INFORMATION MANAGEMENT AND TECHNOLOGY STRATEGY - Health in Wales

YMDDIRIEDOLAETH GIG CEREDIGION A CHANOLBARTH CYMRU CEREDIGION AND MID WALES NHS TRUST

INFORMATION MANAGEMENT AND TECHNOLOGY STRATEGY

Author Head of IM&T Equality impact Low Original Date September 2002 This Revision November 2005

Equality assessment done No

Next Review Date May 2007 Review Body IM&T Steering Group Approved by IM&T Steering Group Policy Number CS06 Date of Approval November 2006 Classification Corporate Strategies

Information Management and Technology Strategy 2003/2006 Version 1.7 - ii -

Version Control

Revision and approval History Revision Date

Previous Revision Date

Summary of Changes

Approval date Version Status

September 2002

N/A Initial Draft 1.0 Draft

Sept 2002 Sept 2002 IM&T Security Group 1.1 Draft March 2003 Sept 2002 IM&T Steering Group 1.2 Draft May 2003 March

2003 Management Board 1.3 Draft

June 2003 May 2003 Trust Board 1.3 Draft October 2003 June 2003 IM&T Steering Group 1.4 Draft November 2004

October 2003

IM&T Steering Group 1.5 Draft

March 2005 November 2004

IM&T Steering Committee 1.6 Final Draft

November 2005

March 2005

IM&T Steering Committee 1.7 Final

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Preamble: Version 1.7 of this Strategy reflects a major shift in the composition and direction of the Ceredigion and Mid-Wales NHS Trust’s Information Management and Technology Directorate. Modifications from the previous version include:

• An update of previous goals and objectives. • Goals and objectives pertaining to the Clinical Audit, Library Services and Research

and Development Departments. • The incorporation of Health Records and Partial Booking into the Information

Management Department. • The Electronic Staff Record (ESR) Project. • The Informing Healthcare (IHC) Programme. • The Unified Assessment (UAP) Project. • The Innovations in Care (IiC) Programme, comprising the Telemedicine, Out of Hours

(OOH), Hospital at Night and Theatres Utilisation Projects. • The All-Wales Project for Access to JANET. • The Design for Life (DfL) Programme

The role of this document has fundamentally changed; it now acts only to outline the strategy. A supporting tactical plan will be produced on an annual basis to provide implementation details. This new plan will be available for scrutiny in November 2005, the basis of which has been identified in appendixes A, B, and C of this document.

Mark Bouchier 28/09/2005

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Table of Contents:

Version Control ii

Preamble iii

Table of Contents v

STRATEGIC OBJECTIVES AND POLICY 1

1 Introduction 1

2. All Wales Strategic Aims 1

3. Trust Approach 2

4. Areas of Focus 2 GLOSSARY OF TERMS 8

APPENDIX A – TRUST CLINICAL SYSTEMS 10 APPENDIX B – TRUST ADMINISTRATION SYSTEMS 16 APPENDIX C – TRUST NETWORK SERVICES 18

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STRATEGIC OBJECTIVES AND POLICY

1. Introduction

1.1 The Information Management and Technology (IM & T) strategy has been developed in the light of the Welsh Assembly Government’s (WAG) All-Wales IM&T Strategy document “Informing Healthcare”, and is designed to promote the use of Information and Information Technology (I & IT) by clinical, professional and management staff.

1.2 The Trust’s Strategy is a dynamic document that will respond appropriately to

changes in the wider service development agenda, both external and internal. It is the intent that changes post consultation will be incorporated in this manuscript.

1.3 The detail in this strategy is based upon previous consultative exercises, updated by

recent interviews. Its content records the views and aspirations of staff who have participated in the planning process to date.

2. All Wales Strategic Aims

2.1 “Informing Healthcare” sets out an ambitious vision for IM&T development in Wales over the next 10 years. The document acknowledges that too often in the past IM&T strategy in the NHS has concentrated on structural rather than process change. Its purpose is to deliver healthcare improvements through a clear and co-ordinated strategic direction that all organisations, healthcare professionals and patients can support. It identifies five strategic programs for action;

• New and improved care processes, supported by technology. • A highly skilled, information literate and informed workforce. • Patients empowered to share decision-making about their care • A single integrated electronic health record for each and every patient. • Better use of information.

The overarching objective is the creation of an evidence-based culture.

2.2 A number of parallel initiatives within Wales and across the NHS1 have reiterated the

central role of information in supporting the planning, recording and management of activity.

2.3 To date considerable effort has gone into the improvement of financial and activity-

based management information. Unfortunately, the same has not been true for information used to support improvement in clinical service delivery and quality.

2.4 “Informing Healthcare” recognises that the single integrated electronic health record

is the best way to deliver the benefits made possible by recent technological advances. Its undertaking will ensure that all NHS Wales’ organisations and

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1 ‘Information for Health’, ‘Innovations In Care’, NPfIT, Wanless Report, ‘Designed for Life’

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professionals will have appropriate electronic access to patients’ full medical history. It acts to assure the consistency and quality of systems and information used.

2.5 In the short term, the challenge is to deliver improving services with existing

information systems. “Informing Healthcare” sets four objectives for this period (para 5.53);

• Manage new information requirements carefully to ensure realistic

expectations of current systems. • Ensure that the quality and timeliness of information collected is of the

highest standard. • Ensure improvements to the flow of management and planning information

are undertaken commonly and corporately across Wales. • Ensure that information analysts and analytical tools are available both locally

and nationally.

3. Trust Approach

3.1 In support of the All Wales Strategic Goals and Objectives, the Trust commits to the following precepts:

• In order to provide effective support to clinical services, governance and

management requirements, the Trust’s IM&T services must be of the highest standard.

• Trust staff should have access to information, knowledge, and IT services whenever and wherever they are required.

• Information for planning and management needs to be derived as a by-product of supporting core operational processes.

• Information must be shareable within the NHS, and externally to partner agencies, as is deemed appropriate. In support of this, information sharing protocols and agreements are to be developed and implemented.

• Staff confidence and competency in information management, knowledge management and information technology must be addressed systematically through comprehensive, ongoing training.

• Information must be accurate, complete, relevant, contextual and secure. Further, its confidentiality must be appropriately protected.

• The Trust must observe the requirement of the Data Protection Act, Freedom of Information Act, Caldicott Guidelines and other relevant legislation together with compliance to BS7799.

4. Areas of Focus

4.1 Training and Development

4.1.1 It is recognised that healthcare modernisation cannot be delivered through new systems alone. Staff training and development are seen as key enablers.

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4.1.2 Until recently, the Trust has had no provision for desktop applications, health informatics, or IM&T professional training. In an acknowledgement of this situation, the IHC Programme has chosen to target these areas as part of its ‘Access to Learning’ (A2L) initiative. Funding has been provided to hire trainers as well as set-up training and testing facilities for the ‘European Computer Driver’s License’ (ECDL). The Trust commits to fully implement and support the A2L initiative and the ECDL project.

4.1.3 At present, the Trust provides only minimalist training on its corporate systems.

This service is typically provided around induction; in most cases by key users. Aside from Myrddin, which has a dedicated full-time trainer, the Trust has no on-going programme of applications level training. IM&T will work with the departmental systems managers and Human Resources to remedy this situation through the implementation of structured systems training programmes. It is our goal to leverage the facilities provided by the A2L initiative as part of this remediation.

4.1.4 The Trust commits to providing a high quality, managed IT training

environment.

4.1.5 Wherever possible and appropriate, the Trust will work with partner agencies to develop an integrated approach to IT and Informatics training.

4.1.6 In its role as a leader in change, the IM&T Directorate commits to the continuing

professional training of its entire staff through the existing IPR process and the new initiatives described above. Further, the Directorate commits to aiding other areas within the Trust seeking the same objective.

4.2 Information in the Clinical Environment

4.2.1 A primary goal of IM&T is be to provide clinically relevant, information and knowledge-based systems to practitioners.

4.2.2 The development of clinical practice to a position where it is truly evidenced

based and meets the highest expectations of patients is dependant on accurate, timely and appropriate dissemination of information and knowledge.

4.2.3 The Trust supports the provision of Clinical Governance in parallel with the

delivery of high quality health care. Crucial to this endeavour is on-demand, point of care access to appropriate, evidence-based, reference information. Through their roles as identifiers and providers of knowledge, the Trust Library, Telemedicine Service, Clinical Audit Service, and Research & Development Department are seen as fundamental to success. The IM&T Directorate commits to working with clinical users to develop practical solutions to their Governance needs.

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4.2.4 In order to enable the organisational objectives for Clinical Governance and the delivery of high quality care, IT implementations within the Trust will be ubiquitous and user friendly.

4.2.5 All patient data will be linked directly to that individual’s NHS number. This

unique identifier will form the basis for all clinical systems and clinical process integration.

4.2.6 Information for planning and management is to be collected as a by-product of

supporting core operational processes. Data is to be captured once, and validated upon each subsequent contact. Data capture is to occur at the point of contact/care.

4.2.7 As deemed appropriate, information will be shareable across the NHS and with

partner organisations. The benefits of this sharing are derived from fundamentally changing the pattern of health and healthcare provision.

4.2.8 Following on from recent successful implementations, and in line with All-Wales

objectives, the Trust’s clinical coding function will be expanded to include A&E encounters and GP Referrals/outpatient visits.

4.3 Records Management

4.3.1 The Trust is committed to a systematic and planned approach to the management of records, and understands the importance of robust records management. A culture of recognising the importance of competent records management is continuously being developed within the organisation. Effective records management enables the Trust to manage and control the quality and quantity of the information it holds. It will assist in ensuring the Trust is able to provide high quality healthcare and manage its services effectively. Good records management is also essential if the Trust is to meet the requirements of numerous Acts of Parliament, Welsh Health Circulars and other NHS related standards.

4.3.2 With the increased use of technology, the Trust needs to move towards having

more records held electronically. If done centrally, this would help ease storage problems, reduce duplication and improve accessibility. The continued development of the intranet site will assist this by allowing easy access to electronic copies of documents. The long term movement from paper to electronic media will resolve several issues such as storage, health and safety and appropriate retention. This would be in keeping with the development of the Single Integrated Electronic Health Record and the Electronic Staff Record.

4.3.3 The Trust has developed a Records Management Strategic Framework to outline

the future of records issues within the organisation. It has also developed a Records Management Policy which outlines the issues and requirements for creation, storage and disposal along with the retention times. Retention of records is based on the nature of the information and not the format, and as such electronic information is given the same consideration as manual records. It also


outlines the responsibilities for staff throughout the organisation with regards to the handling or management of records.

4.4 Legacy Systems Management

4.4.1 As a consequence of “Informing Healthcare”, it has been deemed necessary to limit further piecemeal development of local IT solutions.

4.4.2 A central negotiating team has been established to bring support agreements and

replacement plans for significant clinical systems into a single, co-ordinated plan. Extensions to existing contracts, most notably TelePATH, have provided breathing space for transition onto IHC compliant solutions.

4.4.3 In Ceredigion, whilst a number of systems are coming due for replacement (e.g.

Telepath, Swift Pharmacy, Theatres, PROTOS and Endoscribe) opportunities for limited enhancement of existing systems (i.e. Myrddin) do exist pending the “All-Wales Solution”.

4.5 Information Technology

4.5.1 The IT Department is committed to providing a superior quality of service.

4.5.2 Due to previous under-funding, the Trust has lagged behind the rest of NHS Wales in its development and use of information technology.

4.5.3 It is acknowledged that many of the existing IT issues will be resolved by the

influx of funding from the ‘Informing Healthcare’, ‘Innovations in Care’, and other such programmes. To maximise this one-time benefit and to position ourselves for the future, a number of significant changes are required to the IT Department’s operations. These include:

• Implementing industry best practice models, such as the BS7799. • Developing an on-going training programme to improve the technical and

professional competency of IT staff. • Extending the scope and penetrence of the network systems out of hours

support. • Increasing the number of technical analysts to cope with a larger and more

complex technical infrastructure. • Implementing the PRINCE 2 or other such project methodology for tasks

of greater than two weeks in duration. • Extending IT involvement to all Trust projects. • Revisiting the existing helpdesk facility. Current issues surrounding the

inaccessibility of IT support staff, job feedback, and turn-around times must to be resolved if end-user confidence are to be achieved.

• Development and implementation of an asset management strategy, incorporated into the helpdesk management system.


• Development of disaster and contingency plans with departmental system managers and key users.

• Development of a formalised capacity growth strategy, prepared in conjunction with Finance, Estates and departmental systems managers.

• Development and implementation of change, configuration management, back-up and printing strategies.

• Creation of system specific managed test environments, to minimise the deleterious effect of testing in a ‘live’ environment (as is the case currently).

• Involvement in user department re-engineering efforts to develop seamless, integrated processes, products and services.

4.5.4 Presently IT revenue funding reflects only staffing costs and some network

infrastructure support. The IM&T Directorate commits to working with finance to develop a sustainable, mutually agreeable, funding arrangement.

4.6 Library Services

4.6.1 Library services are currently provided at the Bronglais General Hospital site to

all Trust Staff, Junior Doctors, Medical, AHP and Nursing Students, Vocational Training Scheme (VTS) GPs, and members of the local healthcare community.

4.6.2 In an effort to maintain the relevance of its services, the library has kept itself

technologically up to date. Current efforts include implementation of the All Wales project for access to JANET (University Research Network), upgrade of the existing PC network, and implementation of a new Library server.

4.6.3 As a key provider of knowledge, the Library will be instrumental in the Trust’s

identification and delivery of clinical best practice to the point of care. The Trust commits to the Library’s involvement of this integrated solution, and to the service’s further enhancement.

4.7 Clinical Audit 4.7.1 The Clinical Audit Department has recently undergone a transformation in its

service provision; its role has fundamentally changed from that of a clerical service to that of a professional, consultative service.

4.7.2 The Clinical Audit function within the Trust is fundamental to the provision of

Clinical Governance and Clinical Knowledge Management. In response to this, the Trust commits to the on-going professional development of Audit Staff and to the implementation and enforcement of an Audit framework.

4.7.3 The IM&T Directorate commits to working with the Trust’s clinical community

to further expand and enhance the services provided.


4.8 Research and Development 4.8.1 Although only under IM&T Directorate administration, the Research and

Development Department offers a unique opportunity to positively impact the provision of patient care by identifying new methods of improving clinical effectiveness.

4.8.2 In support of this beneficial service the Trust commits to:

• Comply with the WAG Research Governance Framework. • Ensuring that R&D is recognised as an integral part of healthcare and of

service development within the Trust. • Direct research activity in the Trust priority areas. • Ensuring effective management and support of R&D


Glossary of Terms

BS7799/ISO17799 The Information Security Management standard accepted by

the NHS that the Trust is working to achieve compliance with.

Caldicott Report NHS guidance on the protection of patient information,

especially looking at whether the use of patient information is necessary and the extent of any uses.

Citrix Brand name for a thin-client product supplier ECDL/ICDL European Computer Driving License/International Computer

Driving License. Currently being implemented in the NHS as a minimal standard for IT skills

EHR Electronic Health Record, a longitudinal (i.e. cradle to grave)

view of electronic patient data EPR Electronic Patient Record, the acute (i.e. encounter specific)

view of electronic patient data Firewall An electronic barrier or filter residing between the Trust and

the outside world. Its role is to block unauthorised network traffic from entering or leaving the Trust.

HRG Healthcare Resource Group, a designation to associate

individuals with similar disease states for comparison. HSW Health Solutions Wales ICD10 International Classification of Diseases version 10 Informing Healthcare The Welsh Assembly Government’s strategy to support the

modernisation of health services in Wales using information and communication technologies. Combining new working methods and new technologies with better management of knowledge and better support for patients and carers.

Interface engine An application or middleware which allows the transfer of

information from one system to another through data translation.

IP/VPN Internet Protocol - Virtual Private Network. ISDN Integrated Services Digital Network. The digital version of a

phone line and can be used for either data or voice transmission.


LAN Local Area Network Myrddin The Trust’s Patient Administration System NPfIT The National Programme for Information and Technology in

NHS UK OPCS4 Office of Population, Census and Surveys coding standard,

version 4 Order communications The ability to raise electronic orders for systems and services

such as Pathology and Radiology PACS Picture Archiving and Communication System. Used by the

Trust for remote access to radiological images Partial Booking A process which allows hospital staff and patients to agree a

mutually convenient appointment times, thus reducing the likelihood that a patient will not attend.

PAS Patient Administration System (Myrddin) READ3 READ Clinical terms, version 3. Used in the UK as the

standard for clinical coding. SMTP Simple Mail Transfer Protocol. Internetworking protocol for

transmitting e-mail between systems SMOMED CT System Nomenclature for Medicine – Clinical Terms. The

supersedant of SNOMED RT, which incorporates the functionality of READ3, OPCS4 and ICD10 coding systems. NHS UK plans to move to this evolving standard as part of the NPfIT.

SWift Pharmacy Product name for the pharmacy software, developed by the

NHS South-West Information Systems Technology Group, sold to EDS, and sublicensed to Health Solutions Wales

Thin Client technology Software which allows applications to be hosted centrally on

servers, with data output provided by Windows terminal devices.

Waiting list List of patients booked for inpatient or day care admission or

first outpatient attendance, as appropriate WHCSA Welsh Health Computer Support Agency; the former name

for Health Solutions Wales


APPENDIX A – Trust Clinical Systems

A.1 MYRDDIN

A.1.1 The system was created by the software development team of Carmarthenshire NHS Trust in co-operation with Ceredigion and Mid Wales NHS Trust. The system acts as our ‘Gold Standard’ for patient information and comprises: admissions; discharge and transfer (ADT) functionalities; the Trust’s master patient index (MPI); and patient management reporting.

A.1.2 New clinical functionalities such as an Accident and Emergency (A&E) module,

a Theatres module and a Community Module are currently in test. With their addition, Myrddin’s role will change from that of a Patient Information System (PAS), to that of a Clinical Information System (CIS). Further modules, such as Midwifery and electronic discharge summaries are currently under development.

A.1.3 Expansion/clinical enhancements to Myrddin are seen as transitional steps to an

Informing Healthcare solution, and not as alternatives

A.2 RADIS

A.2.1 The Trust uses the WHCSA developed Radiology Information System (RADIS)

which effectively provides an administrative facility to the department.

A.2.2 The application is developed on a second generation PICK database, with access provided through video display units (VDUs) or terminal emulation. A browser-based, dedicated RADIS results viewer is presently in service for extra-departmental reporting.

A.2.3 RADIS is currently being upgraded to incorporate a three-tier, client server

architecture (Version 3). This change will require the purchase of a new web server plus the replacement of all terminal server-based (serial) devices. The current HSW project schedule has the product ready by June 2005; Ceredigion and Mid Wales NHS Trust are being targeted for implementation in January 2006.

A.2.4 At present RADIS only integrates with the Department’s PACS system.

Following the upgrade to RADIS v.3, a unidirectional in-bound interface from Myrddin will be possible. An order communications interface will not be available for the foreseeable future.

A.3 PACS A.3.1 The Trust implemented the Insignia Picture Archiving and Communications

System (PACS) in February 2004.


A.3.2 The system provides online radiology image storage and retrieval. This has enabled the development of a teleradiology service at the Trust, and a migration from hard copy storage of x-ray films.

A.3.3 Due to the prohibitive cost of diagnostic quality, 4K PACS workstations (approx.

£35,000 ea.), these resources are currently only available within the Radiology Department. Recent missed fractures in A&E may require that this technology has a wider distribution.

A.3.4 Hard-wired or TIMS Box integration are now available to most x-ray modalities

at the Bronglais site. Future consideration will need to be taken into account of those modalities at Cardigan, Aberaeron and North Road sites.

A.3.5 The development of a demographics interface between Myrddin and RADIS will

have a knock-on benefit to PACS.

A.3.6 There may be future opportunities for the incorporation of Pathology, Ophthalmology, Diabetology, Podiatry and Dermatology images into the system, thus forming the basis of a patient clinical image repository.

A.4 TelePATH

A.4.1 The Trust uses the TelePATH ‘Classic’ product, comprising modules for Biochemistry, Histology, Microbiology, Haematology, and Blood Bank. This system is now at end-of-life and requires immediate replacement. Although the original support lapses in April 2005, the IHC Team have negotiated a three year contract extension to allow for the purchase of, and transition to a new system. An IHC led All-Wales Pathology Systems procurement is sought.

A.4.2 TelePATH is interfaced via ICS-Talk (integration engine) to the ICS data-

warehouse for electronic results reporting to wards. Results are currently limited to ‘Trust-only’ requests for Biochemistry and Haematology. Information sharing agreements with the Ceredigion LHB and local GP Practices will allow for the reporting of all Biochemistry, Haematology, Blood Bank and Microbiology results. Further negotiations may allow for the provision of some Histology reporting. The Trust’s objective is controlled internal access to full Pathology reporting.

A.4.3 Electronic GP results are provided via the Anglia ICE system. Although

virtually all local GP Practices can now receive results, not all Pathology results are sent. Work is currently underway to provide Practice and GP Clinic-based Histology results as well as Microbiology Results. The Trust’s objective is the provision of electronic results for all GP requested Pathology tests.

A.4.4 TelePATH is interfaced via ICS-Talk with Myrddin for patient demographic

data. Limitations of the current interface have diminished the benefit of the systems integration; due to truncation of the in-bound names, patients can not be


identified properly. The technical and process issues surrounding PAS integration are to be resolved in preparation for ‘Informing Healthcare’.

A.4.5 At present TelePATH’s architecture does not support the electronic order

communications required by IHC. Most ‘work arounds’, such as the use of screen-scraping, technology are deemed to be too risky to warrant consideration as interim solutions. The use of 2D barcodes may offer a possible exception. Work is currently underway through the ‘Bronglais Links’ Forum to investigation this option. The ability to receive electronic order communications will be compulsory for any TelePATH replacement.

A.4.6 The lack of an electronic order communications interface to GP systems, as well

as poor records maintenance, has resulted in large number of records with poor quality patient identifiers. As part of the Trust’s IHC ‘Data Cleansing Project’ work is currently underway to apply NHS numbers; merge duplicate patients; clear down interface queues; and to improve maintenance procedures.

A.5 SWift Pharmacy

A.5.1 The Trust uses the EDS developed/WHCSA modified SWift Pharmacy System. Hosted locally, this implementation provides service to all of Ceredigion and North Powys.

A.5.2 As it is currently used, the system provides only drug inventory, stock

management and ordering functionalities, and is largely non-patient based. There is no capability to support electronic prescribing or medicines management as required by IHC. There is no demographics interface to Myrddin.

A.5.3 A simple interface to the Trust’s General Ledger (GL) exists via the SWift

Report Generator, file transfer protocol (FTP), and the Oracle Open Interface.

A.5.4 Due to its advanced age, loss of hardware and database support, limited functionality, and criticality to IHC, the SWift Pharmacy System needs urgent replacement.

A.5.5 The IHC Programme has included medicines management in its scope, however

has not included the existing ordering and stock management functions. Expansion to IHC scope will be sought to cover these deficiencies.

A.5.6 If procurement of the new pharmacy system is delay, then purchase of

replacement server is advised.

A.6 PROTOS A.6.1 The Trust’s Midwifery service currently uses a standalone, out-of-date version of

the ISoft’s PROTOS Midwifery System.


A.6.2 Access to the system is presently provided on a fixed number of PCs within the Midwifery Unit. Requests have been made to expand this to all community sites and into patient’s homes.

A.6.3 An interface exists to the ‘NHS Numbers for Babies’ service for the provision of

neonate unique identifiers. As there are no interfaces to either Myrddin or the Trust’s Child Health System, this critical information must be transcribed.

A.6.4 Over the next several years it is planned to re-create the PROTOS functionality

in Myrddin. In the interim the PROTOS system will require upgrade and migration to a new server. These modifications will alleviate the existing integrations deficiencies.

A.7 Child Health 2000

A.7.1 The Trust utilises a local, standalone implementation of the WHCSA Child Health 2000 System to track Paediatric encounters and interventions.

A.7.2 Although nominally a clinical system, its main role is more administrative due to

lack of access outside the Bronglais site’s Community Health offices.

A.7.3 The system does not interface to the Trust’s Maternity or PAS systems.

A.8 Accident and Emergency System

A.8.1 The Trust has previously implemented the Accent A&E Product.

A.8.2 Although a multi-user application, access to the system has been limited to two client workstations.

A.8.3 Developed on a DBASE-like platform, the system has proven deficient in its

functionality and report writing capability, and is now slated for replacement by the Myrddin A&E module. Go-live is hoped for by early 2005.

A.9 Theatre System

A.9.1 Theatres currently use a standalone MS Access-based system for patient management. Whilst minimalist in its implementation, the system appears to be well regarded by the staff.

A.9.2 New information demands, driven by the Innovations in Care Programme, are

requiring that the existing system is replaced. A newly developed Myrddin Theatres module is anticipated in April 2005. Implementation of the new functionality will be timed to follow that of the A&E module and the new computer room.


A.10 ICS - Talk

A.10.1 The Trust currently uses the ICS-Talk product for systems integration, data-

warehousing and results reporting. To date, development has been limited to the provision of Trust-ordered Biochemistry and Haematology results. In future it is hoped that this service will be expanded to all Pathology and Radiology reporting, and that there will be a tighter integration to Myrddin.

A.10.2 The appropriateness and functionality of the ICS integration engine needs to be

reviewed, and a determination made whether it should be abandoned in favour of an industry standard platform. If retained, applications training will be required for Information/IT staff.

A.11 WinSCRIBE

A.11.1 WinSCRIBE is a voice recording system used within Radiology to facilitate report transcription into RADIS.

A.11.2 A much needed version upgrade and new server are planned in conjunction with

the inception of the new IT computer room in April of 2005.

A.11.3 This product may be an enabler to services elsewhere in the Trust such as Theatres and Pathology. An evaluation of its potential should to be performed after the system upgrade. Alternate more cost effective approaches to this technology, such as voice dictation, should be considered.

A.12 Endoscribe

A.12.1 Endoscribe is a standalone, single-user, MS Access-based system utilised for the recording and reporting of Endoscopic examinations.

A.12.2 Acquired as a donation from a Pharmaceutical company, Endoscribe has

historically never had either hardware or software support. The product has now been put into ‘Legacy’ status by ISoft, and no upgrade path has been defined.

A.13 Out of Hours System (ADASTRA and Plain Software)

A.13.1 The Out of Hours (OOH) Service was acquired by the Trust from a local GP Co-operative in September of 2004. At that time, the existing ADASTRA System was enhanced through its interfacing with Plain Software to provide not only call handling but patient demographics and contact details as well. Further systems and process integration with the former Pembrokeshire Doctors on Call has resulted in a robust, regional Out of Hours Service.


A.13.2 Currently operated in a standalone configuration with dial-up connectivity to Pembrokeshire Doctors on Call, the system will be migrated to Haverford West when the ADASTRA software is upgraded to version 3.0 sometime in June 2005. At that time access will be provided via DAWN to both the Bronglais and Cardigan Hospitals, as well as the Llandysul Surgery.

A.13.3 Following the ADASTRA v3 upgrade, it is planned to use the system to provide

electronic discharge summaries to local GP practices. It is hoped that this service will be in place by December 2005.


APPENDIX B – Trust Administration Systems

B.1 Oracle Finance and Procurement System

B.1.1 In 2002, the Trust implemented the All Wales Finance Management Information System comprising accounts payable, accounts receivable, general ledger and procurement modules. To date this system has proven very successful.

B.1.2 Rollout of enhanced systems functionality, using the ‘Discoverer’ product, is

currently underway to selected finance and Senior Management staff.

B.1.3 Expansion of the user base is planned. This will be contingent on the provision of adequately configured PCs and network infrastructure provided by the Informing Healthcare and Innovations in Care Programmes.

B.2 WHCSA Standard Payroll System

B.2.1 This service is currently provided through the WHCSA Standard Payroll System, hosted by the Carmarthen NHS Trust.

B.2.2 The product has been developed over many years to meet the complexity of the

NHS Staff payment agreements (“Whitley Councils”).

B.2.3 There is no online integration with Personnel Management and almost all of the supporting processes are paper-based.

B.2.4 Historical information is available to the Trust via Payroll Data Query (PDQ).

At present this service can only be accessed by one user at a time.

B.2.5 There is no close integration with finance systems; updates are unidirectional batch processes.

B.2.6 The NHS Electronic Staff Record (ESR) project is planned as the replacement

for the Standard Payroll System. It is expected that the Trust will implement this new system in November 2006.

B.3 Great Plains Human Resources System

B.3.1 The Personnel Department currently uses Microsoft’s Great Plains Human Resources System to provide the department’s internal processing and record keeping needs for recruitment and training.

B.3.2 Further development is desirable, but will be limited by the expected rollout of

the ESR, as mentioned previously.


B.4 SAFECODE Health and Safety System

B.4.1 The unified incident reporting system (SAFECODE) is single user, standalone system, maintained by the Facilities Directorate.

B.4.2 The ability to log incidents online is currently not available, and all reporting

systems are paper based.

B.4.3 Recently plans have been announced to further develop this as a network application. If this work were to proceed, consideration must be given to integrating risk management into the solution.

B.5 Libero Library System

B.5.1 The Libero System is used in a limited manner to manage the Trust’s library collection.

B.5.2 The current implementation resides on a local server within the library, and

operates on a separate domain to other Trust applications.

B.5.3 With the advent of the new computer room in April 2005, the server will be centralised and the application will be upgraded from v3 to v5.

B.6 Nurse Bank System

B.6.1 The existing system was developed in-house using an access database running on a network applications server.

B.6.2 Due to reliability problems and limitations within the application, it has been

decided to use Innovations in Care monies to replace the system with off the shelf software. It is anticipated that this work will be completed by late April, 2005.


APPENDIX C – Trust Network Services

C.1 Local and Wide Area Networks (LAN and WAN)

C.1.1 Bronglais Hospital was part of the All Wales Cabling Project which provided the site with an extensive LAN infrastructure. This has subsequently been enhanced, providing a 1 Gb/sec backbone, and 100 MB/Sec to the desktop. The other Trust sites have varying degrees of wiring installed. IHC Programme funding will allow IT to raise these to a common standard by April 2006.

C.1.2 An 802.11b wireless LAN is currently installed in the student residences. This

facility is currently being upgraded to the 802.11g standard, providing a high speed secure DAWN access to the undergraduate medical students. The upgrade is slated for completion in March 2005.

C.1.3 As of February 2005, all of the Ceredigion and Mid-Wales NHS Trust sites have

been connected as part of a corporate wide area network (WAN). This network comprises: a) an 8 Mb/Sec link to the IP-VPN core from the Bronglais and Cardigan

Hospitals; b) a 2 Mb/sec link to the IP-VPN core from the Tregaron and (recently) the

Aberaeron Hospitals; c) a 10Mb/Sec LES10 circuit from the Bronglais Hospital to the North Road

Clinic; and d) a 2.0 Mb/Sec Symmetric Data Subscriber Line (SDSL) link between the

Bronglais Hospital and the Pantyfedwen Site.

C.2 Dial-Up Services C.2.1 Dial-up services are currently provided by HSW over the Public Switched

Telephone Network (PSTN), using strong authentication.

C.2.2 In most cases, this facility is used to provide access to administrative information residing in user directories on the Trust’s Network Attached Storage devices (NAS).

C.2.3 As the demand for remote access to corporate clinical applications grows, data

encryption and network bandwidth constraints will become critical. CITRIX thin client technology over dial-up is seen as possible solution to these issues.

C.3 Video Conferencing/Telemedicine C.3.1 The Trust currently operates five sets of video conferencing equipment, one each

in: the Trust Headquarters; the Tregaron Hospital; the Cardigan Hospital; the Post Graduate Centre; and the Bronglais A&E Department.


C.3.2 Although still in its infancy, this service has already proved its worth for multi-disciplinary team meetings with regional centres.

C.3.3 Through the Innovations in Care Programme, funding has been provided to link

the Community Casualty Departments with the Bronglais A&E Department. It is planned that this work will be completed by June 2005.

C.3.4 A number of additional projects have recently been proposed, however, further

development will be contingent on recurring funding for the Project Manager position.

C.3.5 The potential of Telemedicine in a rural Trust is immense. It is important that

the organisation is at the forefront of developments in Wales in this area.

C.4 Office Applications

C.4.1 The Trust has adopted Microsoft Office XP Standard Edition for the desktop. This applications suite includes: MS Word; MS PowerPoint; MS Outlook; MS Excel; and MS Internet Explorer.

C.4.2 A number of older PC operating systems and desktop suites currently exist

within the Trust. These have now been identified, and will be targeted for replacement as part of the Informing Healthcare PC roll-out. Desktop standardisation should be achieved by April 2006.

C.4.3 Due to security and performance issues, MS Access is not supported by the

Trust. Other applications such as AutoCAD LT, MS Visio, MS FrontPage and MS Project may be used as deemed appropriate by the IT Department.

C.5 E-mail

C.5.1 The Trust has recently standardised on Microsoft Exchange 2000 Server and Microsoft Outlook for the provision of E-Mail services.

C.5.2 A project is currently underway to transfer the remaining users of GroupWise

v5.2 to this new platform. This migration should be complete by April 2005.

C.5.3 It is intended that all staff will have a Trust e-mail account by April 2007.

C.6 Anti-Virus

C.6.1 The Trust has an active policy of PC/system protection from virus attack.

C.6.2 SOPHOS antivirus software is now included on all servers and as part of the standard desktop.


C.7 Firewalls

C.7.1 The Trust is protected from internet attacks by an All-Wales central Firewall,

however there is currently no protection from DAWN-based assaults.

C.7.2 In January 2005, the Informing Healthcare Programme provided the Trust with CISCO PIX Firewalls for use at the Bronglais, Aberaeron, Cardigan and Tregaron Sites. All of these (excepting Aberaeron) have now been installed in pass-through mode. It is anticipated that ‘Hardening’ of the devices will be done on all Wales basis by September 2005.

C.8 Thin Client Technology

C.8.1 Thin Client technology, in its simplest form, reduces network traffic by transferring key strokes to a central server for retention. This facility reduces the Trust’s “cost of ownership”, allows for improved system support via centralised shadowing and significantly improves security arrangements.

C.8.2 The use of thin client would allow for progress to be made for across site

working.

C.8.3 A CITRIX pilot is currently underway in the Myrddin Training Room. With the advent of the new computer room and the installation of two integrated CITRIX servers, it will be possible to widen the use of this modality.

C.9 Computer Room Facilities

C.9.1 The IT Department currently operates a single computer room in Delfryn, on the Bronglais site. Other Departments such as Pathology, Radiology, Library, Pharmacy, and Estates have their own facilities.

C.9.2 Due to floor loading restrictions in Delfryn, a new purpose-built computer room

is currently being constructed in the former radiology film library at Bronglais. When completed, in April 2005, all Radiology and IT rack-mount servers will be centralised there. Mid-term plans include the centralisation of all remaining servers.


INFORMATION MANAGEMENT AND TECHNOLOGY STRATEGY - Health in Wales

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