NHSScotland assets and facilities 2015: annual report

Annex I: eHealth Strategy 2014-2017

The eHealth Strategy 2014-2017 sets the direction and high-level programme for that period, but also looks beyond that to the capabilities we expect to have in place by 2020.

The eHealth Strategy 2014-2017 maintains a significant focus on healthcare and the needs of NHSScotland and has been redeveloped to recognise the rapidly evolving environment of integrated health and social care and the need to address not only NHSScotland requirements, but also the expectations and requirements of partnership organisations (in particular local authorities), and citizens for electronic information and digital services. Alignment with the aims of Scotland's Digital Public Services Strategy is built in.

The refreshed eHealth Strategy builds on the many core ICT systems and infrastructure that have been invested in over the past 3 to 5 years. But there will also be fresh investment in new technologies, with additional capabilities across all areas of health and care, especially primary and community care.

The six core aims developed as part of the previous eHealth Strategy published in 2011 remain appropriate and are consistent with NHSScotland's 2020 Vision. A seventh aim has been added specifically related to innovation. The seven aims are:

The eHealth Aims

• To enhance the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality.
• To support people to communicate with NHS Scotland, manage their own health and wellbeing, and to become more active participants in the care and services they receive.
• To contribute to care integration and to support people with long term conditions.
• To improve the safety of people taking medicines and their effective use.
• To provide clinical and other managers across the health and social care spectrum with the timely management information they need to inform their decisions on service quality, performance and delivery.
• To maximise efficient working practices, minimise wasteful variation, bring about measurable savings and ensure value for money.
• To contribute to innovation occurring through the Health Innovation Partnerships, the research community and suppliers, including the small and medium enterprise ( SME) sector.

The potential of information technology to support and transform healthcare services is fully recognised across NHSScotland and eHealth has a pivotal role to play in ensuring that the 2020 Vision for Healthcare in Scotland and its Quality Ambitions are delivered. There is no doubt that eHealth has massive potential to assist clinicians to do their job better and to provide citizens and patients with better information and services. To meet these demands eHealth will need to continue to address several complex areas.

The current version of the eHealth Strategy was planned to be simply an update of the one published in 2011. But in the three years between 2011 and 2014 significant policy developments in Scotland for Health & Social Care, and for citizen -facing digital services, meant the current eHealth Strategy needed a further shift of emphasis - this time to delivering secure digital access to health and care information to a much wider set of professionals and providing more services and information to people through digital channels.

Challenges addressed by the eHealth Strategy 2014-17 are multifaceted. They include maintaining the resilience of systems operating 24/7/365; ensuring availability of funding for replacement and modernisation of an increasing ICT estate, filling gaps in electronic information coverage and systems integration (most significant being Hospital Electronic Prescribing and Medications Administration); further reducing variation in systems infrastructure and applications; opening portals through which people can access their health and care information; providing secure interfaces between consumer health and care products/tools and core health and care information systems; building capacity development for business intelligence and predictive analytics; and introducing information governance that balances the need to protect with the need to share.

The eHealth Strategy 2014-2017, with a realigned governance structure, will ensure that technology areas that were previously managed in the margins of eHealth will become core to planning and delivery in order to deliver the desired service transformation.

The focus on efficiency, reducing variation and improved management information applies to all services within NHSScotland, including Facilities Services. It is recognised by the Strategic Facilities Group ( SFG) and eHealth Leads Group that technology is essential to support the development of Facilities Services across NHSScotland and collaboration and joint working between Facilities and eHealth is vital at both national and Board level. Work has commenced on the creation of a 'Facilities eHealth Strategy' that will focus on this joint and collaborative approach to significantly support the aims, standards and principles within the eHealth Strategy 2014-2017. The aims of the Facilities eHealth Strategy will ensure that there is clarity of vision and direction for the procurement and implementation of technology into Facilities Services within NHSScotland. The Facilities eHealth Strategy is scheduled to be published in 2016.

Delivery of the eHealth Strategy 2014-2017 is a joint responsibility of the Scottish Government, the NHS Boards and other partners, both public and private. Individual NHSScotland Boards will continue to have their own local eHealth delivery plans which will reflect national priorities and developments in the context of their own local circumstances. Boards' eHealth Plans will be aligned to LDPs and will include:

• benefits being maximised from existing IM&T assets
• information and evidence on eHealth's contribution towards achieving the seven strategic eHealth aims;
• promotion and implementation of good practice and successful local initiatives more widely;
• convergence of approaches to delivery in order to reduce duplication of effort and reduce cost;
• collaborative working between Boards and cross-border eHealth developments

Work Plan

NHSScotland require to consider the priorities of the work plan and split the work into categories such as:

"Must Do" projects. These are generally systems at the end of life, or existing contracts for services and licences that are due for renewal.

"Invest to Save" projects. The basis for undertaking such projects is to release saving in the future.

"Potential Development" projects. These are projects designed to move the IM&T service forward in a strategic direction, or to absorb costs new national systems.

The following projects are considered priority for eHealth and are currently in progress or have plans for initiation.

• Completion of the N3 replacement, SWAN (in Progress)
• Implementation of NHS Mail replacement (planned for implementation)
• Business case and implementation Support Needs System
• Business Case and implementation of CHI Modernisation
• Business and implementation Child Health Systems
• HEPMA, Hospital Electronic Pharmacy and Medicines Administration
• The Full Business Case for HEPMA is scheduled for completion and approval in late 2015. Some NHS Boards will progress HEPMA as an earlier development than others depending on local priorities and resources. However, it is expected that most NHS Boards will have some elements of HEPMA operational by 2020
• Patient Portals
  Patient portals are secure websites through which patients can access a Patient Health Record. This may contain information from a patient's EHR. It is usually "tethered" to a health care organisation with applications that complement an EHR and enables users to complete forms online, communicate with providers, request prescription refills, review lab results, or schedule medical appointments. This is a key driver to enhance patient access and increase administrative efficiency and productivity all in line with the 20:20 vision.
• Electronic Patient Record ( EPR)
  EPR exists within current patient management systems and there are current clinical portals that exploit this information and align acute, community and GP data. Additional functionality will be developed within current applications. There will be increased patient safety by reducing or correcting errors. Improved shared decision making and improved feelings of empowerment and move away from paternalistic NHS. More efficient/accurate transferability of the record.

• Telehealth and Telecare
  There is three-year funding for the Technology Enabled Care Programme for 2015 - 2018, at £10 million per annum. This is currently administered by the Joint Improvement Team ( JIT), within the Directorate for Health & Social Care Integration.

• Mobility
  Given the advance in computer and mobile technology, and its universal use, any constraints are increasingly unacceptable to staff, managers and clinicians in NHSScotland. The request for 'all this' to be an 'app on my mobile' is ubiquitous and there is a danger that, without proper investigation, consideration and governance, expensive and inappropriate approaches may be adopted.
  The appropriate Infrastructure needs to be in place to enable the usage of the SWAN network, local networks, and portable devices.

• Video Conferencing
  Significant investment has taken place in NHS Scotland to provide video conferencing locally at the desktop as well as nationally via video conferencing hubs. This development is to be extended and offers benefits to NHS staff in terms of meetings and clinical services and to patients where video consultations are now being practiced.
  This offers significant reduction in travel of both staff and patients delivering savings and improvements in patient experience and care.
• GP Systems
  The contract for the current GP systems expires in 2017 and so work is underway to procure systems for the framework contract.

• Community System
  The MiDIS system used by a consortium of boards in Scotland comes to the end of support in March 2018 and therefore it is necessary for a new community system to be procured. The consortium of Boards have invited other Boards to join them and once confirmed the project will move towards confirming the requirements and agreeing a way forward to procure the appropriate system.

With the rise of smart phones and tablet devices, there is an increasing demand for access to systems and data away from the traditional desktop environment. This represents a significant challenge to eHealth and suppliers, who have traditionally sourced systems fit for MS Windows based environments. Unless there is significant demand from other clients, suppliers are likely to choose a preferred mobile/tablet provider and make their product fit for purpose. Others may not consider any investment in this space. NHSScotland Health Boards may choose different devices to provide services to their clinicians, potentially leaving suppliers in a position where they must support 3 different platforms for one system. All of this is likely to increase cost pressures on IM&T over the next 5 years. This is without considering the necessary support models and structures required for mobile working.

Patient centred care is an integral part of delivering healthcare. With the increasing penetration of smart phones, tablet devices and the internet usage, it should be expected that patients will demand more information about their care pathway, and to see more of their data on-line. Whilst this is currently a mostly passive relationship with the citizen, increasingly this will change, following the success of initiatives such as 'My Diabetes, My Way', and through telehealth and telemedicine initiatives. Boards will need to increasingly cater for this type of interaction. In-line with equity of access policies, and consistency of care across Scotland, this will require much greater standardisation across the NHS both in IM&T and in some instances care delivery. eHealth Departments will increasingly find themselves in the middle of this, having to securely make data available, and harmonise systems across their portfolio.

With the procurement of TrakCare, and the deployment of Clinical Portal, there is an increasing reliance on IM&T to support NHSScotland activity. As Order Communications is deployed across health boards, it becomes increasingly necessary for IM&T departments to provide 24*7 support. In some cases this is at odds with existing terms and conditions for staff already employed in departments. Increasingly clinical directors will be looking for continuity of support, and the eHealth Leads will need to find a way of providing this. Given the current shape of the workforce, a regional support model, or shared service model may need to be considered, as not all Boards will be able to provide 24*7 support for all systems and services.

Alterations to existing service contracts have the potential to release funding that can be used to encourage smaller and more nimble suppliers. Whilst this may introduce complexity into NHSScotland contract management, the potential benefit is to have a set of suppliers more aligned to eHealth strategy. In addition, such changes will allow NHSScotland to significantly change key parts of the national IT infrastructure without affecting service delivery. Doing this would allow for re-investment to support some of the opportunities and issues highlighted above.

eHealth Budget Prioritisation

• Effective, efficient and robust IT will be a key element in transforming services.
• 24/7/365 require resilient and robust IT systems, primary and Secondary care now totally reliant on IT systems (e.g. Patient Management System, GP IT systems, Emergency Care Summary). Although these systems are reliable there have been examples of system outages or capacity issues that illustrate how reliant the NHS is on IT in its daily operations.
• A key element of the patient safety programme is improving and reconciling medications. The introduction of a HEPMA system to Hospitals is important in completing the electronic patient record.
• The recent Out of Hours review highlighted the dependencies on IT and access to information.
• Public expectation is for more sharing of information across primary and secondary care and in the wider health and social care setting.
• The developing clinical strategy also sees IT playing a key role.