Delivering paperless electronic patient records

1. Delivering paperless electronic patient records Brian James, Chief Executive The Rotherham NHS Foundation Trust

2. The Rotherham NHS Foundation Trust • District General Hospital; 650 Beds • Population served c.320,000; 3,500 staff • CQC rated “Double-Excellent” (07/08, 08/09 and provisionally for 09/10) • Monitor rated “Double-Green” • Amongst the lowest waiting times in the NHS • Amongst the lowest HCAI in the NHS • CHKS 40Top Hospital 2008/9 and 2009/10 • Health Investor Magazine’s “FT of the year” 2009

3. Why we went outside the National Programme • A burning platform? Originally due for replacement in 2004 (20 years old) • No further development by McKesson - Notice of intent to withdraw from market in 2010 (now extended) • No clarity around when Lorenzo phase 1 would be delivered or when all 4 phases would be completed • Increasing concern as to whether it would be fit for purpose and ‘State of the Art’ • The anticipated financial position beyond 2011 (before the global financial meltdown!) • Ambition to achieve a step-change in performance - improve quality and safety and to eliminate bureaucracy

4. The challenges we faced • Real concern that NPFIT products would not be fit for “business” • Preceded FTs • Preceded introduction of market reforms • Preceded PbR • New technologies and innovations emerging that would not be included in the NPFIT spec • Real difficulties in engaging alternative suppliers within the National Programme • Significant political opposition to us moving outside the National Programme • The EPR market outside the National Programme was severely depleted • The “Triple-Whammy” threat

5. Stage 1 - Preparing the way • Vision setting – EPR Strategic Outline Case • Initial EPR scoping requirements • Initial market assessment • EPR option appraisal by front line staff (NPfIT / Non NPfIT) • EPR Outline Business Case

6. The Vision (2007) • Paperless Patient Records, not just EPR • Fully integrated HISS environment • Clinician owned and led • Truly transformational – supporting major cultural change • Snomed throughout • Substantial improvements in quality – Safety, Experience, Outcomes, Performance, Value • Simple intuitive interfaces and ways of communicating with the system • A platform for a whole range of other technological innovations: • E.g. RFID/GPS/tracking of staff, patients and equipment • Fully integrated pathways across the system • Spine compliant and able to interface seamlessly with GP systems • Delivered, installed and operational in 2010/11

7. IM&T Strategy • Develop the IT infrastructure • Implement EPR • Implement Data Warehouse • Develop industry standard Service Desk • Support business as usual

8. Preparing the way (2007/8-2008/9) • £8M extra funding over two years • Replace entire Network • 10Gb wired and • 10Gb wireless • Two new Computer data centres with VM Ware Technology • Desktop replacement programme to latest operating standards (2010)

9. Stage 2 – Procurement • OBS • OJEU • Short-listing • Site Visits UK and USA – Executives and Doctors • Procurement and contractual negotiation • Full Business Case • Final Contract negotiation • Contract Award March 09

10. Financing the Strategy • Solid Business Case developed over one year (despite weak evidence on ROI) • Hypothecation - All Specialties required to fund the investment, equal to a 2.2% recurrent CIP • Capital sourced from NHS Bank • Repayment by surpluses generated through increased efficiency • Tough approach to benefits realisation

11. Stage 3 - Implementation • Contract let from 1/4/2009 • Phase 1 comprises 14 core and clinical systems and goes live later this year (current schedule is 30 October 2010) • Phase 2 comprises 12 clinical systems and goes live in 2011/12

12. Major advances in RFT Deployment • Paperless across entire patient pathway • Snomed drives the clinical input across the entire patient journey • Internal Service Improvement Teams drive redesigned processes using lean principles: • Current State • Ideal State • Future State • Use of third party (Dell/PEROT) to undertake configuration to support redesigned processes • Sophisticated Project Management, governance, assurance and risk management processes • Massive attention paid to benefits realisation

13. Why Meditech? • World Class System • Truly integrated solution • Doctors liked it best • Responsive and flexible supplier • Competitive price

14. Our Experience so far • Initial problems in getting the suppliers to work well together (Filetek, Meditech, PEROT) • The trust are having to drive Anglicisation and the SNOMED development hard • Unrealistic expectation of Trust resources (and we have had to significantly increase internal resources accordingly • Suppliers want a much looser approach to project management and delivery • Supplier commitment to succeed

15. Risks & Challenges • Unhelpful SHA • Complexity of programme management • Anglicisation of product • Securing a stable project plan • Recruitment of skilled staff with relevant experience • Training – skills, numbers, facilities, timing • Data Migration – deciding what to transfer to the new system • Managing to time and budget • Clinical engagement and ownership of the benefits • The clinical-user interface • Realising the benefits • Relationships with the suppliers • Process redesign & configuration consumes enormous HR