Professional Documents
Culture Documents
Version 5.2
Author: Chris Cook, Interim Chief Informatics Officer
1. Document Purpose
This document outlines the Bolton NHS Foundation Trust Informatics Strategy which has been
approved in principle by the Board of Directors on 26 June 2012. For clarity, the Board approved all
cost neutral actions, including a merger of the IT and Information teams1. All investments/projects
which require funding over and above existing agreed budgets will need business cases to be
approved as normal.
This paper sets out a direction of travel in key strategic areas. A strategy implementation plan /
roadmap will be developed and it is expected that this will evolve over time.
It should also be noted that there is much work ongoing in the IT and Information teams that is not
included here. This does not indicate that this work will stop or that it is not important. However,
all current and future activities will be reviewed to ensure they align with this strategy this paper is
a first draft and the strategy will be updated as required.
2. Executive Summary
This document summarises the strategy for Informatics for Bolton NHS Foundation Trust over the
next 5 years. Informatics is the term that is becoming widely used in the NHS to cover the IT and
information management functions.
In 2011, Amor Group was commissioned to review Informatics at the Trust. This strategy document
builds on the key recommendations made by Amor, and endorsed by the Board of Directors in
October 2011, including the proposal to integrate the current IT and Information functions into a
single department.
The Trust is undergoing a period of unprecedented change and is now entering the new world of
commissioning and competition, with staff and patients who have ever higher expectations of how
the NHS should be using technology. At the same time, in a period of scrutiny by Monitor, the quality
of the Trusts management reporting has been found to be lacking.
This strategy seeks to support the Trust in the challenges it faces, to help develop the reputation of
the Trust and to enable it to meet its objectives. The strategy also aims to align Informatics
development at BFT with the objectives set by the Department of Healths Power of Information
strategy for Informatics in the NHS (May 2012) which highlights technology as being a critical enabler
in the provision of care quality over the coming years.
This strategy document proposes action in the following areas:
1. Integration of IT and Information to create an Informatics department.
2. A shift from data production to the provision of business intelligence (for example,
improved analysis for divisions and Board reporting).
3. The development of Clinical Informatics to support efficiency, care quality and mitigate
clinical and information governance risks, with a long term aim of an Electronic Patient
Record.
4. The use of mobile technology to support care quality and to enable flexible working.
Innovative use of mobile technology would enhance BFTs reputation and could also support
achievement of CQUINS and the avoidance of contract penalties.
5. Responding to the challenges of commissioning and competition: eg service level reporting,
providing integrated systems for GPs.
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Informatics Strategy
6. The integration of Community Services IT and information reporting
7. IT infrastructure requirements, in particular, the need to invest in wireless networking, PC
upgrades and investment required for telephony
8. Business engagement: the Informatics team must engage effectively with the organisation to
ensure IT systems are used to optimise business processes and care delivery and
management information is accurate and timely.
9. The development of an Informatics Service Delivery capability that provides a professional,
service level-based support service based on best industry practice and with a commitment
to continuous improvement. Once established, the service can be benchmarked against
third party service providers with a view to outsourcing if a more cost efficient and higher
quality service can be provided externally.
10. Implement best practice Informatics governance, including a project management
methodology (aligned with that being developed in BICS).
3. Background
The Trust is undergoing a period of unprecedented change. In July 2011 it took over responsibility
for Community Services in Bolton, including an additional 1,600+ staff, from the Primary Care Trust
and it is now gearing up to the new world of commissioning and competition for health service
provision. In the last 6 months the Trust has also been challenged by its own Board and by Monitor
over the quality of its management reporting.
The Trust, and the NHS in general, faces a growing challenge in information governance (for example
the use of paper based patient records in the hospital and across community services) as well as
growing technology expectations of staff and patients (for example, the use of mobile technology).
Clinicians see other trusts as more advanced than Bolton for example, Salford Royal has been using
an Electronic Patient Record system for 11 years.
In 2011, Amor Group was commissioned to review Informatics at the
IM&T Spend as % of Annual
Revenue Spend
Trust. Their report, presented to the Board of Directors in October
5%
2011, highlighted that investment in IT at Bolton was running at less
4%
than half the national NHS average.
3%
Amor made a number of recommendations, including:
2%
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4. Vision
The Informatics service at Bolton NHS Foundation Trust will have a vision as being recognised as one
of the most proactive, innovate and customer focussed Informatics services in the NHS. It will be
professional and well governed. It will be an integral part of the organisation. It will be a key enabler
of the Trusts objectives and it will be an exemplar for the Department of Healths information
strategy, The Power of Information.
5. Building Blocks
Despite a lack of sophistication in clinical informatics, the Trust has made a number of astute
investments in IT in recent years:
It has a world-leading integration engine (InterSystems
Ensemble) which enables systems to communicate to each
other (for example the patient administration system sends
patient demographics, via the integration engine, to
departmental system such as Pathology, Radiology,
Theatres etc)
It has a best of breed data warehouse (SAP Business
Objects) for management reporting
Key Hospital Systems
It has a modern, resilient data network on the hospital
campus and two data centres
It has on-line links to GP practices, including diagnostics ordering and electronic discharge
correspondence
It has established the capability to support secure flexible working using a variety of mobile
technologies
It has designed and has started to implement an innovative virtual desktop to enable fast
deployment and centralised management of thin client (low energy) PCs
These building blocks, aligned with existing technical skills in both the IT and Information teams,
provide a sound foundation for the development of strong Informatics capability.
6. Strategy Overview
This section outlines the key areas of the Bolton FT Informatics strategy. For each area, quick wins
have been identified along with medium and longer term proposals, which will require more
detailed planning and costing. Individual business cases will be developed for the component
projects that will be required to deliver the strategy.
6.1 Creation of an Informatics function
A key proposal from the Amor report was the integration of the current IT and Information teams to
form a single Informatics team. There are clear benefits from this including:
A joint approach to improving data accuracy (and hence the quality of health records and
management reporting) through improved operational processes and training (in
conjunction with system owners in the Trust)
Shared functions, such as business engagement, service desk and project management
Section 7 below outlines the approach to achieving the organisational change required.
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6.2 Business Intelligence
The development of a data warehouse has fuelled a growing demand for management reporting.
The current Information team face a constant barrage of requests for data reports. There is
currently little capacity to provide value-added activities, such as data quality improvement or
intelligent analysis of information, particularly with respect to key operational and clinical
performance indicators.
The Information function must move from producing reports and data to become a trusted Business
Intelligence advisor. This will be achieved through:
1. A focus on the key operational and clinical performance indicators, particularly Board
reporting and analysis and the provision of the new Performance Assessment Frameworks.
2. Improved business engagement, including monthly reviews of Board reporting and PAFs
with divisional teams. Informatics will provide reporting and analysis, though divisions will
retain ownership of the data.
3. The development of data analysis tools for end users (for example, QlikView)
4. The development of a report request process to control, prioritise and plan the production
of ad-hocs reporting
The Informatics team will provide leadership for ensuring the accuracy and integrity of management
information by working with system owners (see Business Engagement below) to develop
standard processes for the use of IT systems and in particular the capture of data. Informatics will
work with system owners to agree training requirements and also ensure staff follow standard
processes and enter data accurately (through auditing, training and supporting performance
management).
The Informatics team will retain responsibility for clinical coding and will continue to ensure the
highest quality of coding. The Informatics team will also work proactively with users of medical
records to minimise the level of uncoded activity.
Quick Wins
Improved Board reporting (starting in June)
Establish monthly report production timetable, incorporating Andy McGraths Performance
Assessment Framework (from June)
Agree action plan to eliminate uncoded activity (July)
Establish monthly divisional and CCG reviews business intelligence reviews in line with the
new COOs requirements (June/July)
Informatics Strategy 2012 - Ver 5.2
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Allow data warehouse users to obtain reports in more flexible formats, eg Excel rather than
just PDF format subject to further discussion ! (July)
Medium/Longer term actions
Develop the QlikView application (already procured to support the Patient Level Costing
project) to provide an end user data analysis tool
Review processes and training requirements with system owners with the objective of
improving the quality of data capture
Develop professional customer reporting (eg for CCG, AQP customers)
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The approach to Clinical Informatics can be summarised as follows:
Quick Wins
Establish system owners (expert end users), Informatics owners and user groups for key
clinical systems, then agree development and process optimisation plans
Upgrade ExtraMed to the latest supported version
Agree an action plan to address discharge correspondence issues [this has been initiated,
using consultancy from Ascribe]
Initiate a BICS (Bolton Improving Care System) review of Informatics in A&E and the new
CDU to look for efficiencies and improvements and also to gain clinical engagement [planned
to start on 16 July]
Develop the strategy for online diagnostics ordering (to agree how we deliver this prior to
the implementation of a full EPR system, in particular do we push on with the iCM system?)
Work with the PACS Manager to initiate the first stage of a plan to move PACS support away
from NHS National Programme contract with CSC (which ends in June 2013), including
localisation of diagnostic images (migrated from CSCs data centre) and contracting through
the Greater Manchester PACS consortium for a new maintenance and support contract
Review Harm Free Care and other data collection requirements by nurses and evaluate the
potential for using mobile devices (see also Mobile Devices below)
Re-establish the Clinical Advisory Group with a remit to develop the Clinical Informatics
Strategy
Appoint a dedicated Clinical Lead for Informatics
Medium/Longer term actions
Implement automatic discharge/transfer updates from ExtraMed to PAS (to enable real-time
bed occupancy and discharge reporting and to save nurses having to double enter data)
Initiate a review of best practice in the use of EDMS systems by NHS trusts, evaluate
suppliers and develop a business case and implementation plan for Bolton NHS FT (clinically
led)
Initiate the evaluation of requirements for an EPR, including Community Services, GP and
local authority requirements (clinically led)
Evaluate the potential for using e-Health technology to support patients in their own homes
(rather than needing to stay in hospital)
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Quick Wins
Develop business cases, including technology proposal, for the use of mobile technology to
support a number of requirements:
Management of patients with strokes
Data collection for Harm Free Care
Pre and post-natal maternity care management
Data collection and alerting for patient deterioration
Collection of patient satisfaction surveys
Evaluate requirements for flexible working and use of mobile technology by staff, clinicians
and management. Start with the requirements of directors and senior manager in order to
cost the set-up, implementation and ongoing support required.
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A project has been initiated with the PCTs Interim Associate Director of IM&T to enable the
completion of the Community Services IT integration. There are three key issues to resolve to
ensure a successful completion:
Central coordination of which clinical services are moving to which community buildings and
when is essential to inform IT planning (also required by Estates)
Costs need to be agreed and approved, including resource requirements (project
management and engineers)
The migration of patient data from the PCT PAS (Lorenzo) to the Trusts PAS (LE2)
Quick Wins
Appointment of a Community Services Development programme manager to coordinate all
aspects of clinical service moves [through BICS PMO? currently under discussion]
Migrate all PCT email accounts to BFT email for all Community Service staff [August]
Initiate Community Services site surveys to agree IT requirements [started]
The development of a costed proposal, including resource requirements funding to be
discussed with the PCT
Agree and communicate the approach for the migration of patient data from the Community
Services PAS to the Trusts PAS
Medium / Longer Term
Complete the migration by 1 April 2013:
- Implement data network connections to all community sites
- Upgrade PCs and printers
- Applications to move to BFT network and support service
- Migrate Lorenzo patient records to the Trust PAS
- Migrate PCT ExtraMed to BFTs instance
- Software licences to be novated to BFT
- Migrate PCT applications to BFT Informatics Service Desk support
Procure and implement Voice over IP telephony system at community sites (to be agreed
with Estates)
- to replace PCT phone system
- to utilise data network (eliminating line rental and internal calling costs)
- with capacity to replace RBH telephone system when the current contract expires
6.7 IT Infrastructure
The Trust has a sound IT infrastructure base with a high bandwidth, resilient data network with two
on-site data centres on the hospital campus. However, many PCs and printers are old and need
replacing.
A modern, fast virtual desktop has been developed which can utilise power efficient thin client
PCs. It has been successfully piloted at Bolton One and is now ready to be deployed throughout the
hospital and across community sites.
The potential for using a managed printer service, and the level of cost savings available, should be
explored as an alternative to retaining and upgrading existing printers.
The current wireless network is at end of life (no longer supported), it has a limited range, it is not
available in all areas of the hospital and it is only designed for use by staff (using the internal data
network). Investment in a new wireless network is proposed to enable flexible working and also to
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provide patients with wi-fi Internet access. This investment is also a pre-requisite to support the use
of mobile devices in the Trust.
A single sign-on capability will be developed to provide easier access to the multiple systems used
across the trust.
A plan will also be developed with Estates for the implementation of a new (Voice over IP) telephony
network to replace the current Trust telephony system with a modern system by the time the
contract to support the current legacy system expires (2015).
See also Community Services for the requirement to integrate community sites with the BFT IT
network.
Quick Wins
Develop business case and implementation plan for standardised virtual desktop PC rollout
Seek approval for existing business case for wi-fi network
Evaluate case for a managed printer service
Evaluate Single Sign on requirements
Medium / Longer Term
Roll out virtual desk PC upgrades (2 to 3 year project)
Roll out new wi-fi network (12 month implementation)
Roll out Single Sign On
Replace telephony system (2012/2013)
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Establish user groups for all key systems
Establish clear roles and responsibilities for System Owners
Informatics Divisional Business Manager to be appointed [subject to budget approval] in a
new Informatics organisation structure:
- to represent Informatics at Divisional Boards
- to be agree monthly Board reporting and analysis with Divisions
- to ensure Informatics Service Delivery aligns with Divisional requirements
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6.10
Governance
The IM&T Committee will continue to oversee the provision of Informatics to the Trust and will
continue to report to the Executive Board.
All Trust projects that require investment in Informatics (eg new IT applications, new IT hardware,
new reporting requirements etc) or changes to existing Informatics provision must have that
Informatics component approved at the IM&T Committee.
It is proposed that an Informatics project management function be created to manage project
planning and delivery. Informatics project progress will be reported to the new BICS PMO (Project
Management Office) alongside, or as part of other business projects, and all Informatics projects will
report progress monthly to the IM&T Committee.
A standard project methodology will be agreed with BICS PMO - for use on Informatics and all other
BFT projects in order to ensure a common approach across the Trust.
Project management and implementation resource should be costed into project proposals in order
to manage incremental investment costs and to avoid a dependency on Informatics support staff.
The Information Governance (IG) function will remain with Informatics. It too will develop key
service metrics. The IG function will also develop the capability to gain ISO27001 Information
Security certification in order to demonstrate our IG capability in support of the Trusts reputation.
Ann Schenk will remain as the Senior Information Risk Owner and as such will continue to chair the
IG Committee, in order to provide a non-partisan challenge to the Informatics IG function.
The Informatics function will be managed professionally, with a strong customer focus and a
philosophy of continual improvement. In particular, staff will be managed and developed in a
professional manner in accordance with the Trusts Workforce practices.
Quick Wins
Professional documentation and standard templates will be developed and identified as
Informatics documents
Monthly reporting will be established for all Informatics managers (from June)
Agree a standard project management methodology with the Head of BICS and ensure all
Informatics projects conform
Report project progress to BICS PMO and IM&T Committee (monthly)
Due diligence on Informatics contract commitments
Development of an Informatics project management and planning function
Development of IG metrics
Medium / Longer Term
Gain ISO27001 certification for Information Security
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7. Organisational Change
The IT and Information teams with be integrated into a single Informatics function capable of
delivering the strategy outlined above.
7.1 Plan
A consultation plan is being developed with Workforce. The Chair of Staffside has also been notified.
It is proposed to manage the reorganisation in two phases:
Phase 1: Establish the new Informatics management structure
1. Propose new Informatics management structure and commence consultation on the
proposed structure with IT and Information managers
2. Complete consultation with managers and establish the new Informatics
management team
3. Communicate the establishment of the Informatics team and its strategic priorities
and leadership responsibilities (+ change of name on documents and Intranet etc).
Phase 2: Review overall Informatics team
1. The new Informatics management team to review the resource and skill
requirements needed to deliver the strategy
2. Propose any changes required and consult with any staff members who would be
affected by the proposed change
Timescales to be agreed with Workforce.
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8. Next Steps
Action Quick Wins (ongoing)
Consultation with IT and Information managers over proposed new Informatics
management structure (Jul-Aug)
Launch Informatics team (Aug)
Development of an action plan and roadmap to deliver the strategy (Aug-Sep)
Budgetary costing and prioritisation of strategic projects (Sep-Oct)
Recruitment of a permanent Chief Informatics Officer (Nov)
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