Services Description

GPSoC Service Name Orion Health Clinical Portal & EMPI Package

GPSoC Service ID OHHW

Service Overview Orion Health’s Cross Community Care Record (CCCR) solution, based on our highly successful

Clinical Portal, has been deployed extensively throughout the world and with over 300,000 clinical users managing over 40 million patients; we have un-rivalled experience in clinical integration, workflow and document management. Our solution offering will meet the business requirements, without any bespoke development or extensive technical design, saving time, money and resources (for the avoidance of doubt, the solution will still require configuration, but not software development). Already live at over 65 sites throughout the UK and Ireland, Orion Health technology has been architected to support all prevailing clinical data standards, regulations and modes of working.

Orion Health’s Cross Community Care Record (CCCR) provides a platform for care teams to support the effective coordination of care between multiple agencies across the community.

Modern healthcare often requires many different care sectors to work together, focused on one patient, including acute care and it's clinical specialties, primary care, community care, social care, unscheduled care, mental health and out of hours.

The Orion Health solution supports the delivery of integrated care at three important levels:

• Shared, single view of patient data, integrating key patient and citizen information from multiple sources, from multiple agencies, and providing secure, consent-based access

• Coordination of best-practice care workflows involving cross-agency and multi-disciplinary teams

• Direct involvement of the patient in the care process by providing relevant information to them via web and mobile devices

The solution does not replace existing systems – it connects them to create a shared, secure single view of the patient.

The following diagram demonstrates the key components of the Orion Health solution. The core of the solution is comprised of the established Orion Health Clinical Portal, Orion Health Healthcare Pathways, Orion Health Clinical Data Repository, NextGate MatchMetrix EMPI, PDS adaptor and Orion Health Rhapsody Integration Engine.

Orion Health Clinical Portal

A modern, secure web based Clinical Portal is the foundation Orion Health solution, ensuring that the right information is accessible by the appropriate users at the right time by providing a single point of access to a unified view of patient information that resides in data silos across the wider health and social care community.

Orion Health Healthcare Pathways

Orion Health Healthcare Pathways provides users with the tools to manage and coordinate patient care via Healthcare Pathways. Healthcare Pathways enables users to follow best clinical practice for the treatment of users patient’s condition. By following a proven path that includes diagnostic tests, goal setting and monitoring, users give their patient the best chance to achieving a better health outcome.

Orion Health Clinical Data Repository

Orion Health’s Clinical Data Repository is a single database that stores discrete patient data from source systems for the purpose of making it available for viewing within the Clinical and Patient Portal. It is a dynamic repository capable of storing user-defined models. It includes a pluggable infrastructure for adding custom message processing and comes with out-of-the-box support for a number of standard HL7 interfaces.

NextGate MatchMetrix EMPI

NextGate’s MatchMetrix EMPI is an enterprise master person index software application that links and tracks related patient data from disparate applications and facilities into an enterprise master index of patients. It uses probabilistic and deterministic algorithms to evaluate patient records and assigns an Enterprise Unique ID (EUID) to facilitate data quality management and interoperability. The EMPI identifies and resolves duplicate patient records, improves the accuracy of patient identification, enables a patient-centric view of information, and simplifies connectivity with source systems.

PDS Adaptor

Orion Health’s PDS adaptor is a certified component that will allow connectivity between Rhapsody Integration Engine and the Patient Demographic Service hosted on the Spine.

Orion Health Rhapsody Integration Engine

Orion Health's Rhapsody Integration Engine is a comprehensive and powerful back-end integration broker for health enterprises. It delivers advanced inter-system messaging capabilities. Rhapsody is designed for rapid, effortless installation and use, and enables quick, accurate, and efficient exchange of electronic health data. It will take messages in any format, from any source, translate between formats and route the messages to their correct destinations.

Orion Health Professional Services Group

The Orion Health Professional Services Group (PSG) focuses mainly on project delivery, implementing Orion Health solutions and managing client relationships throughout the entire project lifecycle. Our experienced team members have significant industry experience including clinical, consulting, and technology expertise.

Orion Health PSG uses standard project management and project lifecycle approaches to ensure our client's implementation phase—including evaluate, build, test, and launch—are successful.

Case Studies The following case studies demonstrate Orion Health’s capability to deliver an integrated solution across health and social care settings. Further case studies are available on our website – www.orionhealth.com.

Health and Social Care (HSC), Northern Ireland

In 2012 Health and Social Care Northern Ireland (HSCNI) selected Orion Health to provide a clinical portal-based Electronic Care Record (ECR) for the entire population of Northern Ireland. Covering a population of more than 1.8 million people, the ECR enables the communication and sharing of patient data taken from multiple, existing information systems across acute, community, primary health and social care.

Previous to full roll out that went live in June 2013, Orion Health successfully implemented a ‘Proof of Concept’ pilot of the EHR in Ulster Hospital Dundonald, the Belfast City Hospital and 2 general practices in 2010. This involved 200 clinicians and more than 9000 patients and provided the business case for the full roll out of the ECR across the HSC. It also demonstrated that the solution could reduce the length of encounters, improve the quality and safety of patient services, and achieve cost and efficiency savings in staff time and resources.

As part of the ECR project, the Orion Health Clinical Portal provides streamlined, secure, web-based access, from a single browser view, of patient information to authorised HSCNI health and social care professionals. The ECR includes critical patient information, including latest lab results, patient medications, allergies and clinical correspondence. Audit tools and patient privacy controls have been built into the ECR to help ensure patient confidentiality.

In addition to the Clinical Portal, HSCNI now has access to Orion Health’s Rhapsody Integration Engine, forms technology, patient portal and case management software that will help support the management of long-term conditions and will provide the underpinning technology framework for sharing information across multi-disciplinary teams.

Orion Health is aligned with Northern Ireland’s vision for more integrated healthcare to help manage patients across care settings, accessing and sharing information in a secure, role-based manner and our technology portfolio enables this journey. The Electronic Care Record programme improves the quality and safety of patient care as the system makes all of the relevant existing information available to doctors, nurses and other staff at the point of care.

“I am confident that the Electronic Care Record system will assist in developing a sustainable health care system that delivers now and will continue to deliver in the future for the good of everyone in Northern Ireland.”

Edwin Poots, Minister of HealthNorthern Ireland

The benefits document created after the proof of concept shows that many efficiencies were realised as a result of implementing Orion Health technology. Most importantly there was very positive feedback from the clinical community which shows that they like the solution, and they felt it contributed to improving patient safety and outcomes. Significant results noted in the Proof of Concept Evaluation report included:

• 94% of clinical users agreed that the use of the ECR improved the quality of patient care• 83% of doctors reported a better clinical outcome as a result of use of the ECR• 89% of users “strongly agreed” or “agreed” that the ECR improved patient safety• Reduction of time to resolution of medications reconciliation for Clinical Pharmacists from 3

hours 45 minutes to 22 minutes (ECR was 10 times faster)• A time use audit revealed that using the ECR to look up data on 30 patients per day,

compared to existing legacy systems, could save clinicians 53 minutes per day• Significant evidence of a reduction in the duplication of laboratory tests and diagnostic

imaging – saving both clinical time and valuable resources

NHS Greater Glasgow and Clyde Health Board

The NHS Greater Glasgow and Clyde Health Board, was formed in 2006 through the merger of NHS Greater Glasgow and part of NHS Argyll and Clyde. Now the largest health board in the United Kingdom, it delivers services through 35 major hospitals, 10 specialised units and 50 health centres and clinics. General practitioners, dentists, pharmacies, physiotherapists and other health care providers work through these facilities.

• 44,000 staff• 1,000 consultants• 300 additional general practitioners• 270 dental services local• 180 optician practices• 300 pharmacies

Following the merger, the new board embarked on a series of major building projects to move services from cramped Victorian-era buildings into modern hospitals that could better support 21st Century medicine.

One of the first projects the health board wished to undertake was to make it easier for its tens of thousands of providers across these dozens of facilities to access patient medical records. It wanted to implement an electronic health record (EHR) system that incorporated a portal with an intuitive user interface that could provide all clinicians with access to a unified patient medical record regardless of where the patient lived or where the clinician was located.

The health board selected the Orion Health Clinical Portal as the key that would realise the NHS Greater Glasgow and Clyde EHR vision. Using the Clinical Portal, real-time ward lists and clinic lists are built by consolidating data from multiple Patient Administration Systems (PAS), including Meditech and iSoft. All A&E visits, outpatient appointments and inpatient episodes can be viewed regardless of which facility the patient attended, complete with procedure and treatment codes. Upon opening a patient record, data is aggregated and displayed in a variety of formats including XML, XLS, DOC, PDF, TIFF, GIF, HTML and JPEG.

The Clinical Portal provides single-click access to view Kodak PACS images and place diagnostic orders using its Single Sign On scripting tools. Before the Clinical Portal went live, finding the Ordering screen in Meditech involved navigating through up to nine screens, including login and patient search. With the Clinical Portal, users can reach the Ordering screen in just one mouse click, saving several seconds per order and minimising the chance of opening the wrong patient record in Meditech. For users in North Glasgow, a similar single sign on interface is used to access iSoft PASWeb.

The health board uses Rhapsody to send 2,000 clinic letters per day and 1,000 referral letters per day to SCI Store. SCI Store also stores clinical documents, discharge summaries, ECGs and endoscopy results generated in other point of care systems.

The system at Glasgow is integrated across multiple care settings and includes integration to social care systems, SWIFT and CareFirst.

The system was deployed to staff at a rate of 70 per week, and now supports the viewing of over 160,000 results per week via the portal. The estimated savings attributed to reduced ordering of tests is in the order of £75M per annum, with an additional £15M per annum in reduced transportation costs now that letters and documentation is available online.

NHS Camden CCG

The Integrated Care record in NHS Camden aims to improve outcomes for patients; create access to better, more integrated care outside of hospital; reduce unnecessary hospital admissions and enable effective working of professionals across organisational boundaries.

As part of NHS Camden Integrated care vision, the Orion Health Cross Care Community Record solution (CCCR) has been procured, to provide professionals, involved in delivery health and social care in Camden, with a unified view of data from a variety of existing clinical and social information systems.

The NHS Camden Commissioning Partnership model has been developed to enable clinicians, from different provider organisations to work together in multi-disciplinary groups. Within this multi- disciplinary system, the model will be supported by overarching enablers including a joint governance model, aligned incentives, information sharing and organisational development.

The Integrated Care pilot was launched on the 2nd of April 2012 and includes hospital, general practice, community care, social care and mental health provider organisations. Patient representation is an important element of this pilot.

NHS Camden Commissioning Partnership Partners include:

• Camden Clinical Commissioning Group (CCCG)• Royal Free Hospital (RFH)• University College London Hospital (UCLH)• Camden and Islington Mental Health Foundation Trust (C&I FT)• Central and North West London Trust (CNWL)• London Borough of Camden (LBC)• Camden GP Practices

Orion Health’s overall approach to deliver the NHS Camden Integrated Care IT system is to;

• Install the Orion Health Cross Community Care Record (CCCR) with Healthcare Pathways, NextGate to provide the EMPI and Risk Stratification services.

• Utilise an experienced project delivery team that has specific domain knowledge and experience in integrated care projects to fast-track the implementation

• Apply the “Lessons Learned” from previous projects• Transfer the necessary skills and knowledge to NHS Camden ensuring their Integrated Care

solution investment will be self-sustaining in the future.

The approach is to (1) extract data from source systems; GP data from EMIS & Vision via the MiG, Community from RiO, Acute from Royal Free (Cerner) and UCLH (Carecast), Mental Health from RiO (2) aggregate, transform, normalise, and unify the data into a patient-centric view and (3) make this available as an Electronic Care Record to health and care providers at the point of care via our Clinical Portal, accessed from a desktop, laptop, tablet or iPad over N3.

Future phases will include integration into Hospice, OOH and the Ambulance Service.

Connecting Care, Avon

In December 2013, the Connecting Care Project went live. Underpinned by the Orion Health CCCR to integrate health and social care information, to provide an integrated record across Bristol, North Somerset and South Gloucestershire.

Connecting Care is addressing the silos of care related information that currently exist within Bristol, North Somerset and South Gloucestershire in order to improve and streamline care pathways across health and social care and to address some of the issues that face patients/clients, staff and commissioners today.

The first phase of the Connecting Care project is taking data from; Primary Care, Acute Trusts, Community Health Providers, Social Services and Out of Hours providers.

Connecting Care’s business case for funding for a full roll out contained a number of measured benefits, but at this time Connecting Care are unable to make those and their Business Case public. Orion Health provided significant support in developing the benefits realisation for the Connecting Care project and have shared those to help inform future projects.

In the context of social care, some of the key benefits realised from an integrated health and social care record include:

1. Enhanced support for referral management2. Time saved on triage and assessment3. Informed assessments and care planning4. Reduced installation and equipment costs5. Enhanced support for risk management & safeguarding

Support Because Orion Health is an international company with clients in a number of time zones, we provide 24-hour support, 365 days a year. The Orion Health Customer Services and Support Team manages, tracks and resolves technical questions, and manages bug fixes and enhancements where necessary. Our Customer Services and Support team is backed by a dedicated organisation of over 1,100 employees worldwide.

The standard Orion Health support model includes:

• Third line and break fix supporto Standard break fixo Product supporto Knowledge base

• Out-of-hours covero Out-of-hours and weekend cover for High Priority Issueso Assistance from global 24 x 7 structureo On-call roster

• Request fulfilmento Facilitating change requestso Liaison for engaging Professional Services Group resourceso License and Software requests

• Major incident supporto Support for P1s and P2so Major incident reportso Root cause analysis

The tables below detail our standard service level agreements and associated definitions for issue prioritisation for on-going support, these would be finalised during negotiation with individual customers.

Issue Response and Resolution Times

Each Fault Priority Level has specific response times. The following table describes each level’s response times.

Fault Priority Level Initial Response Time

Progress Report Target Resolution Time

Level 1 – Production Failure (Critical)

30 minutes 1 hour 4 hours

Level 2 – Production Degradation (Urgent)

1 hour 4 hours 8 hours

Level 3 – Functional Impact (Major)

Next working day 1 week 2 weeks for a work around; next release for code changes

Level 4 – No Production Impact (Planed)

Next working day By arrangement By arrangement

Issue Prioritisation

Support Tracker has several levels of prioritising issues, referred to as the Fault Priority Level. Queries are assigned a Fault Priority Level depending on how critical the problem is. The following table defines the Fault Priority Levels.

Fault Priority Level

Definition

Level 1 Critical business impact – Problems which, if not fixed, prevent the business from continuing. No workaround is possible.Examples: A critical application is unavailable or all users lose access.

Level 2 Problems which do not currently stop the business but whose consequences could interrupt or stop the business within 24 hours; these may go unnoticed by other groups, but can be very serious for the people needing the service that has stopped.Examples: Some users lose access; severely degraded performance; the system is still functioning, but slow performance is impacting the efficiency of the unit.

Level 3 Problems causing minor operational impact or people have lost functionality, but there is a workaround.Example: Cannot action a request on an application at one terminal, but can at another.

Level 4 No impact on production and implementation can wait for a future release.

Dependencies Service dependencies may include (To be ratified at time of call off):

1. Customer project team in placea. Project managerb. Clinical leadsc. Technical lead

d. Infrastructure leade. Testersf. Trainersg. Service teamh. Systems Admini. DBA

2. Environments must be available for installation of the software, specified and provisioned to match the scale of roll out and likely message volume, storage requirements and concurrent access requirements. Indicative environment specifications will be provided to the Customer by Orion Health to support this activity

3. Access to systems must be granted from remote user4. Any arrangements with third party suppliers5. Procurement of Microsoft or Oracle database licenses (where applicable)6. Information feeds or extracts7. For context launching, the technical mechanism of passing and receiving credentials

Indicative Customer Responsibilities (Will be ratified at time of call off)

The following lists some of the Customer obligations which, if fulfilled, will enable the successful delivery of the Orion Health software:

• Staff – The customer is expected to provide adequate staff for the project and allow Orion Health access to these staff for the purpose of delivering the software.

• Governance – Any governance associated with decision making is the responsibility of the customer and a clear governance structure, including a Change Control Board, should be put in place to mitigate the risk of delays due to delays in decision making. The customer is responsible for reviewing and approving the deliverables within agreed timescale including design documents, test plans and acceptance criteria.

• Testing – The customer will work with Orion Health to test the solution. This includes preparing test scripts and providing anonymised test data.

• Infrastructure – The customer is responsible for ensuring they have provided adequate infrastructure to support the solution including network infrastructure to the hosted environment and end-user devices.

• Third Party Organisations / Source Systems – The customer is expected to manage any necessary arrangements with third party organisations / source systems to support the development of information feeds.

• End-user Training – Orion Health will provide Train-the-Trainer training for customer staff. The customer is expected to support Orion Health in the delivery of training including producing a training plan and making resources available for training.

• First Line Support – The customer will provide first line support to appropriate triage issues including suitably qualified and trained staff. Support staff will provide data to the Orion Health help desk in order to resolve the issue. Orion Health provides technical training for support staff.

Sub-Contractor(s) No key sub-contractors identified.

Pricing Information

Implementation Charges £1,136,979 excl VAT for professional services fees to configure the software procured in the Service Charges section

Service Charges Charge Description Unit Price (excl VAT);

License & Support Band 1 Tariff £909.79 per user assuming 1000 users

License & Support Band 2 Tariff £528.89 per user assuming 2500 users

License & Support Band 3 Tariff £360.29 per user assuming 5000 users

Exit Charges

Invoicing Terms Invoicing for the Implementation Charges and the License element of the Service Charges will be based upon the following principles.

Invoicing will be milestone-based, against the milestones agreed with the Customer in the implementation plan.

Such milestones may, indicatively, include: completion of planning and design; installation of license keys; completion of interface build, completion of configuration build, entry to user acceptance testing, exit from user acceptance testing, go-live, completion of post go-live implementation support.

The proportion of the charges applied to each milestone will be commensurate with the work performed and delivery of tangible work products.

Payment Terms The Support element of the Service Charges will be apportioned from go-live, and the charges will be payable in arrears.

Discounts Volume discount applied, please see tariff charges above

Resource Based Pricing Resources are available on T&M rates according to the rate card below:

Role Daily Rate (£) excluding VAT and expenses

PMO Analyst £550Test Analyst £650Systems Engineer £700Business Analyst £850Implementation Consultant £850Technology Specialist £850Trainer £850Test Manager £950Senior Implementation Consultant £950Senior Technology Specialist £950PMO Leader £1,000

Project Manager £1,000Database Administrator £1,000Programme Manager £1,100Project Director £1,200Technical Services Manager £1,200Solution Architect £1,200Clinical Consultant £1,200Professional Services Group Director £1,400

Other Pricing Information Implementation assumes:

10 feeds – 4 simple, 4 medium, 2 complex

Messages are assumed to be in HL7v2 format

MiG service available

4 roles, 4 tailored view system

No backloading (bulk loading of historical data)

Reuse of existing privacy model

3 environments

2 pathways, intermediate complexity

2 context links

8 month deployment assumed

Pricing is for install & configuration services only.

Pricing does not include Hardware, Network, Database or any 3rd party system costs, such as 3rd party interface costs or MiG service costs, or triage and remediation of issues with any of these components.

Service Pricing:

Tariff 1 – minimum purchase 1000 units (registered users) for 1 year. Ongoing year on year maintenance charge would be agreed based on volume of units purchased.

Tariff 2 – minimum purchase 2500 units (registered users) for 1 year. Ongoing year on year maintenance charge would be agreed based on volume of units purchased.

Tariff 3 – minimum purchase 5000 units (registered users)for 1 year. Ongoing year on year maintenance charge would be agreed based on volume of units purchased.

For EMPI, up to 1M UID’s are available in this pricing model.

Service pricing includes 3rd level break-fix support on Orion Health standard

SLA as described above.