Yorkshire Ambulance Service Information Communications Technology NYHDIF Presentation

Yorkshire Ambulance Service Information Communications Technology NYHDIF Presentation 14th January 2011 David Johnson Assistant Director - ICT

My presentation… • Some Ambulance Facts • Intro to YAS ICT • What we’ve done • Resilience • The Changing World • Things I’d like you to know and support: • Emergency Care Solution (ECS) • Communication Enabled Business Applications (CEBA) • Clinical Hub • Capacity Management System (CMS) • Directory of Services (DOS) • SystmOne Ask Questions as we go along…

My presentation… • Some Ambulance Facts • Intro to YAS ICT • What we’ve done • Resilience • The Changing World • Things I’d like you to know and support: • Emergency Care Solution (ECS) • Communication Enabled Business Applications (CEBA) • Clinical Hub • Capacity Management System (CMS) • Directory of Services (DOS) • SystmOne

2009-10 Category A - 8 minute 70.84% Category A - 19 minute 96.71% Category B - 19 minute 91.1% Nationally bottom A&E Response Standards & Activity 2009-10 Activity: • 999 Calls = 711,000 • 999 Incidents Attended = 599,000 (1650 per day) • Transports to Hospital = 485,000 • Not Hospital = 114,000 • PTS = 1,200,000 (4,300 per day) • April-Nov 2010 • Category A - 8 minute • 76.1% • Category A - 19 minute • 97.8% • Category B - 19 minute • 94.6% • 5th position nationally

A&E Response Standards • Winter pressures • Demand increases • System pressures across the health service • Huge improvements in response performance • Delivering our Operational Improvement Plan

Adverse Weather Interesting Facts

A&E Resources • New stations - York, Hull East, Hull West, Wetherby, Penistone • New deployment points • New vehicles - 41 ambulances, 19 RRVs, 19 out-of-hours doctors’ cars, neonatal vehicle • New equipment • New staff • New ways of working • Over 750 new staff recruited • 51 student paramedics graduated with a Foundation Degree in Paramedic Science, and an additional 30 commenced their year one programme • Nearly 100 technicians were successfully supported to achieve Paramedic qualification

ICT - Some Background Information (1) 1st July 2006: Merger of- SYAS WYMAS TENYAS 36 WTE

ICT - Some Background Information (2) Budget 2010-11: £000’s Pay 1,232 Non-Pay 4,212 Total 5,444 (2.9%) Net of £440k CRES saving Capital 1,500 (11%) • Support Service: • All 1st and 2nd Line Support • Network, Desktops, Servers, Applications, Telephony & Radio • 24 / 7 / 365 – Service Desk 09:00 to 17:00 Monday to Friday • Project Support and Application Development • Supporting 3rd Parties with e-learning and ECS Reporting • Dell, Cisco, Nortel, Microsoft

ICT - Supporting Patient Services: • A&E Operations • 999 Communication Centres • Patient Transport Services • GP Out Of Hours • Supporting Support Services

From 3 to 2 Communication Centres  VIRTUALISATION From 3 to 1 PTS System Resource Management Fleet Management Finance System HR / Payroll  ESR Domain / Email / Intranet / Internet Management Information New Telephony and Call Centre Management Tools Emergency Call Management and Call Connect Support Desktop and Network Infrastructure Standardisation WAN Upgrades and Encryption Estates Reconfigurations GP OOH software upgrade and hardware refresh What Have We Completed?

Mobile Data System Radio System Controlled Drugs and Access Control PTS Mobile Data PTS Communication Centre Re-design Telephony Management – GUI and IVR Enterprise Backup / Virtualisation / Email Archiving Sharepoint Enterprise Expanded Citrix Farm Lone Worker Protection Continued…

Yorkshire Ambulance Service – NHS Trust Service Delivery & Interoperability Architecture 999 & Non-999 Telephone Traffic Pstn. / BTOS External Service Delivery iSDN Services (2 x Independent Suppliers) Multiple Channels Of iSDN Delivery PDA & MDT & ‘Lone Worker’ Support Multiple Channels Of iSDN Delivery GPOOH & Remote Sites Vodafone APN Remote Sites Multiple Channels Of iSDN Delivery Airwave Digital Radio Infrastructure VPN VPN “Envoy” Enterprise **CEBA Hosting (under development) **CEBA is a multi-channel automated Multi-media contact management platform Physical Site 100MB YAS WAN 30MB Fibre Fibre Wakefield S-Hill 1 Wakefield S-Hill 2 York Fairfields York DR Fairfields YAS ICT Infrastructure Telephony YAS LAN YAS LAN Digital Radio Control Room Operations Centricity Telephony Telephony Digital Radio Digital Radio SAN ‘Mirrored’ Application Infrastructure CAD Cleric DNS NAS Fleet SAN ‘Mirrored’ Application Infrastructure CAD Cleric DNS NAS Fleet Technical & Operational Interoperability BCP & DR YAS DR Control Room YAS PTS Control Room YAS A&E Control Room YAS A&E Control Room Common YAS Desktops Common Telephony & Contacts Database Common Digital Radio Interface Common YAS Desktops Common Telephony & Contacts Database Common Digital Radio Interface

Virtualised CAD System Infrastructure 999 & non-999 for Central-North-South BT EISEC 999 & non-999 for Central-North-South BT EISEC IRIS PCs IRIS PCs SMG CS1K C3 Web Server C3 interface CC6 Reporting server Centricity Reporting server Centricity C3 CAD C3 CAD R900 Pilot AQUA Wakefield 30 MB CAD traffic only York DR PSIAM WAN 100 MB AQUA York C3 SAN-CX300 Terrafix MDT PSIAM Terrafix MDT SAN-CX320 Vodafone

The Changing World: • Doing more with less (ICT as enabler) • Green IT • KPIs  CPIs  Clinical Outcomes • Clock Start • Cat B • The complete patient experience • PbR • Calls • Hear & Treat • See & Treat • See & Convey • Clinical Hub – Pathways (CMS-DOS) - 111

Clearly this is not good… • For the Ambulance Service, Or • The Receiving Hospital. • We know the problems/limitations of paper!!! • However, there is a tradition for the Ambulance PRF… Where are we heading?

What, Why and When: The Emergency Care Solution (ECS) from CSC • An Electronic Patient Report Form for Pre-Hospital Care • Panasonic Toughbook • 3G/GPRS Bearer • Access to Protocols, Drug lists, links to Medical Equipment, etc To Improve data capture, transfer and ultimately patient care. Over the next 2-3 years • Over 600 vehicles • Over 2000 staff

ECS? • This is not a stand alone product • Integration to wider NPfIT solutions is key • Our primary interface is with our patient receiving locations (RLs) Engagement…

Completed Roll-out: • Current Hospitals with RLs: Pontefract General Hospital Pinderfields General Hospital Dewsbury District Hospital Leeds Teaching Hospitals Barnsley & District General Hospital Doncaster Royal Infirmary Montagu Hospital Bassetlaw Hospital Fieldhead Hospital Bradford Royal Infirmary • Current Stations: Wakefield South Kirby Castleford Sherburn Over 30 vehicles 24/7 Over 120,000 e-PRFs Thanks to: SHA Support and Staff at Hospital Receiving Locations

Completed 2010-11: • Hull Royal Infirmary • Link to ED Ambulance pre-Arrival information • Electronic Capture of Patient Handover • Information to Support ED Escalation process • Extend usage to RRV Vehicles in the Wakefield Area • Training Department (mainstreaming…) • HART Vehicles • Officers

Continuing the project: Engage with other Hospitals to provide RLs Roll out to other Ambulance Areas Complete Hull and East Riding Improve access to Clinical Audit Information Provide Paramedic access to their individual reports Upgrade to Release 5 (Sept 2011) Further integration – Pathways / CMS, SystmOne…

Summary: • The ECS is a key part of the Modernisation of the NHS • It is designed to be a solution integrated with the wider NHS • Now it is about making it happen across Yorkshire to improve patient care…

CEBA – Modernising PTS

Automated Journey Confirmation

Automated On-Day Journey Status

CEBA – Message Cascade & Major Incidents

Automated Incident Management Automated Incident Management

Clinical Hub…Changing the Response… • Capacity Management System (CMS) • Directory of Services (DOS) = PATHWAYS = Reduced ED Admissions = most appropriate patient care = supporting the informed patient. • SystmOne…

SystmOne Implementation Project

Patient Data Access • Access to full patient data on SystmOne will only be made by Clinical Hub staff who are clinically qualified. • The information on SystmOne will be used by Clinical Hub staff to support better patient care. • It will support decision making on the best course of action such as an alternative care pathway or other care advice.

Patient Consent and Governance • Patients, with conditions appropriate for telephone advice, will be asked for their consent to view the data by the emergency call receiver. • This consent will be entered onto the control logs and be passed on to the Clinical Hub advisors. • The patient data will not be retrieved in the case of an explicit refusal.

Patient Consent and Governance • If no explicit consent/refusal can be obtained, the box ‘Consent not asked’ would be checked and only if the presenting condition warranted would access to data be undertaken, any access would be supported - stating the reason why the data was retrieved and this recorded in the call logs. • Where the patient cannot be found or where there are multiple patients matched and the correct one cannot be identified on SystmOne with complete certainty, no patient information will be retrieved. Current YAS processes will be used.

Patient Record Update and Communications • The Clinical Hub advisors will update the patient record with a brief statement of the action taken. This text will be selected from a list of options which is to be agreed. • An automatic task will be sent to the SystmOne GP/User informing them of the access of the patient record by the YAS 999 Communication Centre. • All patients not found on SystmOne will be handled within current processes.

How will YAS use SystmOne? ? Category A or B 999 Call YAS Comms Triage Category C non life threatening YAS will ask if the caller wishes to speak to a clinical advisor? If No then YAS will refer back to a Clinical Response If Yes then we will gain all personal information and request authorisation to access their GP medical records Transfer call to Clinical Advisor

Clinical Advisor • The clinical advisor will confirm all patient details and that there is consent to access the patient’s GP record. • The advisor will only read review the records for pre-existing conditions and present pharmacology before calling the patient back. • Following the outcome of the call the advisor will make an entry into the journal to inform the Primary Care SystmOne user of the YAS Clinical Hub record access and patient care advice. • Any follow on actions will be a decision for the Primary Care SystmOne user.

Clinical Health desk Clinician on scene requests referral to alternative care pathway e.g. falls, diabetic after gaining the patient’s permission to authorise - informing their GP by accessing their medical record. The health desk will complete the referral documentation and forward it to the required team. The health desk will access SystmOne and leave a message for information only to the Primary Care user of YAS actions/referral to an alternative response.

Benefits of using SystmOne • Better and more informed patient care. • Increased caller satisfaction by improving the quality of information and pro-active support. • Reducing unnecessary emergency ambulance responses and transports to ED.

…the end… Thank you for your time.

Yorkshire Ambulance Service Information Communications Technology NYHDIF Presentation