1. Informing Healthcare An Overview David Ll. Davies – Programme Manager
Deborah El Sayed – Single Record Project Manager

2. What is it? A strategy and an implementation programme In summary:
‘…………..It is a significant and strategic approach to investing in information and communications technologies infrastructure and to modernising service delivery by supporting new ways of working…………………..’

3. Principles (what’s different?)
Ministerial support
Corporate and All Wales
Comprehensive scope
Long term Investment (£91 m first 3 years)
User led
Incremental implementation
Evidence based development
F,D,I,E
Concept of ‘dependencies’ & ‘readiness’

4. Benefit Areas
Single integrated electronic health record for every patient
Service improvement supported by technology
Empowerment of the workforce through information literacy and tools
Empowerment of patients through shared decision making
High quality knowledge and information management

5. Strategy Implementation Programme Board
Programme Organisation
Health Services
Informing Healthcare
Strategy Implementation Programme Board
Users
Executive
Resources
Projects
Benefit Groups
Chair
& Director
Design &
Support Offices
Staff/second
Stakeholders
Products

6. Progress – Setup and Personnel
Year 1 Programme Plan approved by Programme Board
Support Office Commissioned in Bro Morgannwg Trust (Glanrhyd)
Ian Kelsall appointed as Chair
Bob Grindrod, Interim Director last 12 months
Substantive Director appointment in progress
2 of 5 Benefit Directors appointed – Drs Rhodri Evans & Adrian Edwards
Programme Manager, Deputy PM’s and PSO Director in place.
Other key appointments being made

7. Progress - Activity Technical Proof of Concept Project completed
Projects moving forward from programme plan in areas of:
Single record development phase 1
Training and development
Knowledge management
Infrastructure and access devices
Confidentiality and security
Research and development
Readiness planning progressing in Trusts and LHBS
£18m + invested in 2004/5

8. Progress – Activity (2) Engagement of users/stakeholders
Developing relationships with related areas e.g.
England
Diagnostic Services Review
Social Care
Wanless
Innovations in Care
ESR
Three year Programme ‘Route Map’ in preparation

9. So what’s in it for nursing staff?
Recognition – nurses run the show!
Electronic support for day to day work:
structured ‘intelligent’ records
nursing record and access to all other relevant records
new electronically supported processes
orders and results
medicines management
referrals, admissions, transfers and discharges
bed management
scheduling
alerts and reminders
pathways/decision support

10. So what’s in it for nursing staff (2)?
Training and skills to maximise benefit from electronic systems
Skills as informaticians – evidence based professionals
Benefits:
actions supported by timely accurate information
automation of routine tasks
reduced possibility of error
reduced wasted effort
improved and safer services for patients
less stressful more rewarding working conditions for staff

11. Strategy to delivery ( Single Record)
Structure and objectives of the Single Record Phase 1 Development Project
How we plan to deliver this
Progress Made to date
Next steps

12. Overview of Work-Streams
Core:
Functionality
Presentation
Usability
Record structure
Process Redesign
Dependency
Network
Patient Identification
Staff Identification
Service Management

13. Overview of Work-Streams
Dependency Objective
Network
The ability of the network to Support the Single Record
Dependency
Network
Patient Identification
Staff Identification
Service Management

14. Overview of Work-Streams
Dependency Objective
Patient Identification
The ability to uniquely identify patients in electronic systems
Dependency
Network
Patient Identification
Staff Identification
Service Management

15. Overview of Work-Streams
Dependency Objective
Staff Identification
The ability to uniquely identify staff accessing Single Record access
Dependency
Network
Patient Identification
Staff Identification
Service Management

16. Overview of Work-Streams
Dependency Objective
Service Management
The ability to deliver a co-ordinated service management function to manage the services to be provided within SR:P1 Dev Project
Dependency
Network
Patient Identification
Staff Identification
Service Management

17. Overview of Work-Streams
Core:
Functionality
Presentation
Usability
Record structure
Process Redesign
Functionality
What will the system
actually do?
Which clinical
processes
will it support?

18. Overview of Work-Streams
Core:
Functionality
Presentation
Usability
Record structure
Process Redesign
Presentation
What will the system
look like?
How will it differ to
support the range of
professional groups?

19. Overview of Work-Streams
Core:
Functionality
Presentation
Usability
Record structure
Process Redesign
Usability
How easy is the system to use?
How intuitive is it?
How ergonomic is it?

20. Overview of Work-Streams
Core:
Functionality
Presentation
Usability
Record structure
Process Redesign/Change Management
Record structure
How should patient data be
structured within the record?

21. Overview of work-Streams
Core:
Functionality
Presentation
Usability
Record structure
Process Redesign/Change Management
Process Redesign/
Change Management
The largest and most complex
part of this project is the
change management aspect.
A good technical system
overlaid onto an inefficient
process will not deliver
improved patient care

22. Development of Outline Business Case
An Outline Business Case in five case model form is being developed for Single Record
The Programme is also subject to the Office of Government Commerce (OGC) Gateway process
Purpose
To provide external/independent assurance
Review at key decision points to ensure that the project is ‘ready’ to progress to the next stage.
Dates for Gateway Reviews to be agreed

23. Methodology for getting it right
The services and functionality delivered MUST be guided by NHS stakeholders across NHS Wales
All Wales stakeholder events
Design Teams established
Reference Groups established
Clinically focused Project Board
Constant engagement process to maximise numbers of clinicians and NHS staff involved in design, decision making, consultation and validation.

24. Stakeholder Events and Clinical Representation
Three stakeholder workshops were held during September and early October for all stakeholders.
In excess of 200 people attended to provide views on the approach to Single Record across Wales.
This included clinicians from various disciplines and accounted for 20% of the attendees
Further development of the options has taken place through a further six OBC options meetings involved over 60 stakeholders.
Design Team and Reference Group meetings initiated

25. Stakeholder Prioritisation of Scope for Phase 1
Result of the workshops to date have prioritised the following*
Access to accurate, consistent corporate patient demographic information
Access to basic clinical information for all Welsh patients
Enhanced demographics
Requests and results reporting
Referrals (1°care to 2°care and tertiary referrals)
Discharge summaries from 2°care (including death notification)
*shown in rank order

26. Design Team and Reference Group dates for 2004
23rd November 30th November
7th December 14th December
21st December
Reference Group: 9th December
25 people register for Design Team
54 registered for Reference group

27. Other issues for consideration
The current requirements of each organisation are likely to be different – Need a corporate approach to deliver benefits to patients across Wales
The Requirements of different professional groups will be different need to ensure we have an approach that ensures representation of all of the key professional groups to ensure that we deliver a cohesive service to patients
The current experience for patients is difference based upon where they live and the approach taken by their local hospital or the pace of development – Need to develop an approach that gives equity of patient experience wherever possible.

28. Next steps: Scope Focus for Design Teams and Reference Group
Outline Business Case ( defines and approves the options and high level scope)
Develop Clinical (business) Processes for each area of functionality (defines the detailed scope)
Develop the requirements of systems to support these processes ( refines detailed scope)
Develop a specification to drive forward procurement activity