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Paper 19

Ayrshire and Arran NHS Board Monday 8 October 2018 Digital Strategy Author: Andy Grayer – Assistant Director of Digital Services

Sponsoring Director: John Wright – Director of Corporate Support Services

Date: 28 September 2018 Recommendation The Board is asked to approve the Digital Strategy. Summary The Digital strategy sets out the direction of travel for the delivery of digital services across NHS Ayrshire & Arran for the next five years. The strategy builds on and is aligned to the National Digital Strategy for Health and Social Care in Scotland. The Strategy has been approved by the Digital Steering Group and by the Corporate Management Team. The Strategy is the culmination of an extensive twelve month engagement programme involving staff throughout the organisation including the Partnerships. The engagement has been wide ranging including the “My Digital Journey” roadshows; staff surveys; as well as focussed meetings with individuals and small groups. Key Messages: The strategy is ambitious and challenging and will be underpinned by a 5 year Digital Development Programme which will be a key enabler of the NHS Board’s Transformational Change programme. This will provide new opportunities for patients and how they choose to engage with healthcare services throughout Ayrshire & Arran. Glossary of Terms CMT DSG NHS A&A

Corporate Management Team Digital Steering Group NHS Ayrshire and Arran

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1. Introduction NHS Ayrshire & Arran’s Digital Strategy (2018 – 2023), has been developed following an extensive engagement and consultation programme with key stakeholders including the three Partnerships. The Strategy has been approved by the Digital Steering Group and by the Corporate Management Team.

2. Benefits The strategy is wide ranging in its scope, and is based on and aligns with NHS Scotland’s National Digital Strategy. It identifies the importance and benefits of digital services in supporting service transformation and in delivering tangible benefits to patients, staff and the citizens of Ayrshire and Arran. Delivery of the strategy will also be crucial in helping support the modernisation of the Board’s estate by enabling more flexible and agile working for clinicians and support staff. Through the further development of Technology Enabled Care the strategy will also increasingly enable patients to safely manage their own care, where this is appropriate. The Strategy adopts a Once for Scotland and Once for Ayrshire model for service delivery. There is a clear focus on improving the interoperability of NHS Ayrshire & Arran’s clinical information systems in order to improve the safe and secure sharing of patient data on a needs to know basis and to further develop the single Electronic Patient Record. Given the increasing threats from state sponsored cyber attacks on a global scale, and the potential threat which this presents to front line services, investing in a modern, resilient and secure technical infrastructure is of critical importance. This will be based on the adoption of best practice and adherence to national and international security standards. The strategy will be underpinned by a 5 year Digital Services Development Plan which will be overseen by the Digital Steering Group and monitored by CMT.

3. Recommendations The Digital Strategy is both ambitious and challenging and provides a real opportunity for the delivery of safer and more effective healthcare services for the people of Ayrshire & Arran. The NHS Board is asked to approve the attached Digital Strategy.

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Monitoring Form

Policy/Strategy Implications

This Digital Strategy sets the direction of travel for The delivery of digital services over the next 5 years.

Workforce Implications

This strategy has no staffing implications.

Financial Implications

Successful delivery of the strategy will depend on the necessary investments in capital and revenue.

Consultation (including Professional Committees)

There has been extensive consultation throughout the development of the strategy.

Risk Assessment

Not required

Best Value - Vision and leadership - Effective partnerships - Governance and

accountability - Use of resources - Performance management

The strategy delivers all strands of Best Value

Compliance with Corporate Objectives

Deliver transformational change in the provision of health and social care and service improvements through the use of Digital technologies. Protect and improve the health and wellbeing of the population and reduce inequalities, through advocacy, prevention and anticipatory care. Create compassionate partnerships between patients, their families and those delivering health and care services which respect individual needs and values; and result in the people using our services having a positive experience of care to get the outcome they expect. Attract, develop, support and retain skilled, committed, adaptable and healthy staff and ensure our workforce is affordable and sustainable. Deliver best value through efficient and effective use of all resources.

Single Outcome Agreement (SOA)

Not required

Impact Assessment Not required

Authors John Wright, Director of Corporate Support Services Andy Grayer, Assistant Director of Digital Services

Date: September 2018

Version: 0.9 – Draft (for approval)

DIGITAL STRATEGY 2018-2023

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Table of Contents 1. Executive Summary ............................................................................................ 4

2. Introduction ......................................................................................................... 7

3. Key Digital Programmes for the next Five Years ................................................ 9

.................................................................................................. 10

Enhanced Clinical and Social Care applications ...................................... 10

(a) Electronic Care Record (ECR) .......................................................... 10

(b) TrakCare Patient Management System ............................................ 11

(c) Community-based Services, Mental health and Child Health ............ 11

(d) Other Major Clinical Systems ............................................................ 12

(e) Systems Development ...................................................................... 13

.................................................................................................. 14

Mobile and Digitally connected Workforce ............................................... 14

.................................................................................................. 14

Digitally Connected Patients / Citizens ..................................................... 14

(a) Technology Enabled Care (TEC) ...................................................... 15

(b) Health and Social Care Portal ........................................................... 15

................................................................................................. 15

Integrated Applications and Infrastructure ............................................... 15

(a) Regional Clinical Portal ..................................................................... 16

(b) National CHI and Child Health........................................................... 16

(c) Infrastructure ..................................................................................... 16

(d) Desktop ............................................................................................. 16

(e) Security ............................................................................................. 17

(f) Active Directory ................................................................................. 17

(g) Microsoft Office and SharePoint ........................................................ 17

(h) Telephony ......................................................................................... 18

(i) Health and Social Care Communication and Collaboration ............... 18

................................................................................................. 19

Decision support tools for insights ........................................................... 19

4. Policy and Governance ..................................................................................... 21

4.1 Governance Structure ................................................................................ 21

4.2 Digital Services - Clinical Leadership ......................................................... 21

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5. Human Resources, Development and Staff Engagement ................................. 21

6. Finance and Financial Challenges .................................................................... 22

7. Appendix One: Alignment with National Strategy .............................................. 23

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1. Executive Summary

“Connect citizens, health and social care through digital information, tools and services to help achieve the healthiest life possible for everyone in Ayrshire and Arran” The way we communicate, interact and manage our relationship with the public and staff is changing. Over the next five years we have an opportunity to enhance and enable integrated real-time health and care. With sustainable investment in technology and our workforce we can connect citizens to the health and social care services they require through digital tools, information and services. Digital technologies will be key to delivering and enabling transformational change in NHS Ayrshire & Arran including the integration of Health and Social Care services. This strategy outlines NHS Ayrshire & Arran’s ambitions for the use of digital technology over the next five years, and provides a roadmap showing how these ambitions will be achieved. The approach is to build on the NHS Board’s existing investments in technology, and to develop new systems and services based on a modern and resilient infrastructure in order to continuously improve and develop a fully integrated health and care system. This will support our clinical staff in making care safer and enable patients to actively participate in the planning and management of their own care. The focus of NHS Ayrshire & Arran’s Estates strategy is to develop facilities which are welcoming, safe, and promote a sense of wellbeing for patients and staff. This includes the demolition of those older properties which are expensive to maintain and are no longer fit for purpose. Digital Services has a key role to play in the delivery of the NHS Board’s Estates Strategy in supporting and enabling agile working, where support staff are no longer confined to the boundaries of the desk or the office, but are able to work flexibly in the communities which they serve. Five key building blocks have been identified which will provide the foundations for NHS Ayrshire & Arran’s to achieve its service ambitions: Enhanced clinical and social care applications

A set of applications will be provided that support the needs of individual services and the ability to share information across organisational boundaries

Mobile and digitally connected workforce Staff will be able to access information wherever and whenever services are provided.

Digitally connected citizens People will be able to connect with health and social care services more easily to support their own care and wellbeing.

Integrated applications and infrastructure Appropriate standards will be used to ensure an integrated approach to service delivery working closely with other

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organisations, locally, regionally and nationally, sharing technological platforms wherever possible.

Decision support tools Analytics to drive continuous improvement and innovation by providing information for improved decision making, planning for service change, and to support improvement in quality and performance.

The approach to realising the opportunities which Digital Services present will be as follows:

• Continue to invest in the development of a modern, sustainable infrastructure that is able to adapt to emerging regional and national initiatives

• Improve the interoperability of systems

• Convergence of Health and Social Care systems

• Adopt best practice and adherence to national standards in the areas of data

protection and cyber security

• Continue to ensure that the technical infrastructure is robust and able to meet evolving business continuity and disaster recovery requirements

• Develop a sustainable end user device strategy that reflects the evolving

requirements for newer devices such as handhelds and tablets which allow self-service and improved user experience

• Support regional and national initiatives in order to realise the benefits of

standardisation including devices, applications and core infrastructure services

• Ensure that existing technology and infrastructure investments are leveraged to their maximum potential.

Implementation of the Digital Strategy will be underpinned by a 5 year Implementation Plan which will require significant and sustainable investment in terms of both capital and revenue funding. In the current financial climate this will present a number of challenges to successful delivery. The rewards of meeting this challenge are however significant as over the lifetime of this strategy the following will be delivered:

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Enhanced clinical and social care applications A single regional Electronic Patient Record (EPR):

o Additional datasets from local and regional partners including Mental Health, Child Health and social care

Electronic sign off of results: o This will negate the need for paper results to be filed

Single hosted GP System o GP services hosted on a single system with the ability to share information not

only between partners, regional services, acute services but also with patients Single Community based system

o All community based staff will be using the same system that will be fully integrated into GP and Acute as well as throughout the three Health & Social Care Partnerships.

Mobile and digitally connected workforce Agile working:

o Support a range of devices and tools to access and share information at the point of care

Skills Development and change management o Staff will develop the skills and confidence to think “digital first” and embrace

new ways of working using digital tools.

Digitally connected citizens Patient access:

o Continued partnership with NHS Greater Glasgow and Clyde to further develop the patient portal for Scotland

TEC: o Patients supported to manage their own conditions

Digital Citizens: o Access to letters and reminders o Booking appointments o Access to expert advice and self-management o Develop a variety of methods to interact with services in real time.

Integrated applications and infrastructure A new business desktop:

o Windows 10 – the latest desktop platform from Microsoft with built-in cyber security

o Office 365 – evergreen up to date core business applications for word processing, email services, spreadsheet, and shared calendars and cloud based files accessible anywhere with an Internet connection

o Skype for Business – seamless video and messaging collaboration services for both staff and opportunities for patients

o Remote access – enabling clinical staff to access records and provide treatment at the point of need.

Decision support tools for: Business Intelligence Providing proactive intelligence to clinical leaders for service planning.

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2. Introduction

“Connect citizens, health and social care through digital information, tools and services to help achieve the healthiest life possible for everyone in Ayrshire and Arran” The way we communicate, interact and manage our relationship with the public and staff is changing. Over the next five years we have an opportunity to enhance and enable integrated real-time health and care. With sustainable investment in technology and our workforce we can connect citizens to the health and social care services they require through digital tools, information and services. Digital technologies will be key to delivering and enabling transformational change in NHS Ayrshire & Arran including the integration of Health and Social Care services. This strategy outlines NHS Ayrshire & Arran’s ambitions for the use of digital technology over the next five years, and provides a roadmap showing how these ambitions will be achieved. The approach is to build on the NHS Board’s existing investments in technology to develop new systems and services based on a modern and resilient infrastructure in order to continuously improve and innovate a fully integrated health and care system. This will support our clinical staff in making care safer and enable whilst enabling patients to actively participate in the planning and management of their own care. The focus of NHS Ayrshire & Arran’s Estates strategy is to develop facilities which are welcoming, safe, and promote a sense of wellbeing for patients and staff. This includes the demolition of those older properties which are expensive to maintain and are no longer fit for purpose. Digital Services has a key role to play in the delivery of the NHS Board’s Estates Strategy in supporting and enabling agile working, where support staff are no longer confined to the boundaries of the desk or the office, but are able to work flexibly in the communities which they serve. The internal and external factors that have influenced the development of the strategy are summarised in Diagram one.

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Diagram One: External and internal factors that have

influenced the strategy Scotland’s Digital Health and Care Strategy was published in April 2018. It makes reference to Health and Social Care community working collaboratively across six named domains. NHSA&A’s Digital Strategy is closely aligned to the national Strategy (see Appendix One). A ‘once for Scotland’ and a ‘once for Ayrshire’ approach has been taken in the development of the strategy. . . The strategy is also flexible, so that it can be adapted to changing priorities, future financial challenges, new opportunities and technological advances. A robust governance structure will oversee implementation of the strategy, future developments, and investments. Benefits will be clearly identified and quantified in conjunction with service departments. Five building blocks have been identified to underpin the delivery of the strategy:

Digital Agenda•Digital Health &

Care Strategy•Public Sector Action

Plan•GDPR

Industry Trends

•Cyber Security•Cloud-based

Services•Data Analytics•Multiple Devices

Demographics•Older population•People living longer•Digital demand

Organisational Strategy

•Strategic Aims•Transformation•Regional & National

Working•Financial Constraints

Stakeholder Engagement

•Dumfries House•Digital Survey•Clinical and Social

Care meetings•“Our Digital

Journey”Digital Strategy

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These building blocks will enable us to:

• Adopt a patient centred approach • Engage and listen to staff to support change within the organisation • Develop governance and structures to promote the change agenda • Adopt and promote national standards wherever possible; • Work collaboratively with local, regional and national partners • Adopt a robust fiscal policy to deliver change within defined financial

boundaries The building blocks and the key programmes required to support each of these are discussed in more detail in Section 3. 3. Key Digital Programmes for the next Five Years

The foundations for the success of a fully integrated digital platform are linked to a number of key strategic programmes. To address the challenges which face NHS Ayrshire & Arran and realise the opportunities which these present, the following goals have been set related to NHSA&A’s technology infrastructure and the applications, tools and other services that depend on this:

• Continue to develop and maintain a modern, robust and sustainable infrastructure that is able to adapt to emerging regional and national initiatives

• Improve the interoperability of systems

• Convergence of health and social care systems

• Adopt best practice and adherence to national standards in the areas of data

protection and cyber security

• Continue to ensure that NHSA&A’s digital infrastructure is able to meet evolving business continuity and disaster recovery needs

• Develop a sustainable end user device strategy that reflects the evolving

requirements for newer devices such as hand held and tablets which enable self-service and improved user experience

• Support regional and national initiatives in order to realise the benefits of

standardisation including devices, applications and core infrastructure services

• Ensure that existing technology and infrastructure investments are leveraged to their maximum potential.

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The following sections provide a summary of the key areas of work for each of the building blocks of the strategy.

Enhanced Clinical and Social Care applications NHS Ayrshire & Arran requires to develop a broad portfolio of applications that support the needs of individual service users and provide the ability to share information across organisational boundaries. By maximising the use of existing applications and investing in new applications NHSA&A will:

• Capture information electronically in real-time at all levels including acute, community and primary care

• Use technology routinely in all care settings to support professionals and other staff to do their jobs effectively

• Create an integrated health and social care Electronic Patient Record, which will be accessible across organisational boundaries and in different care settings.

The main strategic initiatives to deliver this are set out below.

(a) Electronic Care Record (ECR) Further development of an Electronic Care Record, accessed through the Clinical Portal, will enable information to be made available electronically wherever and whenever services are delivered. This will also reduce the reliance on paper-based records and support the move to “paper-lite” working, initially for Outpatient Clinics from April 2019. There is already a wide range of clinical information available in the Electronic Care Record, and there are a number of initiatives already underway or planned to expand the information available (Diagram Two).

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Diagram Two: Current and planned availability of information in the Electronic Care Record, accessed through the Clinical Portal

(b) TrakCare Patient Management System Building on the major upgrade to TrakCare completed this year, implementation of additional functionality is already planned. This includes:

• Provision of electronic ordering for diagnostic services, Estates services, and Health and Social Care

• Electronic sign-off for results, which will be introduced in advance of paper-lite working in Outpatients

• Support for safe handover of patients between shifts • Real-time recording of clinical observations • Further enhancements to support the delayed discharge pathway.

Appropriate information will be available through the Clinical Portal. (c) Community-based Services, Mental health and Child Health EMIS Web already provides the clinical record for many community-based Services, including AHPs and Integrated Care Teams. Implementation for District Nursing and other AHP services is already underway. Additional functionality will also be introduced, including support for care planning and data capture for national reporting. The community clinical record will also be accessible through the Clinical Portal.

CarePartner provides the electronic care record for several Services, including Mental Health, Child Health and Learning Disabilities. Further enhancements are planned, including integration with other systems.

Medical History

DemographicsAttendances & Appointments

ContactsAlerts & Alarms

ECSA&E

Child HealthMental Health

Community Health Record

Social Care Record

Correspondence

Immediate Discharge Letter

A&E DischargeInternal and External

ReferralsMSK Assessments

SERPA Letters

Diagnostics & Reports

RadiologyLaboratory

Endoscopy ECHOECG

Medical ImagesClinical ObservationsPulmonary Function

Clinical Notes

Operation Notes

Continuation ReportsPre-Op assessments

Current

Planned

Digital Care Record

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Support will be provided to expand the use of mobile-working for community-based services. Integration with the social work systems of the Board’s Local Authority Health and Social Care partners will be investigated, and appropriate datasets made available through the Clinical Portal.

(d) Other Major Clinical Systems

Accident and Emergency The A&E system (Symphony) has been acquired by EMIS Health, who already provide the Board’s GP and Community systems. EMIS Health has a strategic roadmap to include the A&E functions into the EMIS Web family of applications. This will maintain alignment to key core systems and facilitate discharges into the community.

Emergency Care Summary (ECS) ECS is available through the Clinical Portal. It provides clinical and pharmacy staff with key information regarding current prescribed drugs for medicines reconciliation and other alerts as well as allergy information. Within the time period of this strategy it is anticipated that the majority of current GP platforms will be approaching end of life. This will provide an opportunity to consider the migration to a single hosted service. With the latest upgrade to HEPMA, consideration will also require to be given a new platform for digital medicines reconciliation.

The ECS dataset also includes the Key Information Summary (KIS) which includes the Anticipatory Care Plan (ACP). This will provide an opportunity to provide ACPs not only in an acute setting but also within multi-disciplinary team meetings in the community.

Maternity The current Maternity System, eClipse, is also approaching end of life which will provide an opportunity for NHS Ayrshire & Arran to migrate to another platform currently used by eleven other Health Boards in NHS Scotland.

Hospital Electronic Prescribing and Medicines Administration (HEPMA) A major upgrade for the JAC HEPMA System will commence this year (2018). The Scottish Government has provided funding for all boards to pursue their Digital HEPMA implementations, with NHS Ayrshire and Arran being seen as the lead for implementation and innovation.

The upgrade will provide a fully web-based technology platform that enables agile and remote working and better integration with the Board’s Single Sign-on authentication tool.

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After this upgrade is completed, implementation in Maternity and Mental Health services will be considered. Closer links with community pharmacy and GP systems will also be investigated.

GP Systems The new GP contract came into being in April 2018 and the current GP system will be replaced within the first 2 years of the new strategy. This will provide an opportunity for even greater integration with the Electronic Care Record, subject to appropriate information governance arrangements being agreed. More seamless care, where records can be shared between the Primary Care systems and EMIS Web and between Practices and the Community teams, will also be possible. There will also be an opportunity for Primary Care to access the Clinical Portal.

There is a significant opportunity to support Primary Care to adopt a clustered model of working, where resources can be shared more effectively across the wider teams. The adoption of digital services will underpin this shift and deliver efficiencies within the service through sharing critical and scarce clinical resources.

At present it is recognised that the existing Primary Care platforms being used in General Practice can be challenging to support particularly within rural settings. To assist clinicians and their support staff in improving service performance regardless of location and underlying infrastructure as well as assisting in Practices Business Continuity (BC) plans, consideration will be given to hosting GP systems within NHS Ayrshire & Arran’s data centres. This review will be carried out prior to a migration to a new GP system, subject to approval by Primary Care colleagues.

(e) Systems Development The in-house development team will continue to provide key strategic systems to help fill gaps and provide rapid solutions to business problems. Major developments already planned include:

• Implementation of electronic Whiteboards for Maternity Services; • Development of a reminder service for the removal of surgical Stents.

NHS Ayrshire & Arran is currently working in partnership with ISD and the Scottish Government to produce a national Drug and Alcohol Information System (DAISy). The system will be implemented for our Health and Social Care partnerships and Third sector organisations in October 2018.

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Mobile and Digitally connected Workforce It is important that staff are able to access information wherever and whenever necessary. To do this we will:

o Provide access to information for staff on a “Need to know” basis, irrespective of location, in a paper-lite environment

o Support a range of devices to access and share information at the point of care.

It is also recognised that to move to a “Digital First” approach (or philosophy) will require a significant cultural change. Workforce development will also be needed to ensure staff have the skills and confidence to:

• Engage in service redesign, and • Embrace new ways of working using digital tools • Use technology to develop new and better ways of working in conjunction

with staff and staff side. The main strategic initiatives to deliver this are discussed below.

• Agile working

A focus of NHS Ayrshire & Arran’s Estates strategy is to develop facilities

which are welcoming, safe, and promote a sense of wellbeing for patients and staff. This includes the demolition of those older properties which are expensive to maintain and are no longer fit for purpose. Digital Services has a key role to play in the delivery of the NHS Board’s Estates Strategy in supporting and enabling agile working, where support staff are no longer confined to the boundaries of the desk or the office, but are able to work flexibly in the communities which they serve.

In order to bring about these changes and deliver the resulting efficiency savings which will come from a modern and efficient estate, it is planned to deploy mobile technologies including smart phones, tablets and laptops to facilitate agile working. These devices will be equipped with the ability to use 3G/4G/5G SIM cards to facilitate staff to work in the community, at a touchdown facility or possibly at home.

Digitally Connected Patients / Citizens Patients will be able to connect with health and social care services more easily to support their own wellbeing. They will be able to:

• View, update and maintain their own records

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• Update their health record with data collected from portable Apps and wearable devices. Connect online, for example, to arrange and receive appointments, order repeat prescriptions, and participate in video consultations.

The two key strategic initiatives that support this are the expansion of the use of Technology Enabled Care (TEC) and the development of a national Health and Social Care portal. Both of these are summarised below.

(a) Technology Enabled Care (TEC) People are becoming more engaged in planning and managing their own care and rehabilitation. The data that is gathered can form an important part of the Electronic Care Record and a strategy will be devised to enable the inclusion of patient collected information into their mainstream record. NHS Ayrshire & Arran is the first Health Board in Scotland to fully integrate and merge the TEC Team within the operational service delivery of eHealth under the Digital Services umbrella. NHS Ayrshire & Arran is recognised as an exemplar Health Board for the delivery of TEC services. The intention is to extend the capabilities of TEC in to new areas and to deliver TEC services at scale, to enable patient care to be delivered at home or in a homely setting. (b) Health and Social Care Portal Work has already started on the development of a Patient / Citizen Portal. NHS Ayrshire and Arran has entered in to partnership with NHS Greater Glasgow and Clyde to develop and rollout the system. The core aim of the portal is to allow people safe and secure access to their own health record online. Some of the key functions available include access to appointments in the hospital and GP Practices as well as access to online forms and correspondence. In time, the portal will provide a one-stop-shop for people to interact with the NHS as well as Health & Social Care Partnerships.

Integrated Applications and Infrastructure NHS Ayrshire & Arran will adopt appropriate standards to ensure an integrated approach to services and infrastructure and will work with other organisations locally, regionally and nationally, to support integrated service delivery using shared technology platforms, wherever possible. Adopt common standards to enable integration and interoperability between systems:

• Use secure cloud-based services wherever possible and subject to affordability

• Work with other organisations to support both regional and national collaboration, and to avoid “reinventing the wheel”.

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(a) Regional Clinical Portal A regionally funded project enabled NHS Ayrshire and Arran, The Golden Jubilee Hospital and NHS Greater Glasgow and Clyde to launch each other’s Clinical Portals seamlessly within each health board. Those services which have patients in regional centres, have delivered a number of immediate benefits. Some of the testimonies from clinical staff include “the radical difference it has made to dealing with complaints and concerns from patients and relatives”. “Where it used to take several days to get case notes from other board areas, the information is now immediately available allowing consultants and medical staff to deal with concerns the same day”. Additional connectivity has also been established with NHS Lanarkshire and NHS Dumfries and Galloway, with plans to connect to NHS Forth Valley within the lifetime of this strategy. Over the next five years there will be a focus on even greater convergence, with plans to develop one fully integrated regional portal for the West of Scotland. (b) National CHI and Child Health The national CHI (Community Health Index) has been in existence since the mid 1970s and is still running on legacy mainframe equipment at one of the national data centres. A replacement facility is urgently needed and a national programme is nearing the completion of negotiation with suppliers. A main feed from the existing system is Child Health and a new national child health system will also be introduced at the same time. The impact on local boards is still not fully understood but it is expected that migration to a new system will be completed within a 2 year timeframe.

(c) Infrastructure Whilst the Board’s Digital Services Infrastructure is key to the delivery of safe and secure services, a significant investment in additional capacity will be required to support the new services outlined in the Digital Services Strategy. This infrastructure has to be flexible and adaptable to change. Whilst the preferred strategic direction is to move to a “cloud-first” model, this will be subject to affordability. This will not however, negate the need for continual capital and revenue investment in the Board’s infrastructure. “Cloud-first” is a consumption based revenue model that will require the appropriate revenue funding to support such a move.

Digital Services will continue to work with capital planning and estates colleagues to ensure that the Board’s data centres are fit for purpose with adequate environmental protections and controls in place. (d) Desktop The current funding model for the replacement of desktop devices is not sufficient to meet the Board’s needs. As a result, more than 70% of the Board’s desktop estate are at least 5 years old. Whilst existing desktops will

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be upgraded to prolong and extend their useful life wherever possible, a large number of units are incapable of being upgraded to currently supported versions of software, leaving the Board vulnerable to cyber attack and service disruption. The current version of Microsoft Office 2007 is already unsupported. In addition, the Windows 7 operating system will no longer be supported by Microsoft, after January 2020. The pressure to move to Windows10 is heightened by the lack of compatibility of new desktop hardware (which comes with Windows 10), with older operating systems. Migration to Windows 10 is also a prerequisite for the introduction of Office 365. The costs of upgrading all of the Board’s operational environment to Windows 10 and Microsoft Office 365 by the required date of 2019, comes at significant cost to all Boards.

(e) Security NHS Ayrshire & Arran’s preparedness, resilience and diligence with regard to cyber security have been recognised by the Scottish Government, as an exemplar Health Board. To maintain this level of resilience however there needs to be a continuing investment in software tools and in developing the necessary expertise and skills in the Board’s scarce Digital Services security staff. Every effort will be made to ensure that the Board complies with the outcome and recommendations arising from the national Cyber Security Audit. The Board will also seek to obtain full Public Sector Cyber Security Accreditation by the end of October 2018, although this remains in doubt under clarity about funding for the migration to Microsoft Office 365 is provided by SG.

Consideration will also be given to introducing a system of “tap-on tap-off” technologies to ensure robust and rapid authentication of users in different working environments, using smartcards (ID badges). (f) Active Directory Active Directory is a database system that provides authentication, directory, policy, and other services in a Windows environment. It underpins all daily digital activity. With the advent of Office 365 and other new technologies including cloud-based services, there will be a change in the way service users are authenticated on to the network. NHS Ayrshire & Arran’s Active Directory will use Microsoft Azure, a cloud-based service, to provide the authentication service required to improve communication and collaboration with Partners. This ability to authenticate Health Service users with trusted Partners could provide opportunities such as the sharing of Intranets and other Office 365 content. (g) Microsoft Office and SharePoint It is planned to:

o Upgrade to Microsoft Exchange Service 2013, which will facilitate the migration to Office 365 and enable the use of a new electronic mail clients

o Move to Office 2013 as an interim measure before a future migration to cloud-based Office 365, shared drives and SharePoint.

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AthenA currently runs on an unsupported version of Microsoft SharePoint. The current platform will therefore be migrated to a “holding” version (SharePoint 2010), until a new SharePoint 2013 platform is created. This version will host not only AthenA but also provide a separate platform for the management of Corporate Records. Lync will be replaced with Microsoft Skype for Business, which provides a range of tools including video conferencing and instant messaging. The combination of Skype and Office 365 will enable more effective communication and collaboration both internally and externally. (h) Telephony The Board’s telephony platforms remain a core service in engaging with members of the public. The Board will continue to support a mixed estate within the acute sites, which are a blend of analogue and digital systems. This mix ensures that the telephony estate is highly resilient. Further development of the Board’s digital telephony systems will be key to supporting service transformation and lowering costs to the organisation. A core function of the telephony service is the paging platform. The existing paging platform is at the end of its useful life and is scheduled to be replaced within the current financial year. This replacement platform will support traditional paging and also deliver enhanced features that the Board will seek to adopt. Community sites are traditionally served by legacy telephony platforms. These require to be replaced with digital solutions linked to the core telephony platforms used within the Board’s acute sites. This will bring the advantage of five digit on-net dialling while lowering revenue costs. This service also has the potential to be offered to GP sites also to lower cost. The current switchboards based at University Hospital Ayr (UHA) and University Hospital Crosshouse (UHC) will combine into one single switchboard based within updated and extended accommodation within University Hospital Crosshouse. Use of new automated telephony tools will reduce the number of internal calls routed to the switchboard.

(i) Health and Social Care Communication and Collaboration The single biggest work stream for the three Partnerships will be the delivery of Technology Enabled Care (TEC) to the people of Ayrshire and Arran. This has already been discussed in Digitally Connected Patient/Citizen above. Other opportunities to improve communication include: Agile Working Working with the Board’s partners in the three Local

Authorities. The aim is to provide seamless Wi-Fi coverage, regardless of location, to enhance the delivery of agile working throughout Ayrshire and Arran. This will be delivered regardless of employer or building owner.

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The intention is to stretch this capability further with the potential to extend Wi-Fi services to GP premises.

Clinical Portal Clinical Portal will be developed to provide information from the three Local Authority social care platforms as well as GP and community data. At present the three Partnerships are embarking on changing their social care platforms and the outcome of this is awaited, prior to commencing the integration work.

Calendar Management

At present eHealth and the Partnerships run separate email platforms. The intention is to link these email platforms together securely so that calendar free/busy information can be shared.

Voice Calls During the lifetime of this strategy it is planned to link the Board’s telephone systems with those of the three Local Authorities using the existing data circuits that are already established between the organisations. These linkages will lower phone charges.

Lone Worker Protection

At present there is no commonality or consistent use of lone worker protection systems. Further work is being carried out to identify potential opportunities to collaborate on the use of a single platform.

Predictive analytics will be fully exploited to drive continuous improvement and innovation by providing information for improved decision making; planning for service change; and to support improvements in service quality and performance. As an organisation it is therefore important that staff and management have access to reliable and up to date data to inform decision making. A move from reporting “What has happened” to predicting “What might happen” will be increasingly important in future service planning and development. This is illustrated in Diagram Three. The information needs to be qualified with the appropriate caveats. Given that the organisation now stores and manipulates ever increasing volumes of business intelligence data, it is vitally important that this important resource is managed and readily accessible to promote and evidence change. A further development of this will be to provide the appropriate staff with the ability to ‘self-serve’ information and for the Business Intelligence team to provide predictive analytics and ‘what if’ scenarios.

Decision support tools for insights

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At present there are a number of different platforms supporting the needs of the organisation. Alongside this the dataset is getting larger and therefore the extraction of data takes longer. Furthermore there are a number of key datasets that do not exist within the Business Intelligence platforms, the two largest examples being Radiology and Labs. Subject to appropriate funding we will implement the following:

• Rationalise the number of business intelligence reporting platforms (working alongside Service Transformation and Sustainability colleagues)

• Utilise emerging technologies for the manipulation and presentation of information

• Establish a ‘self-service’ portal for information • Develop a predictive analytics and ‘what-if’ scenario capability • Qualify and caveat all reports provided • Integrate additional universes in to the Business Intelligence platform of

choice • Work more closely with the services to identify efficiencies, opportunity and

unwarranted variance. First line support A new Service Desk system - Service Now, has been purchased and will be operational during September 2018. This system will provide accurate data to populate key performance indicators for Digital Services as well as providing a self-service portal for users to log and track their own incidents or requests.

Diagram Three: Key objectives for the use of Business Intelligence tools

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4. Policy and Governance

4.1 Governance Structure The implementation of this Digital strategy requires strong and effective governance supported by meaningful and ongoing stakeholder engagement across the directorates and departments. The main governance model within the organisation is shown below:

4.2 Digital Services - Clinical Leadership A number of Clinical Leadership resources have been established within Digital Services including consultant and nursing professions. This allows the needs and views of stakeholders to be represented at a senior level with the Digital Services team. The Digital Services clinical leads work within the established governance and directly with health and care teams to support, facilitate and advise on developments and implementations are critical to the successful delivery of the strategy. 5. Human Resources, Development and Staff Engagement

A Review of Digital Services is due to be completed and implemented by the end of 2018/2019. The new departmental structure will assist in the delivery of the outcomes and recommendations set out in the Digital Services Development Plan, following approval of the Digital Services Strategy. It is vitally important that NHS Ayrshire & Arran is able to attract, retain and develop staff with the necessary skills and expertise if the vision and the objectives set out in this strategy are to be delivered and as a result, the benefits to staff and patients. Training and development of staff will be key to this.

NHS A&A Board

Corporate Management Team

Digital Steering Group

EPR Group Primary Care and

Community Services Group

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It is the ambition of Digital Services to involve and develop staff regardless of their role or position within their teams. Furthermore we aspire to develop our staff to meet the future needs of the NHS based on Diagram 4 shown below. The intention is to challenge the norm and provide a work environment that promotes flexibility and focuses on outcomes where every individual plays an essential role in their delivery. The intention is to play to staff’s strengths and empower team members to make decisions. The implementation of Office 365 will provide the appropriate collaboration tools to drive sustainability and service transformation.

Diagram 4 Apprentices:

- Commitment to sustainable training and development of young people - Investment in the future of the NHS.

6. Finance and Financial Challenges

Successful delivery of the Digital Strategy will require a robust and sustainable financial plan. This is required not only for the development of new digital services, but to address a historic lack of investment made in the Board’s Digital Services estate. New investment will also be essential if the NHS Board is to deliver its Transformational Change programmes at scale and at pace. Without this additional investment, the vision and opportunities set out in this Strategy will not be achievable.

Work anytime

Work anywhere

Use any device

Focus on outputs

Shares information

Relies on collaboration tools

Can become a leader

Work 9-5

Work in an office

Use NHS A&A equipment

Focus on inputs

Hoards information

Relies on email

No voice

PAST FUTURE

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Get Involved With the increasing impact of digital across the organisation, it is important to provide feedback channels from users of Digital Services, to ensure that the digital strategy continues to meet not only the strategic direction of the Board, and the Scottish Government, but also the needs of end-users. Here are some ways you can get involved and help support this strategy:

Email We have created a dedicated in-box for questions. If you have any questions, or would like to learn how to gain access to more information about the associated documents or programmes mentioned in the strategy then please email: digitalstrategy@aapct.scot.nhs.uk

Digital training & support There is help available for those wishing to advance their digital skills here. NES digital initiative provided by NHS Education for Scotland. http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/nesdigital.aspx

7. Appendix One: Alignment with National Strategy

Scotland’s Digital Health and Care Strategy was published in April 2018. This strategy makes reference to Health and Social Care community working collaboratively across 6 named domains. This strategy aligns to the national strategic domains as follows: Domain A – National Direction NHS Ayrshire and Arran will continue to be represented on national groups to lead, influence and contribute to national developments and implementations. The Digital Services team play an active role in key national systems such as GPIT, e:ESS, PACS, CHI and Child Health. Domain B – Information Governance and Cyber Security Digital Services will ensure that the organisation reaches the Cyber Essentials and NIS Directives standards by the due dates and will work closely with our information governance colleagues to ensure the organisation maintains compliance with the new GDPR regulations. A number of key projects are earmarked over the next 5 years to enable our continued progress:

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- Windows 10 (with Advanced Threat Protection) - Office 365 - SharePoint replacement - eMail - HEAT - SIEM (QRadar)

Domain C – Service Transformation The Digital Services teams will continue to work closely with our local and regional colleagues on delivery of the single shared electronic record. At present the department have a number of transformational projects earmarked for delivery over the next 5 years among them being:

- Electronic Order Communications - Electronic Order sign off

Technology Enabled Care (TEC) has a proven role to play in business transformation by enabling patients to be more confident in controlling and caring for their condition and preventing admissions and presentations to Primary Care services. A number of key projects are highlighted in the report and further opportunities will be identified through the use of business intelligence data to deliver TEC services throughout Ayrshire & Arran at scale:

- Attend Anywhere - Hypertension - CoPD

Domain D – Workforce Capability With the arrival of agile and home working technologies the workforce will be given greater flexibility and services will be able to offer treatment at the point of care. We will be able to provide greater access to shared calendars, email, and instant messaging services across Health and social care boundaries, regardless of location and device. We will continue to invest in our workforce training and seek every opportunity to ensure we have sustainable succession planning built into our workforce plans. Domain E – National Digital Platform The national digital platform will allow access for citizens to access their digital data and health records. This platform will also enable the new national CHI system to link to Health and Social care records allowing access via the EPR. Suppliers and 3rd parties will also benefit from a single open standard Application Programming Interface (API) to allow best of breed systems to fully integrate into the EPR.

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