Hertfordshire and West Essex ICS’s digital strategy is available in text and video format, covering their visions, goals, digital strategy mission and actions for the future.

The strategy opens with a comment from Dr Jane Haplin, CEO and SRO For Digital Transformation Hertfordshire and West Essex ICB. Dr Haplin highlights the ‘What Good Looks Like’ framework in developing their strategy and states: “Better and faster sharing of information between residents, patients and care staff gives residents a better experience and also helps us make services more efficient. Digital tools that capture information or carry out analytical tasks will help increase safety and quality… Our digital strategy is ambitious and forward looking – and we don’t expect the journey to be easy to deliver. It will give us the base to build better pathways for residents now and in the future.”

Visions, goals and principles 

The document lays out what the ICS digital strategy focuses on, namely supporting ICS transformation initiatives as needed with ICS-wide solutions that remain consistent with place level; making a measurable difference to the collective health and care provision across the region through common approaches to digital technology; improving the commonality of digital solutions and their interoperability; driving digital maturity; and securing the best value for the ICS through digital investments.

The overall vision is for the ICS to work together for a healthier future, in which teams “come together to deliver an effortless, integrated digital experience without boundaries to improve health and care outcomes for all people”.

The strategy sets out a number of digital principles, split between investment and delivery.

Under investment, it lists a need to prioritise the things that residents and staff need; projects at ICS level should focus on benefits to residents and staff, with benefits explicitly demonstrated and competing projects evaluated against these. Getting the best out of digital suppliers is another priority, with a need to develop and maintain strategic supply relationships at ICS level along with using the same solutions where procurement rules allow and where it makes strategic sense. The ICS pledges to set clear, realistic goals; to ensure the primary aim of digital investment is realistically achievable. Finally, it notes a priority to invest in a dedicated, cross-functional ICS team to maintain focus on the vision and ensure learning and approaches are coordinated.

Under delivery, the principles are to think long-term and deliver in the short-term; to test, measure and learn, with focus placed upon innovating locally and blueprinting models and technology approaches; to set rigorous delivery assurance against business cases and outcomes; and to address digital inclusion and exclusion, adopting a benefits realisation framework and develop digital capability for residents and staff.

Digital strategy mission 

The mission is categorised under collaboration; platforms; direct care; innovation; and skills.

Collaboration

Here the ICS states a goal to work together to maximise opportunities to coordinate system-wide solutions, providing the right care at the right time through multidisciplinary teams. “To achieve this,” the document states, “we will work together to adopt a coordinated health and care needs led approach to digital that focuses on local demands, but which is coordinated through place-based digital and care professional networks”. This will include care representatives closer to the resident such as GPs, social workers and pharmacists. “This will enable a broader and more holistic approach to digital.”

Actions already taken include empowering clinical leaders to drive transformation and benefits; investing in time for national Digital Academy training; establishing an ICS clinical reference and practitioner group; and securing an ICS Programme Management Office to oversee clinical workstream programmes.

Plans for 2023 into 2024 include investing in a sustainable and multidisciplinary “office of the CCIO” at ICS level to bring together CCIO professionals and knowledge. The ICS will also invest in digital board education and in digital clinical fellows at ICS levels, along with care professional digital leads for all organisations within the ICS. Finally, they will introduce a quality improvement/benefits realisation method in order to support identification of digital initiatives.

Platforms

The goal is to bring together the “essential connectivity, information, intelligence and data for all care settings”. The ICS plans to build then enhance and optimise key strategic digital platforms that are either needed once at ICS-level, or else will provide a “fully joined up, interoperable landscape of local platforms”.

The ICS states that it has developed a shared care record and continues to evolve it, and delivered high speed connectivity for GPs in collaboration with the Digital Innovation Zone. Other achievements include developing a plan for a system-wide data platform, developing a Child and Adolescent Mental Health Services access point, and designing West Essex and East and North Hertfordshire Care Coordination centres. In addition, West Hertfordshire Teaching Hospitals NHS Trust has implemented an EPR.

Work on a shared care record and interoperable EPRs is set to continue until 2027. In 2023 to 2024, the ICS plans to dedicate attention to shared data platform and population health management technologies, resident access platforms and care coordination centres. Looking to the next decade, the ICS will focus on ensuring that core infrastructure is unified across all health and care in the region.

Direct care

Sharing their goal to use digital technology to keep people well in their homes, offer choice and improve overall life chances, the ICS states: “To achieve this, we will use digital technology at scale to bring care closer to our residents… We will focus on engagement with our users internally and residents in the co-creation of new ways of digital working and make solutions easy to use and with a consistent look and feel.”

The ICS has already mobilised a Digital First for Primary Care programme, piloted virtual chronic kidney disease support for primary care clinicians using digital technology, and is running a number of virtual wards with widespread use of online consultations.

Plans for 2024 and 2025 included developing early assessment and practical support around residents with severe mental illness who may be suffering from dementia; this will take the form of an early memory diagnosis and support service, and remote monitoring for patients with severe mental illness. The ICS lists an ambition for Adult Social Care Falls Prevention to be used to protect 20 percent of care home residents by 2024, and also aims to support better diagnosis for community nurses through a wound care digital app.

Further ahead, the ICS aims to improve resident outcomes and reduce system pressures through expansion of virtual ward and hospital programmes, to further expand online consultations, and to facilitate secondary care advice for primary care clinicians caring for residents with multiple long-term conditions.

Innovation

Here the ICS notes that they will “strive to lead digital innovation partnering with AHSNs, universities and the private sector, to identify and adopt new technologies that offer scalable benefits to support our ICS challenges and workstream priorities”. This will include piloting innovation at smaller scale where there is potential to grow, and prioritising learning from others around technologies such as AI, precision medicines and robotics.

With regards to actions already taken, the ICS shares set plans to invest in a digital innovation team. A rapid review process for research and innovation has been developed. East and North Hertfordshire NHS Trust has also supported a national Health Data Research UK programme in the creation of a Gut Reaction Data Access model using AI and machine learning approaches to enhance drug discovery.

Ambitions for 2023 into 2025 include establishing links with the wider NHS, universities, AHSNs and others, and supporting new remote monitoring pathways. In 2026 and beyond, the ICS aims to eliminate time-consuming manual tasks through robotic process automation, support clinicians to identify and grade cancers through development of AI in diagnostics, and develop genomic treatments to support cancer patients.

Skills

The final goal is to improve inclusion in accessing digital health and building a digitally confident and skilled workforce. The document says: “we will develop a coordinated approach with third sector partners and others to address barriers to accessing health and care services digitally, providing access to technology, information and navigation to those least able to access digital services.” In addition, they will support and train staff to develop confidence and skills, particularly at the frontline, and will “strive to build trust in digital solutions”.

Actions to date include developing the ‘WeAreDigital’ primary care digital inclusion assessment which involved surveying residents on access to primary care, and supporting digitally excluded service users through the third sector by providing recycled IT equipment.

Future plans include progressively moving services to accessible digital platforms for most of the population whilst ensuring that the digitally excluded remain supported (2023 – 2027). By March 2025, the strategy states that all constituent organisations of the ICS will have established digital, data and technology talent pipelines and improved digital literacy among leaders and the workforce. Finally, 2025/2026 will see the ICS focus on supporting people without access to technology to gain access and the skills needed to interact with healthcare services digitally.

To read the strategy in full, please click here.

The strategy opens with comments from chief clinical information officer, Ashley May, in which she states: “I believe that digital systems can support long-term change and improvement in this trust. It will help us to deliver better care that is more appropriate to the people who give it and to the people we serve.” She notes that the next years will see the trust implement a new EPR and work with primary, community and mental health partners in the area to share information and use data ti provide a more proactive and personalised service.

“Patient outcomes are the driving force of digital transformation and clinicians need to be key players in designing and encouraging digital change,” Ashley summarises. “We pledge, in this document, to challenge our organisation to think and act differently when it comes to digital strategy. This means supporting our workforce to embed digital processes in the way we work, the way we communicate and the way we improve and develop.”

Director of digital transformation, Rebecca Gallimore, adds: “The pace of digital change has never been so fast; nor will it slow down. It is crucial that we act now, collectively, to deliver this strategy. This will ensure that we have the digital foundations in place to provide high quality care for our patients, while allowing us to plan for the future and make the most of digital opportunities in the coming years.

“To some, digital transformation is exciting and aspirational. To others, it may be difficult to picture what this means in practice or looks like in three years. Our commitment is that we will work with our patients, staff and partners to deliver this digital transformation in a way that supports everyone to maximise the potential of digital in delivering safer, more effective care.”

The strategy is split into three sections; how the trust will use digital to improve care for patients, support staff and enhance work; how core digital foundations will be put in place to set them up for future transformation and innovation; and how developments will see the trust become a digitally smart organisation and partner.

Improving care for patients, supporting staff and enhancing work

Here, the trust states that the strategy will support them in putting in place the standards and technology expected of an NHS acute hospital trust.

With regards to contributing towards the NHS meeting national priorities, the trust shares some objectives including embedding a culture of continuous improvement; achieving agreed performance by embedding the Quality Strategy, Maternity Improvement Plan and Getting to Good Programme; to establish themselves as a sustainable, paper-light organisation; and to build foundations ready for their hospital transformation, with new builds planned from 2026.

Focusing on ICS-level improvement, the plan notes that the strategy will “support the ambitions of the ICS in delivering a digital-first approach to improving care. We will work together to fully utilise limited finance and resource, while enabling the sharing of information across complex platforms and delivering new insights into the services we provide.”

The document shares some of the ICS high profile programmes, including the hospital transformation programme, which will see acute reconfiguration of Royal Shrewsbury Hospital as it becomes the primary focal point for emergency care; the Musculoskeletal Programme, with plans to standardise referrals to service and create a single point of referral; and workforce transformation plans, which will enable a digitally enhanced workforce with new ways of working.

The trust’s digital strategy sets an aim to support these programmes by empowering the population and workforce through co-design of digital solutions with the people who will be using them; connecting organisations through interoperable systems; committing to digital inclusion through training and accessible technologies; working together to improve quality and safety outcomes through digital processes; using data to record, predict and respond to ill health and tackle inequalities; embed system thinking to share resources and expertise; and commit to innovation, transformation and doing things differently.

Narrowing down further to a trust-specific view, the strategy shares the trust’s own priorities. Under ‘delivering excellent care for patients’, the plan specifies a need to ensure seamless patient pathways and to deliver a better patient journey and experience. It notes that this will be achieved through patient empowerment, enabling patients to better manage their own health and wellbeing; through building confidence and trust so that patients can book their own appointments, review their medical history and access treatments in the right place at the right time; and co-ordinating care through connecting organisations to share information and improve decision-making.

With regards to ‘enabling staff to provide better care and services’, the trust focuses on improving quality of care and making SaTH a great place to work. Here, they share their aim to support staff to focus on delivery by equipping them with the right tools and skills needed to perform effectively; to drive efficient use of clinical and non-clinical resources; and to support proactive decision-making by using data-driven insights and developing population-based models of care.

Finally, looking at ‘becoming a more effective and efficient organisation’, SaTH highlight the need for modern infrastructure to facilitate a connected experience for patients, carers and staff; to level up by putting in place the standards and tech expected of an NHS acute site; and to focus on sustainability by reducing costs, risks and environmental impact.

Setting up core digital foundations

In this section, the strategy places emphasis on key areas of work: records management, transfer of care, diagnostic requests, results and reporting; medicines management; decision support; remote and assistive support; asset and resource management; business and clinical intelligence; infrastructure and standards; and access and communications.

Here, we will take a look at the actions and aims shared in this areas.

Records management: the EPR programme is to deliver a suite of software modules that will modernise the approach to care provision, with the cloud-based EPR to provide clinicians with a single view of information whilst also introducing digital workflows, decision support and care planning capabilities. The Patient Administration System (PAS) is to provide access to up-to-date information and support the trust in improving the quality of information recorded. The new maternity records system will ensure continuity of care across settings and into the community. In addition, the strategy notes that the theatre teams will be provided with “rich clinical content and the tools for efficient and effective theatre management”, whilst emergency teams will be equipped to track patients on their journeys.

Transfer of care: the trust pledges to support transfer of care by ensuring that the right data feeds into the One Health and Care shared record for the region. Staff will be supported to communicate through secure mobile and web-based messaging, with content recorded and stored within the patient record. A notation system is to be implemented allowing clinicians to capture and share information in real-time, and patients who want access to outpatient letters digitally will be able to do so via mobile devices.

Diagnostic requests: a joined-up network approach with modern systems capable of managing laboratories more safely and securely is to support pathology and imaging services. Staff and service users will be able to request and review diagnostic results electronically along with making blood test bookings online. Pathology and radiology services will be digitally supported to reduce manual input and the trust will expand point of care testing devices to ensure results are made available to the patient rapidly.

Medicines management: implementation of an EPMA system is to support accurate and safer prescribing. Technology is to drive efficiencies in how medicines and managed, creating a smarter process for getting the right dose of the right medication to the right patient at the right time.

Decision support: The trust will continue to roll out ‘at a glance’ screens to provide staff with summary information about their wards and patients, whilst supporting clinicians to make decisions through the introduction of accredited reference tools and guidelines. eObservation alerts are to support teams through automatic detection of patients at risk of deterioration, and patients will be provided with help and direction through a self-triage tool so that they can be directed to the most appropriate care.

Remote and assistive support: remote monitoring and assistive support solutions are to be introduced in collaboration with SaTH’s partners, and virtual appointments extended. Patients will have access and control over their information through a patient portal. In addition, the trust will continue to expand virtual wards, and care initiatives in the community such as tele-dermatology.

Asset and resource management: solutions are to be introduced to enable the trust to proactively and automatically manage resources and stock, with hardware, software and end-user devices monitored to ensure that they are fit for purpose, safe and secure through regular updates. Staff will have the flexibility to book rooms at sites across the service to help meet the needs of patients and staff alike, and patient tracking will ensure that pathways and treatment timescales are appropriate and compliant. The strategy also shares how the trust is to support the Hospital Transformation Programme, introducing real-time location services that allow them to locate their devices at any given time, and also enabling patients to check in digitally.

Business and clinical intelligence: the trust shares an ambition to develop a Performance and Business Intelligence capability to act as a reporting centre of excellence, producing standard reports and initial analysis. To do this, they will build a new data warehouse with access to data driven through supported self-service initiatives. Live data feeds will help staff prepare and plan for patient care, which will mean widening data sets to include information provided by others such as the West Midlands Ambulance Service. In addition, the trust will collaborate with partners in using data to benchmark and improve services, supporting the development and adoption of innovative, population-based, digitally-driven models of care.

Infrastructure and standards: IT infrastructure is to enable a digital-first approach, underpinning everyday activities of staff. Patient experience will be improved through increased WiFi access. Cyber security will be improved with collaborative work with partners, and capacity will be increased to hold data and open up greater flexibility for future digital opportunities.

Access and communications: The Hospital Transformation Programme is to deliver new and refurbished facilities that co-exist and operate seamlessly with legacy facilities, with technologies such as digital screens and kiosks providing interactive guidance and mapping to direct patients. The switchboard will be a focal access point for staff and patients alike, with intelligence gathered and used to drive improvements across services. Access will be inclusive, with different ways to get in touch. Finally, staff will have the opportunity to work remotely where appropriate and will be equipped with the most up-to-date tools to do their jobs effectively.

Becoming a digitally smart organisation and partner

“Revolutionising our digital workforce starts with leadership,” the strategy states. “We must ensure our digital programmes are well-led and that our Trust Board is equipped to lead digital transformation and collaboration.”

Here, actions to be put in place include investing time and energy into creating a team of well-informed clinical informaticians who will assist in delivery of transformation; investing in regular board development sessions to develop digital confidence, manage cyber security risk and achieve sustainability goals; and building a network of clinical ambassadors for digital.

The Digital Programme Team are to feed into the Trust Board, as well as the ICS digital governing bodies. In addition, board governance will be established that regularly reviews digital and data strategy, cyber security, services, delivery and risk, with focus on “meaningful metrics and targets”.

In terms of specific roles, the trust highlights a need to recruit a Clinical Nurse Information Officer, as well as extending and maturing the Chief Clinical Information Officer role.

The strategy highlights that digital plans will align with and support the ICS strategy, and states: “Our leadership will visibly advocate for digital transformation and will support staff throughout this journey.”

A number of actions are also shared around the digital workforce, including regularly assessing and gathering requirements from clinicians to proactively plan for future needs; to produce a Statement of Service to show what services the IT function will deliver to customers; to collaborative with the ICS and strategic partners to learn and develop; and to establish clear responsibilities and accountabilities including the required roles and supporting relationships needed to deliver services today and in the future.

Looking at embedding digital into the trust’s culture, the strategy notes that the trust will take actions including investing in digital champions and clinical ambassadors, establishing a digital change management programme, assessing staff confidence in digital via a survey, developing a super user programme for the EPR implementation, and building a library of FAQs around how digital works.

With regards to taking a partnership approach to digital, the trust shares how population health insights will be used to inform and develop strategies. Opportunities to engage with a variety of stakeholders including local residents, adult social care providers and the voluntary sector will be explored, and they vow to “foster, structure and promote an ethos of partnership and co-production”.

To view the strategy in full, please click here.