Implementing IDX Carecast

Implementing Carecast:
The UCLH Experience
Kevin Jarrold
Director of Information Management
& EPR Project Director
Wednesday, 24
November 2004
Issues to Address
• Communications and getting staff on-board
• The effect of having a new build going on at
the same time: has it helped or hindered?
• Technical matters such as configuration, data
migration, functionality, etc.
• The supplier's understanding of the NHS
• Resourcing and training
Wednesday, 24
November 2004
Planned Agenda
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Some background on UCLH
Overview of the new hospital scheme
The EPR project
Progress to date
UCLH EPR and the CRS
Key issues moving forwards
Wednesday, 24
November 2004
Overview of UCLH
• The Middlesex Hospital
• University College Hospital
• The Obstetric Hospital & Elizabeth Garrett
Anderson Hospital
• National Hospital for Neurology &
Neurosurgery
• Eastman Dental Hospital
• Hospital for Tropical Diseases
• The Heart Hospital
• Royal London Homeopathic Hospital
Wednesday, 24
November 2004
Eight Hospitals - One Vision
Wednesday, 24
November 2004
Key Facts
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Annual turnover of circa £400m
Staff employed 6,000
1000 beds
One of the largest NHS Trusts
National specialities - some world class
One of the largest build projects in the NHS
Association with University College London
Part of the North London hospital network
Wednesday, 24
November 2004
New Hospital
• The Middlesex Hospital
• University College Hospital
• The Obstetric Hospital & Elizabeth Garrett
Anderson Hospital
• Hospital for Tropical Diseases
• National Hospital for Neurology & Neurosurgery.
• Eastman Dental Hospital
• The Heart Hospital
• Royal London Homeopathic Hospital
Wednesday, 24
November 2004
New Hospital - the Vision
• Where we are now…
– World class health
care delivered from
Victorian buildings
– Huge underinvestment in
maintenance
– Struggle to meet
modern standards
– Green screen
technology
Wednesday, 24
November 2004
• Where we want to be...
– £422m PFI scheme
for state of the art
hospital
– Vision for a
University/Health
campus
– Designed on the
assumption that it
will be paper light
– Clinical commitment
The New Hospital – The Reality
Wednesday, 24
November 2004
Wednesday, 24
November 2004
IT – The Challenge
• Work to a fixed date for the opening of the New
Hospital
• Deliver paper light operation to fit with the vision and
design assumptions
• Retain four existing hospitals so it is not green field
• Do it under PFI and traditional procurement process
• Change software part way through the project
• Do it while the National Programme is emerging and
changing the world
Wednesday, 24
November 2004
EPR Project Scope
• EPR environment
– Organisation-wide scheduling
– Clinical noting and alerts
– Electronic ordering and results reporting
• Delivery of Managed IM&T Service
– Provide the Trust IT Department
• Network the new hospital
– Data and voice
Wednesday, 24
November 2004
Selection process & timetable
No
OJEC Advert responses
July 2001
32
Preliminary Invite to Negotiate (ITN) Sept 2001
14
Long List for demos & discussions
Oct 2001
7
Shortlist agreed, ITN issued
May 2002
3
Responses, Negotiations, Demos
Jun-Dec ‘02
3
Final Negotiations, visits
Jan-April ‘03
2
Preferred supplier
July 2003
1
Contract signed
Sept 2003
1
Wednesday, 24
November 2004
Aims of the deal
• Robust specification of what will be
delivered
• Solution that meets user needs
• Provides value for money
• Is affordable
• Can be delivered in time for the new
hospital
• Provides a migration path to CRS
Wednesday, 24
November 2004
Trust commitment...
• Clinical buy-in to the EPR - seen as
critical to the vision of world class
patient care
• Resources for project - procurement
costs were over £1m
• Plan to commit at least £85m of trust
resources over 10 years
Wednesday, 24
November 2004
Key Features of the Contract
• IDX are prime
contractor
• LogicaCMG provide
managed IT service
• 20 staff TUPED from
McKesson to LCMG
• LCMG now employ 40
staff plus 20 on EPR
work
• 24/7 helpdesk
Wednesday, 24
November 2004
• Marconi are installing
active network in the
new hospital
• Wireless LAN has gone
into retained hospitals
• 2,400 new PCs plus
1,000 upgrades
• Standardised on XP
with Active Directory
• Refresh every 4 years
Original EPR Phase Plan
Phase 1 – PAS plus Maternity and A&E
July/August 2004
Phase 2 – Orders/Results, Theatres, TTOs
October 2004
Phase 3 – Clinical applications for movers
December 2004
Move into New Hospital
Phase 4 – Clinical applications – the rest
Phase 5 – Electronic Prescribing
Wednesday, 24
November 2004
April 2005
October 2005
December 2005
UCLH
IDX
Chief Exec (Chair)
Finance Director
Medical Director
Director of Cap. Invest
HR Director
Senior Clinician
UCLH Project Director
MD for IDX UK
Chief Operating Officer
for IDX US
EPR
Implementation
Steering Group
Clinical Boards x3
Nurse lead
Consultant lead
Corporate Services
IDX Project Manager
EPR Project
Team
UCLH Project Director
UCLH Project Manager
Phase leads and stream
leads
IDX Project Director
IDX Project Manager
Phase leads and stream
leads
EPR Project
Board
Wednesday, 24
November 2004
IDX Project Director
Streams
• Application
development
• Application tailoring
• Training
• Testing
• Data Migration
• Interfaces
Wednesday, 24
November 2004
• Management
Information
• PC roll out
• Disaster Recovery
• Security
• Cut-Over Plan
Streams
• Application
development
• Application tailoring
• Data Migration
• Training
• Testing
• Interfaces
Wednesday, 24
November 2004
• Management
Information
• PC roll out
• Disaster Recovery
• Security
• Cut-Over Plan
Application Development
• Key issues:
– Lastword to Carecast migration
– Anglicisation of the Carecast product
– IDX software development process
Wednesday, 24
November 2004
Lastword to Carecast
• Made the decision to migrate to Carecast in
Feb/March 2004
– IDX gave an assurance it would have no impact
on timescales…
– London and the South were doing it
– The product is better
– It has saved re-training
• But IDX seriously underestimated the effort
needed
Wednesday, 24
November 2004
Anglicisation
• C&W had concentrated on clinical
benefits rather than admin functionality
• Key issues
– Real time commissioning
– Compliance with NHS data model and
production of Clearnet extract
– Outpatient scheduling
Wednesday, 24
November 2004
IDX Software Development
• An implementation project turned into a
software development project
• Challenges have included:
– Fully communicating NHS needs
– Development effort split between London and
Seattle
– Product integration
– Ensuring tight project management so that the
software that gets delivered matches expectations
Wednesday, 24
November 2004
Where we are now
• We do now have a product…
• Code Drop 9 has delivered most of the go live
software for Phase 1
• Final delivery in December will complete the
picture
• Software Development project now turning
back into an Implementation Project
• Other streams like data migration and
interfaces can now plan in earnest..
• Currently re-cutting plan for Q1 2005 go live
Wednesday, 24
November 2004
Data Migration
• Is part of the scope of
the services IDX have
to deliver
– Users
– PMI inc address history &
GP history
– Waiting List
– A&E
– Outpatients
– Inpatients
– Casenote movements
Wednesday, 24
November 2004
• Some manual and
some electronic transfer
• For example:
– Outpatient clinic
templates will be manual
– Appointments electronic
• DM is now on critical
path
• Additional UCLH testing
resources
Training
• Train the trainer
training was part of
scope
• End user training an
option
• Have gone for
mixed economy
• 20 Deverills trainers
• 10 UCLH
Wednesday, 24
November 2004
• Suite of 12 training
rooms (x12 training
places) dedicated
for the purpose
• Developing training
materials to reflect
UCLH processes
• Training mandatory
• On line assessment
Security
• Two factor
authentication part
of scope
• Keen to use NPfIT
approach as it
becomes available
• Have team in place:
– 1wte IT
– 0.5wte HR
Wednesday, 24
November 2004
• Setting up
Registration
Authority
• Issue card to the
right person
• Complete
competency test
• Have authorised
access
Resources
• Planned investment of £85m over ten
years
• IDX contract value is circa £70-75m
• Balance is investment within the Trust
Wednesday, 24
November 2004
UCLH Resource
Project Manage ment
Project Director & Manager
Phase Project Managers
Process Review
Process Review Lead
Process Analysts x 5
Manage ment Reporting
Information Analysts x2
Tailoring
Tailoring Lead
Tailoring Analysts x 4
Training
Training Manager
UCLH Trainers x10
Deverills Trainers x 20
Admin support x2
Wednesday, 24
November 2004
UCLH Resource (2)
Other Key Roles
QA
Communications
PC Roll Out
Clinical Advisor
Interfaces
Security x1.5
Testing x3
Data Quality x4
Clinical Board
Clinical Board Implementation Lead
Key Users and Super Users
Testers and Trainers
Leads on Training and PC roll out
Wednesday, 24
November 2004
User Engagement
• Key to clinical
engagement is:
– A product that supports
the workflow
– Is easy to use
– Ready to deliver
– Flexible to tailor
• For UCLH EPR
supports the vision of
modernisation
Wednesday, 24
November 2004
• Input from PR team
• Regular items in staff
paper and briefing
• Roadshows to explain
what will happen and
when
• Clinical input to process
– NB they are the
paymasters…
UCLH and NPfIT
• IDX only have one
product
• UCLH has wider
scope and earlier
delivery
• Anglicisation issues
are generic NHS
issues
Wednesday, 24
November 2004
• NPfIT is taking
UCLH output to
build on
• UCLH will migrate
from local database
• Working closely with
BT to ensure
integrated approach
Key issues going forwards
• Final delivery of
software for Phase1
• Developments for
Phase 2 on Orders
• Re cutting the plan for
Q1 2005 go live
• Delivering Phase 1 and
2 before the New
Hospital opens
Wednesday, 24
November 2004
• Moving forwards the
clinical functionality
• Planning work in:
– A&E
– Urology
– Diabetes
• Delivering electronic
Prescribing
• Integration with NPfIT
Issues to Address
• Communications and getting staff on-board
• The effect of having a new build going on at
the same time: has it helped or hindered?
• Technical matters such as configuration, data
migration, functionality, etc.
• The supplier's understanding of the NHS
• Resourcing and training
Wednesday, 24
November 2004