directional PAS on Flow

electronic whiteboards and TMS Interface with the Anaesthetics Electronic

Record. PAS now interfaces to all of our patient information systems as a single

patient demographic record.

An emphasis on information being recorded only once, duplicate entry minimised

and systems accessed securely but more easily – e.g. single sign on.

Alongside this, ensuring that we develop and maintain a sound, robust, resilient,

secure and reliable information systems infrastructure.

Trust-wide engagement to update our ICT Strategy will commence at the beginning of

2016 and the following engagement methodologies will be used:

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Figure 5.8.1 – Planned Engagement Methodology ICT Strategy 2016 – 2019

In addition, learning will be applied through:

Feedback from Specialist Exhibitions;

Engagement at a local and National level with other Trusts; and

Use of the Technology Partnership Agreement expertise and learning.

Planned ICT Strategy

Engagement Workshops

Online Survey /

Suggestions

Existing Forums

1:1 Interviews

Regional Stakeholder

Meetings Patient Access Groups

Staff Groups/

Workforce

Ward / Department

Visits

Walk rounds

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6.0 EXPENDITURE 2014/15

The Trust’s total ICT Expenditure in 2014/15 was as follows:

Table 6.1 – Summary of ICT Expenditure 2014/15

Category Source Expenditure

Capital CRL

Ring-fenced

CIS

£975,981

£5,018,874

£1,683,486

Capital Total £7,678,341

NNR Total £642,326

Salaries £3,376,356

Good &

Services

£626,464

Recurrent Total £4,002,820

Grand Total £12,323,487

6.2 Analysis of 2014/15 Expenditure

Capital

Total capital expenditure increased by £1.2M compared to the previous year. This

was due to £2.6M investment in Microsoft Licencing Agreement to ensure desktop

and data centre licencing compliance for the next 3 years.

Non Recurrent Revenue

NNR investment decreased by £100,000 compared to the previous year.

Recurrent Investment

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Recurrent investment remained relatively static with an increase of £10,000 due to

incremental rises in salaries.

7.0 REGIONAL E-HEALTH PROGRAMME

2015/16 year to date has been an unusual year in the HSCNI ICT Investment arena.

Firstly, availability of capital funding Regionally has been at an all-time low and

allocated funding at the end of December was £2,860,000, with a circa £4,000,000

shortfall compared to requirements (Trust own priorities – excludes Regional priorities

such as Accelerated Access to ICT). There has been increased Regional interest in

ICT in the following context:

7.1 Regional E-Health & Care Strategy

A Regional E-Health & Care Strategy has been drafted and awaits Ministerial

approval. Fundamentally, the main thrust of this strategy is a ‘Once for NI’

approach to ICT implementation. This is a new direction for HSCNI, where up

until now, commissioning of ICT has encouraged local innovation to help reform

services.

This new approach is inevitably resulting in longer decision making timeframes

and has led to limited investment in local priorities year to date. However, it is

recognised and hoped that this approach will lead to efficiencies and reduce the

Trust boundaries which exist in terms of patient and client information sharing.

7.2 Shared Services ICT & Business Intelligence

A scoping study earlier in the year has led to the appointment of Deliotte to

conduct a feasibility study on the potential for shared ICT and Business

Intelligence services, most likely managed by BSO. Again this has placed new

emphasis and interest in ICT investment decisions and all investment in ICT has

required DHSSPS approval, which has led to delays in business case and service

investment approvals.

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7.3 EHCR for HSCNI

Due to the urgent need to replace the HSCNI PAS System, a Regional scoping

study has led to investigation of a potential single Electronic Health & Care

Record for Northern Ireland. A business case is being produced to identify the

preferred option and cost. However, local investment decisions are being

delayed in this context, to avoid any investment being counter strategic.

It is acknowledged by the Trust that these are 3 important factors and

considerations and the Trust continues to engage with DHSSPS, HSCB and BSO

to help inform Regional business cases and scoping studies.

7.4 Tele-Health & Telecare

The Regional Tele-monitoring contract is due to expire and a review of the

service outcomes is underway, alongside a planning workshop which will take

place in January 2016. Tele-health is likely to play a key part in future HSCNI

service delivery in the future.

7.5 CAWT

The CAWT project is already starting to acknowledge the huge part that

technology can play in terms of cross boundary service delivery. It is anticipated

that CAWT initiatives are likely to include ICT investment in the future to share

services and information.

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8.0 PLANS FOR 2015/16 & 2016/17

This section will outline the following:

ICT Procurements undertaken in 2014/15, which are currently being

implemented in 2015/16;

Technical Infrastructure Refresh requirements for 2015-2017 including

costs.

Service Development aspirations in the Trust which are dependent upon

funding availability and also Regional Strategic Direction, as outlined in

Section 7 of this Plan.

Projects which have not progressed, as they have been deemed

Regionally as counter strategic.

Ongoing assessments of best practice technologies which may bring

service improvements in the Southern Trust.

Summary of Funding Gaps.

8.1 ICT Procurements Undertaken in 2014/15 – Implementation Progress

Update

Anaesthetic Record Keeping

This system was procured from OxygenCare in 2014/15. It is the system of

Regional choice and has been in use for some time in the South Eastern Trust.

This system creates an electronic Anaesthetic Record and went live on 20th July

2015 in Theatres 1-8 in Craigavon Area Hospital. The Southern Trust has

enhanced the system through interfacing with the Regional Theatre Management

System (TMS) which means that the Theatres lists are automatically populated.

The Southern Trust has also made a further enhancement through an interface

with PAS to automatically download patient demographics. This fits in with the

Trust Technology Enabled Change Strategy by ensuring that data is entered only

once and minimises duel entry thus saving time and reducing errors.

In addition,, the Trust is making best use of this system and is piloting a Pre-

Operative Assessment Module. Learning from this pilot is being shared

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Regionally. The pilot is testing the proof of concept of patients completing

electronic assessment forms using an iPad device, which means that the

information is available for Anaesthetists, Surgeons and also ward or Day

Surgery staff. The current model for Pre-Operative Assessment is very paper

dependent and there have been occasions where not all of the documentation is

available at the point of care. This system therefore manages this risk.

It is a challenging project implementation as it requires all Theatre staff to move

from papers to electronic processes. However, there has been excellent

leadership within the Theatres and Anaesthetics Department and as a result,

excellent progress has been made. It is expected that roll out will be completed

Trust-wide by 31st March 2016.

Multi-Functional Device (MfD) Retendering

The Trust’s contract for Multi-Functional Devices is now end of life. A re-

procurement was completed in 2015/16 and Konica Minolta have been appointed

as the preferred supplier. A project plan is now being drafted to replace all

existing Multi-Functional Devices with new state of the art functionality. Some of

the enhancements to the new devices include the Trust’s ability to meet ISO

standards for scanning which will enable the Trust’s scanned documents to meet

legal admissibility requirements. All Multi-Functional Devices should be replaced

by 30th June 2016.

Cleanliness Audit System

The Southern Trust participated in a Regional procurement of a Cleanliness Audit

System. Two other Trusts have worked with the Southern Trust to implement this

and the system is now in use.

Single Sign-On

Single Sign-On Functionality continues to be developed. There are now 7,760

active users in the Trust and over 400,000 system accesses per month. Single

Sign-On cards are now being offered as a replacement to staff identity cards.

Proximity readers to allow staff to swipe their Single Sign-On Card to access the

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systems that they are entitled to, are currently in use in two departments in the

Trust. Further roll-out is planned this year.

Implementation of Community Information System

Roll-out continues and there are now 1,300 users. The majority of Mental Health

Services are now working digitally with Support & Recovery services now in

progress. Significant progress also continues within Integrated Care Teams in

the OPPC Directorate. Paris development was required for Child & Family

Functionality which has delayed aggressive roll out in this area, although services

such as CAHMS and Autisim are making excellent use of the system. Some

progress has been made to interface PARIS with NIECR which when complete,

will significantly assist staff in Acute Care and Non-Acute hospitals in facilitating

early discharge through having the right community based information to assist

with discharge decisions and home care packages.

Funding will be required to continue will roll-out of PARIS for a further 3 years.

An optimum bias paper has been submitted to the Department of Health & Social

Services. It is hoped that this bid will be successful and has Commissioner

support.

Capital cost £750,000 per annum for 3 year period

PARIS Mobile Pilot

50 staff are now using PARIS Mobile functionality. A Consultant from the

Beeches Management Centre has been appointed to undertake focus groups

with PARIS Mobile Users to provide baseline information and indications of

benefits from this.

Based on user feedback, development work continues with Civica and their

partner Total Mobile to add more functionality into the PARIS Mobile Solution,

which is a ‘briefcase’ or off-line version of Paris which can be used when staff

don’t have a wifi or 3/4G connection.

Costs for further roll out of Paris Mobile are included in the Regional Accelerated

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Access to IT business case bid.

ECR Maximisation

The Trust continues to encourage use of the NIECR and throughout the PARIS

Implementation, staff are also being given access and advice on NIECR during

their PARIS training session. The Trust now has over 1,800 regular users and

3,000 registered users. The Trust is enthusiastic about developments on the

NIECR including electronic triage of outpatient Referrals and awaits a timeframe

for implementation from the BSO.

Use of iPads

The Trust procured iPads and VDI (Virtual Desktop Infrastructure) to enable staff

to access IT in a more portable way. An iPad survey was issued and 12

recommendations were made on the basis of this. Work continues on iPad

configuration and some examples of improvements are that the email App has

been extended to include 30 days of emails and instructions have also been

issued to iPad users on how to use these devices outside Trust sites. Work is

on-going to enable access to Apps securely on Trust iPads..

PC Replacement

The Trust continues to refresh its PC Estate. Desktop refresh has now been

completed and all PCs and laptops within the Trust are now a maximum of 4

years old. This minimises user hardware problems and ensures that the Trust

can make best use of any new available software as operating systems are up to

date. This is an annual rolling programme. £450,000 funding has been secured

to replace 750 PCs in 2015/16 to ensure that this hardware remains refreshed.

Continued Implementation of Flow & Note in Acute

The Flow Electronic White Boards were fully implemented across the Trust Acute

and Non-Acute Wards in 2014/15. However, further significant development has

been achieved in 2015/16. A Bi-Directional PAS link has been included in Flow

which means that Nursing Staff and Doctors can use the Electronic Touch Screen

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to discharge and transfer patients in real time. In addition, a suite of reports has

now been developed on Flow which better enables Bed Managers to have a

more accurate picture of actual bed availability across the Trust. Like every

significant transformational change where there are a range of multi-disciplinary

shift and bank staff workers, further engagement is on-going to ensure maximum

use of this system.

Electronic Patient Centre Documents to GPs

The Southern Trust is leading a Regional project to make discharge letters and

clinic letters available directly into GP Systems. This has the advantage from the

Trust perspective in that letters do not have to be printed and sorted by

secretarial and audio typist staff. It has the advantage for GPs in that they get an

immediate copy of the letter as soon as it has been typed. This has been a major

transformational change and will reduce letters generated across the HSC by

18,000 per week. A roll-out plan is in draft and will be approved at project board

in January 2016. It is anticipated that all GPs will be able to access their letters

electronically by the end of the financial year.

Pilot of Voice Recognition Software in Acute Paediatrics

Diagnostic teams in Laboratory and Radiology have been using Voice

Recognition Software for some time. However, as diagnostic reports tend to be

relatively short and succinct, there has been less voice training requirement for

the software than in other specialities. The Paediatrics Department volunteered

to lead on a pilot for Voice Recognition and software was procured last year. The

Informatics division has been working with the Paediatrics Department since

then. It has proven to be very time consuming for the Data Dictionaries to be

developed for such detailed and diverse letters and language, however, there is

some success with individual clinicians who have had the patience to continue to

train the software. Evaluation and feedback continues with users.

Extension of Savience Patient Self Check-In

14 new self-check-in kiosks were procured last year based on the success of

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pilots in Craigavon Area Hospital and Daisy Hill Hospital. These kiosks are

primarily targeted in areas where there are no receptionists on duty. The new

measured term contract for cabling delayed the installation of these kiosks but

this is being addressed in 2015/16 and usage is being monitored by the Assistant

Director of Support Services in Acute Care.

Document Scanning

In 2014/15 the Continence Service agreed to pilot scanning of records attached

to the PARIS record. A post project evaluation has been undertaken in 2015/16

and was presented to the CIS Programme Board in December 2015. The

recommendations from this pilot are that originals of the scanned documents can

be destroyed as the scanned documents are legally admissible and no

documents could not be retrieved digitally in a 12 month period of the pilot. It will

be recommended to SMT that this model is rolled forward with all further PARIS

roll-out and this should bring both efficiencies and improved information

governance.

8.2 Technical Infrastructure Refresh Requirements for 2015/17

The Southern Trust has an extremely complex ICT Infrastructure, linking to BSO

Regional Data Centres to bring access to the Trust to the Regional, private,

Secure HSCNI Network, as well as important Regional Applications such as

NIECR, BSTP, HRPTS, Laboratory System and PACs Radiology System. The

Southern Trust Infrastructure delivers these Regional systems and network to

over 8,000 IT users in the Trust, across 100+ sites. In addition, the Trust hosts

100+ local Applications such as PARIS, email, Flow bed management and E-

Discharge. We also manage cyber security, firewalls, data storage and business

continuity.

The nature of the Trust’s business means that data security is of paramount

importance and there is huge emphasis on ensuring that data is not intercepted

or lost. This is not without a high level of investment.

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This section details the necessary investment in the Trust’s ICT Infrastructure to

ensure the following:

Highly available ICT across the Trust;

Minimum disruption to staff from ICT outages;

Optimum security of data; and

Minimisation of the risk of data loss.

Table 8.2.1 below outlines the Infrastructure investment required in 2015/17 to

achieve these objectives.

Table 8.2.1 – ICT Infrastructure Investment Requirements 2015/17

Capital Requirement Cost Funding Status

Migration of Exchange (Email) to latest version £150,000 Funded

Upgrade of Blackberry Enterprise (end of life) ,

software and devices

£100,000 Funded

Upgrade of Data Storage £250,000 UNFUNDED

SCOM (System Control Operation Manager)

Upgrade

£250,000 Funded

Branch Office Upgrade £65,000 Funded

Video Conferencing Infrastructure Upgrade £98,000 UNFUNDED

Pc Refresh (50% of PCs > 4 years old) £450,000 Funded

PC Refresh (100% of PC > 4 years old) £450,000 UNFUNDED

Core Switch Upgrade and Reablement £250,000 Funded

Back-Up to Disk Storage Expansion £60,000 Funded

Wireless Replacement (Juniper End of Life) £250,000 UNFUNDED

Wireless roll out community sites £100,000 Funded

Wireless roll out community sites phase 2 £150,000 UNFUNDED

PACs Screen upgrade/replacement Theatres £60,000 Funded

Total Funded £1,485,000

Total Unfunded £1,198,000

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A significant amount of non-recurrent revenue has also been invested in ICT in

2015/16, to address licencing and support gaps in the Southern Trust as follows:

Table 8.2.2 – Non Recurrent Investment Requirements 2015/17

Purpose Cost Funding

Data Protector Licence for backup £13,500 Funded

MS Terminal Services Licences £14,050 Funded

Sharepoint Configuration £19,580 Funded

Cisco Support £45,000 Funded

Office Pro Plus £2,620 Funded

Apple Mobility £10,000 Funded

HP Technical Support £24,986 Funded

Adobe Pro Licences £1,378 Funded

Capita Operations Support £56,683 Funded

HP Hardware Support £11,652 Funded

3rd Party ICT Basic Training Support £9,992 Funded

Team Training Up skilling £8,500 Funded

QoS Operational Support £6,700 Funded

IP Routing Operational Support £2,257 Funded

Network Security Admin Licences £3,360 Funded

TOTAL £230,260 Funded

8.3 Service Development Aspirations Dependent on Funding Availability

This section outlines the service development requests and aspirations which

have been raised by employees of the Trust. These are very dependent on

available funding but also Regional strategic direction and approval, due to the

on-going discussions about an EHCR for Northern Ireland (see section 7).

Electronic Solution for Scanned Records for HR

Belfast Trust have implemented a solution known as Automated Intelligence

which has enabled them to scan HR Records but also anotate the scanned

27

version to add notes to them electronically. The Southern Trust had initially

anticipated that this functionality would be available on HRPTS but it is not. The

Director of HR is keen to pursue this solution as HR Records are now required to

be retained for 100 years. A demo has been requested with Belfast Trust and a

business case is being prepared to avail of slippage funding.

Capital cost estimated £200,000.

Health & Safety Risk Assessment System

The HR Department are keen to implement an electronic system to conduct

health and safety assessments. This is based on an audit recommendation.

Discussions are on-going in relation to this, as this would be another system and

password for staff which may be difficult to embrace given the magnitude of

change for staff across the Southern Trust using BSTP and HRPTS Systems as

well, as systems such as Datix and any other clinical systems.

Capital cost £17,000 Recurrent Revenue £6,000 per annum

Paperless IT Requests and Tracking

The Trust currently uses INFRA for logging of IT support requests and equipment

requests. This system is not fit for purpose as it does not allow users to track

their requests for either IT support or equipment. In addition, it does not provide

the data analytics required to effectively run and manage a wide geographically

spread IT service desk, for example highlighting recurrent user issues or area

wide faults.

Capital requirement £150,000 Recurrent Revenue £10,000 per annum

Electronic Ordering Solution

Based on the successes of Flow Electronic Whiteboards, Acute Services

colleagues have indicated that it would be extremely beneficial for the screens to

have a portal ordering system. This exists in areas such as Physio requests, or

28

social work request, but would require extension to enable a request for

cardiology diagnostics or referrals to another speciality. At present all of this is

done on paper which creates time delays and also means that the orders are not

traceable and trackable. A business case is being prepared for this to avail of

slippage if available.


ICU Live Monitoring System

The Southern Trust is the only ICU Department which does not have a live

monitoring system. Visits have been made to other Trusts and Consultant

Intensives are keen to progress this. This would assist in managing risk and is a

once for all solution for Northern Ireland. A business case has been prepared to

avail of slippage funding.

Capital costs £203,000 Recurrent Revenue £38,000 per annum

Electronic NEWS Alerting

The Southern Trust has piloted Electronic NEWS. This involves nursing staff

inputting vital signs onto an iPod other portable device and these being displayed

in a NEWS Score on the Electronic White Boards. A business case is being

prepared to avail of slippage funding for this.

Capital Cost £250,000 Recurrent Revenue £24,000 per annum

Regional Access to IT Business Case

The HSC Board has prepared a business case for improved access to IT. The

costs associated with providing 3,000 additional users with mobile devices and

access to the appropriate applications such as PARIS, NIECR, Equipment

Ordering, BSTP and HRPTS are to included in the business case. The costs are

as follows and would have to be met through a Regionally approved business

case:

29

£7,140,510 Capital £1,601,850 Recurrent Revenue

Patient or Guest Wi-Fi in Hospitals

SMT have approved a business case to implement patient and guest Wi-Fi in

hospitals. This will bring benefits to patients in hospital beds but also those

waiting for outpatients/ED and also strategically enables tools such as ‘survey

monkey’ to be sent to patient’s smart phones or devices, which will make gaining

valuable user feedback easier.

Capital Cost £15,000 Revenue Cost £20,000 per annum

Document Management System on PARIS

Roll-out of PARIS has identified a significant issue for users. Users are scanning

documents to the PARIS Record but as this record grows, a document

management system is required to organise these so that it is clear which

documents are required for direct patient or client care at that time. The Trust

has offered to pilot this on behalf of the HSCNI and share learning on naming

conventions and processes.

Capital cost £200,000 (funding approved by HSCB)

Video Conferencing Units

There is a request for 6 further Video Conferencing Units in Paediatrics, Stroke,

Support & Recovery, Mental Health, Palliative Care and OPPC. The

implementation of these Video Conferencing Units is not only dependent on

funding for the units, but is also dependent on funding identified in the Technical

Infrastructure requirements (Table 8.2.1) to increase the capacity of Video

Conferencing across the Trust. At present, the Trust has used its full capacity for

Video Conferencing and the Infrastructure upgrade is a pre-requisite for any

additional units.

Capital cost £60,000

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Call Recording in the ED Department

Following a SAI, it is recommended that calls are recorded in the ED Department.

Capital cost £8,000. Recurrent Revenue £650.00 per annum

Bluestone Mobile Connectivity

Following an SAI, it is recommended that mobile phone connectivity is boosted in

the Bluestone Unit.


Conference Me iPads

One of the recommendations from a recent iPad survey was that it would be

useful to be able to use Conference Me on their iPads. Some staff have

indicated that if this functionality was available, they would be able to forfeit their

laptops or PCs.

Capital Cost £250,000

Admin Licences for HRPTS

It has been established that due to capacity shortfalls, some Senior Managers are

sharing passwords with secretarial staff to undertake HRPTS functions and BSTP

functions. It is recommended that the Trust invests in administrative licences to

mitigate this risk.


Speech Recognition Point & Click

Following a recent pilot, some staff who have very poor typing skills, have

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requested licences for speech recognition to point and click into the PARIS

Application and a speech recognition software to recognise and type their

dictation.


Direct Access for EEG Reporting

In order to improve EEG Reporting turnaround, software can be installed in the

Royal Victoria Hospital, to allow colleagues remote access to EEG images to

enable digital reporting, thus improving turnaround of results.


Data Analytics

There are a range of Data Analytics projects which are on-going across the Trust.

These include;

Availability of PARIS Data in the Regional Data Warehouse

Making best use of the Microsoft Enterprise Agreement to utilise Microsoft

licences for Data Analytics for Acute Information to present a dashboard.

Department led work on changes on risk adjusted mortality indicator

reporting to new SHIMI. The Trust is working with the Department of

Health to better understand the logic and analytics around this.

M&M (Mortality and Morbidity) reporting. The Trust is working with the

Department to share learning on M&M processes and reporting to facilitate

the specification and development of a Regional system.

Clinical coding improvements in turnaround continue. The Trust is

achieving the Regional 3 month target and now 97% of all Trust FCEs are

coded within 60 days. The importance of timely and accurate clinical

coding to improve data analytics is recognised and a priority for the Trust.

Whilst none of these projects have direct capital costs, they are on-going

investments in staff time to better improve availability of complex information

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across the Trust.

Patient Self Check in Using Paris

Mental Health and OPPC teams are keen to avail of existing self check in kiosks

across the Trust for users to self check in using Paris. At present, the kiosks are

only linked to PAS, but CIVICA (Paris supplier) have done integration work to

facilitate use.

Capital cost £79,000 Recurrent Revenue Cost £3,500 per annum

As indicated in previous sections at this stage in 2015/16, none of these service

developments proposals have attracted any funding with the exception of a

document management system for Paris. However, it is useful to have this list

available for budget planning for 2016/17 and also to avail of slippage as all

projects can be procured at short notice due to business cases being in place,

procurement avenues being secured and the fact that the majority of the

requirements are licenced based which means that they can become Trust

assets very quickly. In summary, the deficit costs are as follows:

Table 8.3.1 Funding Deficit Relating To Requested ICT Service

Developments

Project Capital Cost Revenue Cost

Automated Intelligence (HR record

scanning)

£200,000 None known

Health & Safety Risk Assessment £17,000 £6,000

IT Paperless Requests and Tracking £150,000 £10,000

Electronic Ordering £250,000 £60,000

ICU Live Monitoring £203,000 £38,000

Electronic News Alerting £250,000 £24,000

Regional Access To IT

(excluded from total costs as needs to be

Regionally Funded)

£7,140,510 £1,601,850

Guest Wifi £15,000 £20,000

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Video Conferencing Units £60,000 none

Call Recording in ED £8,000 £650

Mobile phone connectivity Bluestone

Unit

£150,000 none

Conference Me on iPADs £250,000 None known

Admin Licences for HRPTS £172,800 £40,000

Speech Recognition point and click pilot

in Paris

£50,000 None known

Direct Access EEG Reporting £22,000 None known

Patient Self Check-in Paris £79,000 £3,500

TOTAL (excludes Regional Access To IT

business case)

£1,876,800 £202,150

8.4 Projects Which Have Not Progressed As They Have Been Deemed Counter

Strategic

This sections outlines a number of Trust aspirations which have not been

progressed as the HSCB E-Health Programme Board have indicated that they

are counter strategic, due to on-going considerations of a Regional EHCR (see

Section 7). These are as follows:

Microbiology Information System

The Trust Microbiology Consultant is particularly keen to improve Microbiology

Reporting and alerts and it is not possible to do this on the existing Laboratory

system. A preferred Information System was identified by the Southern Trust but

this is not being pursued as it is deemed counter strategic in the context of an

EHCR for Northern Ireland.

Clinical Noting Development

The Trust planned to further develop its Clinical Noting System which is linked to

the Flow Electronic Whiteboards and provides some handover and task

management solutions. The Trust had hoped to develop electronic forms with

some snomed coding and data analytics, so that Clinical noting could be used as

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an alternative to continuation notes in paper case notes, or as an alternative for

completion of paper forms which are currently filed in casenotes. This has been

considered counter strategic in the context of EHCR.

E-Prescribing

The Trust was keen to pursue a digital solution for outpatient prescribing. At

present when a Consultant wishes to change a medication this is handwritten on

a triplicate proformas, with a copy given to the patient to give to the GP. This

leads to issues with legibility and queries from GP practices in relation to dosage

etc. The Trust had planned to develop its Clinical Noting Solution with E-Forms

to overcome this but this is deemed counter strategic.

In addition, Regional plans for a Regional E-Prescribing Module have been halted

whilst discussions continue regarding an EHCR.

8.5 Ongoing Assessments of Best Practice Technologies Which May Bring

Service Improvements in the Southern Trust.

This section outlines the ongoing work with professional teams across the Trust

to establish best practice ICT innovation and potential technology enabled

innovation.

Stroke Service

A visit is planned to University College Hospital, London, to see Stroke Pad in

use. This system has been designed and developed to capture all stroke related

information and seamlessly present the data required for SSNAP reporting. The

visit is scheduled for February 2016 and dependent upon Clinicians views of the

system, may be business case and bid for 2016/17.

RFID

Western Trust is exploring installation of RFID to improve tracking of paper

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records and equipment. A feasibility study is ongoing will be shared with other

Trusts. This may be a business case and bid for 2016/17

Clinical Communication Gateway (CCG)

Southern Trust is keen to be able to receive electronic referrals made by GPs

directly into the Paris application. At present this is only feasible in PAS for acute

services and the Southern Trust has not yet been provided with the software by

BSO – it is still in pilot in Northern Trust. Southern Trust will work with BSO to

influence Paris integration which will minimise data entry of information provided

in a GP referral for community and mental health based services.

Electronic Triage

NIECR includes functionality for electronic triage of acute referrals. This is being

piloted by Northern Trust. The Southern Trust will work with BSO, aiming to be

an early adopter of paperless referrals and triage when the software is signed off

by Northern Trust. This will minimise referral printing, scanning and filing and

also data entry on PAS.

Project Echo

The Trust will continue to invest in Video Conferencing infrastructure and Units

(subject to funding) to facilitate multi-disciplinary learning meetings such as

Cancer and Cardiology MDM and Project Echo.

Emergency Departments

The Emergency Departments in the Southern Trust continue to face exponential

pressure. Best practice in other EDs across the UK is being researched and

there may be potential for technology enabled improvements such as patient self

triage, data control rooms and patient tracking. These investigations continue in

collaboration with the ED Management team. This may require a business case

and funding support in 2016/17.

GP Out of Hours

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Like ED, GP OOH continue to face significant pressure. Investigations continue

with telephony and video conferencing to try to facilitate consultations from GPs

own homes, or across Trust sites. Conceptual ideas are being discussed with

OPPC Directorate. This may require a business case and funding support in

2016/17.

8.6 Summary of Funding Confirmed & Funding Gaps

In summary, the funding confirmed at December 2015, for 2015/16 for ICT is as

follows:

Table 8.6.1 ICT Funding Confirmed

Capital Funding Source Amount Confirmed

CRL £340,000

HSCB Ring fenced Tranche 1 £1,280,000

HSCB Ring fenced Tranche 2 £340,000

HSCB Ring fenced Tranche 3 £900,000

TOTAL £2,860,000

In summary, the funding gaps which exist and will be pursued for either slippage

or new funding opportunities in 2016/17 are as follows:

Table 8.6.2 ICT Funding Gap

Category Capital funding

gap

Revenue

Requirement

Extension of PARIS Community

Information System implementation

(business case submitted to DHSSPS)

£750,000 per

annum for 3

years

None

ICT Infrastructure £1,198,000 None

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Service Development Proposals £1,876,800 £202,150

Regional Access To IT (excluded -

Regional business case)

£7,140,510 £1,601,850

TOTAL £3,824,800 £202,150

This excludes the potential Electronic Health and Care Record (EHCR) and also

those potential ICT service improvements outlined in section 8.5. Every

opportunity will be taken to bid for slippage funding or against 2016/17 budgets to

address this gap.

9.0 CONCLUSION

The financial context in the HSCNI continues to bring challenges for ICT

implementation and support in the Southern Trust. This Business Plan identifies

these challenges but also outlines the significant progress that has been made in

progressing ICT improvements, despite this. It also provides an opportunity to

bid for slippage funding for service developments that have not yet been funded

and prepares us for bidding against new budgets in 2016/17.