Sean Brennan The Evidence-Based EPR Benefits and Cost Model A presentation to the The Northern, Yorkshire and Humberside NHS Directors of Informatics Forum Sean Brennan

Evidence-Based EPR Benefits Model Background Who are Inform Health & Associates? What is the EPR Benefits Model ? How can the model be used by Trusts/Health Boards? Further Information? www.informhealthassociates.co.uk Inform Health & Associates Ltd - EPR Benefits and Cost Model

Background Inform Health & Associates Ltd - EPR Benefits and Cost Model

All our yesterdays ! Linking the Benefits to each level of an incremental EPR started in 1998.

EPR 6 level model 1998: Target 1 Multimedia / Telematics Level 5 Specialty modules / Document Imaging Level 4 Decision support/ Clinical Guidelines Access to Knowledge Order entry/Results reporting/Electronic Prescribing/Integrated Care pathways Level 3 33% Level 2 Integrated departmental systems Labs/X-ray/Pharmacy/Theatre PAS/MPI/ Departmental systems Level 1 By Year 2002 ?

EPR 6 level model 1998: Target 2 Multimedia / Telematics Level 5 Specialty modules / Document Imaging Level 4 Decision support/ Clinical Guidelines Access to Knowledge 100% Order entry/Results reporting/Electronic Prescribing/Integrated Care pathways Level 3 Level 2 Integrated departmental systems Labs/X-ray/Pharmacy/Theatre PAS/MPI/ Departmental systems Level 1 By Year 2005 ?

EPR 6 level model 1998: The Reality Multimedia / Telematics Level 5 Specialty modules / Document Imaging Level 4 Decision support/ Clinical Guidelines Access to Knowledge Order entry/Results reporting/Electronic Prescribing/Integrated Care pathways Level 3 6% Level 2 Integrated departmental systems Labs/X-ray/Pharmacy/Theatre PAS/MPI/ Departmental systems Level 1 In 1999 ( ie when Information for Health published)

The EPR CD Rom The multi-media EPR CD Rom attempted to identify the benefits of each incremental Epr development level. The EPR benefits model has been developed over the last decade and more specifically with Inform Health team in the last three years. Inform Health & Associates Ltd - EPR Benefits and Cost Model

NHS Currently * 0% 1% 47% 4% 9% 16% 15% 8% HIMSS have adopted the same incremental levels approach to ‘growing’ an EPR 0% 1% 47% 4% 9% 16% 15% 8% * source: cohort of NHS sites used for the investigation by HIMSS assessment of NHS hospitals’ IT maturity using its EMRAM data (Electronic Medical Record Adoption Model), Inform Health & Associates Ltd - EPR Benefits and Cost Model

How are countries doing? Inform Health & Associates Ltd - EPR Benefits and Cost Model

Another Maturity Index ! Another maturity index (?initially EHI and now adopted by NHS England) has TWO dimensions: Level of maturity and depth of take-up at each level Inform Health & Associates Ltd - EPR Benefits and Cost Model

Benefits and Digital/System Maturity We need a process to enable us to anticipate, with a level of confidence, the benefits that this increasing maturity of an EPR will bring. The benefits model must be based on evidence and locally tailored to suit contexts/business. It is sometimes difficult to assign a specific benefit to a particular change but the model allows adjustments when a benefit may be the result of multiple changes in practice. The EPR model can support Options Appraisal or Business Case development or for those who are already in an implementation provide a degree of rigour to Benefits Realisation. Inform Health & Associates Ltd - EPR Benefits and Cost Model

Who are Inform Health & Associates? Inform Health & Associates Ltd - EPR Benefits and Cost Model

Who are Inform Health & Associates? A small but highly experienced healthcare informatics consulting firm established in 2013. We only utilise Associates with exceptional NHS experience, typically with CIO or Director backgrounds.  We will only assign Associates that meet our stringent criteria Inform Health & Associates Ltd - EPR Benefits and Cost Model

Supporting Trust Informatics Strategies Inform Health & Associates provide specialist and experienced support in the area of Trust Informatics Strategies, including option appraisals, cost benefits of EPR options and Business Case development. To date we have provided these type of services to numerous Trusts including the following: University Hospital of South Manchester & South Sector Group Royal Liverpool & Broadgreen University Hospitals University Hospitals of Morecambe Bay Calderdale & Huddersfield NHS Foundation Trust University Hospitals of North Midlands Wirral University Teaching Hospital At the core of our offering is the UK’s most advanced EPR Benefits and Cost Model and Business Case collateral. Inform Health & Associates Ltd - EPR Benefits and Cost Model

What is the EPR Benefits Model?

EPR Options Appraisal Process – Benefit and Cost Model Inform Health Provide Overview of the Model to Trust Model provides starter set assumptions and evidence where possible Set up Benefits Model for Trust Acute or Community Wide Option Agree Supplier/Strategic Options to Evaluate Trust Supply their activity, financial and manpower data, plus current IT system costs that will be displaced by EPR Review and amend each EPR benefit assumption of impact Supplement with benefit studies and transformation work Have any of these benefits been achieved already by existing systems or other planned solutions eg EPMA benefits? Review and amend phasing of benefits delivery over the 10 years by supplier if required Inform Health & Associates Ltd - EPR Benefits and Cost Model

EPR Benefits – Example Vignettes Provided Inform Health & Associates provide as part of the EPR Benefits Model example ‘Vignettes’ that help Trusts assess their potential benefits from EPR Vignettes look at what a current pre EPR workflow would look like, then compare to a workflow after the introduction of an advanced EPR. Pre and post benefits are then calculated based on a standard acute hospital Examples of EPR Benefit Vignettes are provided on the web site, go to www.informhealthassociates.co.uk Inform Health & Associates Ltd - EPR Benefits and Cost Model

EPR Options Appraisal – Benefits Model Supplier/Solution Evaluation allows each EPR benefit to be profiled with: Level of confidence (%) the solution will deliver that benefit This Level of Confidence can be driven by a more detailed structured assessment. For example by assessing solutions by up to 6 categories Usability Assessment of UK Functionality Confidence in the Company to Deliver etc Trusts can define up to 6 categories and their weightings Supplier/solutions can have different benefit delivery time profiles Supplier/solutions can have different cash releasing delivery time profiles Various EPR Benefit Reports provided based on Trust data and assumptions Inform Health & Associates Ltd - EPR Benefits and Cost Model

EPR Options Appraisal – Benefits Model Benefits are Grouped under 6 headings: Staff Efficiency Non Staff Savings Clinical Quality & Practice Variation Length of Stay, Readmissions & Demand Management IT Displaced Costs Income Benefits Delivered to be Categorised into Types: Cash Releasing More Time for (or improvements in) Patient Care Increased Capacity Improved Income Cost Avoidance Inform Health & Associates Ltd - EPR Benefits and Cost Model

EPR Options Appraisal – Cost Model EPR Cost Model: Estimated Contract Costs for main suppliers EPR Programme Staffing Model calculates expected increase in EPR staff by supplier option over the 10 years Training Costs calculated Procurement/preparation costs and data migration costs Investment in hardware etc EPR Benefits and Costs Brought Together NPV calculations Various Reports, including relative costs and benefits of different solutions Benefit and Cost Outputs Feed EPR Outline Business Case if Required Inform Health & Associates Ltd - EPR Benefits and Cost Model

EPR Benefits Model Menu I BACKGROUND Set Up Data & Assumptions Benefits & Phasing Supplier Evaluation QUALITY & EFFICIENCY Efficiency Clinical Quality Displaced IT Costs Summary Inform Health & Associates Ltd - EPR Benefits and Cost Model

EPR Benefits Model Menu II Suppliers by year Cash Released Plan by year Benefits & High Projection Cash Benefits by Supplier Non Cash benefits by Supplier Benefits Realisation Plan Costs & Benefits Costs & Benefits summary COSTS Cost Analysis Supplier Costs Estimation Staffing Training Data Migration Procurement and prep costs Supplier Costs Inform Health & Associates Ltd - EPR Benefits and Cost Model

Using the EPR Benefits Model? Inform Health & Associates Ltd - EPR Benefits and Cost Model

Using the EPR Benefits Model EPR Options Appraisal EPR Business Case development EPR Cost Benefits EPR Strategies Inform Health & Associates Ltd - EPR Benefits and Cost Model

How does it work? Initial walk-through of model. No obligations. Once signed up then: IH&A provides an overview of the model and provides starter set assumptions and evidence where possible. ‘Localising’ the model through meetings with IH&A consultants and: Nursing staff AHP Medical Staff Senior Managers Transformational change Anyone else as indicated Data Assumptions sheet completed Follow-up meetings Inform Health & Associates Ltd - EPR Benefits and Cost Model

Outputs/Conclusions Reports generated by the IH&A team Reports/results presented to Trust Inform Health & Associates Ltd - EPR Benefits and Cost Model

Do you want further information? Inform Health & Associates Ltd - EPR Benefits and Cost Model

Additional Information : Contact: Alan Spours Or Sean Brennan Managing Director sean@eprarms.com Inform Health & Associates Ltd aspours@inform-health.co.uk 07585 807959 www.informhealthassociates.co.uk Inform Health & Associates Ltd - EPR Benefits and Cost Model