together with a description of the project management and communication factors that helped to ensure its success. Keywords:
Cox and Marshall (2007) listed five important reasons for knowing more about the impact of information and communication technologies (ICTS) on pedagogical practice and student learning, namely:(
While there are many exemplars of prosaic uses of mobile devices for communication, few examples currently exist of how they might be used as cognitive tools (Jonassen & Reeves,
5) Informal and lifelong learning-activities that promote learning outside a dedicated learning environment and formal curriculum (e g.,
, Campbell, 2005) and the social and cultural shift in communication dynamics through the use of mobile devices (e g.,
and invent pedagogies appropriate to their students'use of a mobile device in completing a complex task within an authentic learning environment. 3. Implement the use of mobile technologies
3. What pedagogical strategies facilitate the use of m-learning devices in authentic learning environments in higher education?
4. What pedagogical principles facilitate the use of m-learning devices in authentic learning environments in higher education?
and perspectives providing alternative solution pathways collaboration allowing for the social construction of knowledge opportunities for reflection involving metacognition opportunities for articulation to enable tacit knowledge to be made explicit coaching
and design learning environments where mobile technologies could be used in their different subject areas and specialisations.
1982) was adopted as a professional development framework to assist in the design of each teacher's learning environment.
and a prototype project website was created. The leadership team, together with professional development and IT experts, met fortnightly for planning and monitoring,
and communication with the team and project reference group was enhanced with the creation of a bimonthly bulletin.
m-learning strategies What pedagogical strategies facilitate the use of mlearning devices in authentic learning environments in higher education?
m-learning principles What pedagogical principles can guide the use of m-learning devices in authentic learning environments in higher education?
Science education Physical education Visual Arts education Maths education IT in education Multimedia education Web-based learning Literacy education Reflective practice Adult education Final
workshops Formative evaluation of learning environments and project website Effectiveness evaluation of 12 learning environments Effectiveness evaluation of whole project Peer review of chapters by team
and worked within the workshop environment to plan an authentic learning environment that comprised 4-6 weeks (about a third of a semester).
or communication from one site to another. When teachers had designed their learning tasks, they were able to trial their ideas in the PD group during this phase,
and plan procedures to evaluate their learning environment when they were implemented in Phase 3. By the end of Phase 2,
the teachers had designed learning environments ready to be implemented in Phase 3, each comprising: an authentic task (to be completed over a period of 4-6 weeks), a range of resources, appropriate supports and integrated assessment strategies.
What pedagogical strategies facilitate the use of m-learning devices in authentic learning environments in higher education?
What pedagogical principles facilitate the use of m-learning devices in authentic learning environments in higher education?
Quality assurance and project management factors Effective project management and communication mechanisms helped to ensure that the project stayed on track
A key role of the project manager throughout the project was effective and sensitive communication with,
both as an important communication device and as a repository for relevant resources, and products generated by the project.
What is an authentic learning environment? In A j. Herrington, & J. Herrington (Eds.),Authentic learning environments in higher education (pp. 1-13.
Hershey, PA: ISP. Herrington, J, . & Oliver, R. 2000). An instructional design framework for authentic learning environments.
Educational Technology Research and development, 48 (3), 23-48. Hoban, G. F. 2004. Enhancing action learning with student feedback.
Supporting teachers'action learning within a web environment. In P. Kommers, & G. Richards (Eds.),
Mobile communications: Re-negotiation of the social sphere (pp. 131-148. London: Springer. Jonassen, D. H. 2000.
In D. Jonassen (Ed.),Handbook of research on educational communications and technology (pp. 693-719.
Joint Statement on Education and Training in the Information Economy. Retrieved February, 2008 from: http://www. mceetya. edu. au/pdf/infoeconomy2005. pdf Mcgill,
NHS Prescription Services: the impact of legacy ICT 1 AUGUST 2013 NHS Business Services Authority The National Audit Office scrutinises public spending for Parliament and is independent of government.
The Comptroller and Auditor General (C&ag), Amyas Morse, is an Officer of the House of commons and leads the NAO,
and with economy. Our studies evaluate the value for money of public spending nationally and locally.
Contents Summary 4 Part One 6 The National Audit Office's assessment of government's legacy ICT 6 Part Two 8 The NHS Business Services
Authority 8 Prescription Services 8 The service model 11 Part Three 14 Financial and performance analysis 14 Service and system performance 14 Financial
analysis 17 Part Four 20 Our enterprise analysis of the NHS Prescriptions Service and the management of the legacy system 20 Part Five 29 The lessons learned from the impact of legacy
ICT on the Authority's prescriptions service 29 Appendix One 32 Timeline 32 Appendix Two 33 Methodology 33 Appendix Three 34 Enterprise analysis
framework 34 Appendix Four 37 National Audit Office reports on government ICT 37 4 Summary NHS Prescription Services:
the impact of legacy ICT Summary 1 The NHS Business Services Authority (the Authority) is an arm's-length body of the Department of health.
NHS Prescription Services is one of the services supplied by the Authority. It calculates how much pharmacists,
and payments amount to around £9 billion a year. 1 2 The National Audit Office examined the way the Authority manages its prescription pricing information and communication technology (ICT),
and meets the current needs of the fee-paying customers and internal system users, despite the hardware being supported by the supplier on a'best endeavours'basis. 2 The legacy system is unable to comply with the latest NHS information standards for drugs and medicines.
This will enable engagement with stakeholders regarding risk cost, prioritisation and funding. 1 ttp://www. nhsbsa. nhsh. uk/Prescriptionservices/809. aspx 2 The Mcdonnell douglas hardware
NHS Prescription Services: the impact of legacy ICT Summary 5 The newer CIP system, operational since 2007, has improved the speed and cost of processing through the use of modern scanning equipment.
However, the IT staff we spoke to are unaware of the arrangements and accreditations to deal with the risks of cyber threat, fraud and other security threats. 6 Part One NHS Prescription Services:
Extending public services to digital channels as per the'digital by default'strategy as set out in the Government Digital Strategy3 can be constrained by legacy modes of operation-processing jobs as a sequence of batches instead of reacting in real time in a way users of digital services have become accustomed.
and when investment is needed to migrate and replace legacy systems. In response, the government said it preferred to extend the life of legacy systems using software layers it called wrappers that would make legacy systems integrate more easily with newer systems. 3 The Cabinet Office
Prescription Services: the impact of legacy ICT Part One 7 Subsequently the Cabinet Office issued further advice6 providing more detail on the approach to handling legacy ICT. 1. 4 We examined how the public sector manages its legacy
and an enterprise analysis8 measuring how mature the organisation is in managing, operating and maintaining the service,
The prescription processing service operated by the NHS Business Services Authority using the 6 year old Capacity Improvement Programme system
can be found in Appendix Two. 8 Our enterprise analysis is performed using a framework containing the seven key areas that most impact performance:
A full description of the enterprise analysis framework we applied during our fieldwork can be found in Appendix Three. 8 Part Two NHS Prescription Services:
the impact of legacy ICT Part Two The NHS Business Services Authority 2. 1 The NHS Business Services Authority (the Authority) is an arm's-length body of the Department of health.
Prescription Services 2. 2 NHS Prescription Services, which is one of the services supplied by the Authority,
calculates the remuneration and reimbursement due to pharmacists, GPS and appliance contractors for medicines and medical devices dispensed to patients from NHS prescription forms.
and prescribing related data to NHS stakeholders and the general public. For example the Electronic Prescribing
While information services form a significant part of the role of the Authority, they are beyond the scope of this report.
NHS Prescription Services: the impact of legacy ICT Part Two 9 Prescription pricing ICT 2. 4 The Authority currently uses two ICT systems to process prescriptions:
The Authority's aim is to transfer all remaining prescription services to the CIP system
and local pharmaceutical services (Figure 1). The business rules for these customer groups have not yet been added to the CIP system.
000 prescription items per month in 2011-12 NOTE 1.'Other'includes prescriptions provided by private practices, out-of-hours prescriptions and local pharmaceutical services,
National Audit Office analysis 23%21%21%35%Jersey Guernsey Isle of man Other 10 Part Two NHS Prescription Services:
and to address impending risks relating to technology approaching end-of-life. 2. 8 To meet the capacity demands,
at a cost of £2 million. 2. 9 The EPS provides the Authority's customers with the ability to submit prescriptions electronically as an alternative to paper prescription forms.
The ownership of EPS transferred from NHS Connecting to Health to the NHS Commissioning Board on 1 april 2013.2.10 Our focus in this report is the impact of the legacy ICT system on the delivery of Prescription Services.
NHS Prescription Services: the impact of legacy ICT Part Two 11 The service model 2. 11 Figure 2 shows the components of the prescription pricing service
Customers The Authority provides the prescription service to 11,700 pharmacists, 116 appliance contractors and around 47,000 doctors from 8, 000 practices (of which just over 1,
Responsibility for remuneration policy in relation to dispensing contractor services and the EPS service was transferred to the NHS Commissioning Board from 1 april 2013.
Channels NHS prescription forms are submitted by the customers to claim reimbursement for prescriptions dispensed. These can be submitted in batches of paper prescriptions by post (all legacy customers submit by post) or via EPS.
From April to December 2012,5. 4 million prescription line items were submitted electronically, which represents around less than 1 per cent of total transactions,
Services NHS Prescription Services calculates how much its customers should be paid as reimbursement and remuneration for medicines and medical devices dispensed to patients from NHS prescription forms.
and prescribing related data to NHS stakeholders and the general public (see paragraph 2. 3). 12 Part Two NHS Prescription Services:
the impact of legacy ICT Figure 2 Prescription pricing service model NOTE 1. Information services are beyond the scope of this report.
Source: National Audit Office analysis Processes In 2011-12 over 960 million prescription items were processed
NHS Prescription Services: the impact of legacy ICT Part Two 13 2. 12 Figure 3 shows that where the legacy system requires manual input of line items and application of the rules,
) Source NAO analysis of prescription pricing processes 14 Part Three NHS Prescription Services: the impact of legacy ICT Part Three Financial and performance analysis 3. 1 In this part of the report, we analyse the investment the NHS Business Services Authority (the Authority) has made in the Capacity Improvement
Programme (CIP) and the legacy system, the cost of running the prescription pricing service and the performance achieved. 3. 2 For this review,
NHS Prescription Services: the impact of legacy ICT Part Three 15 Figure 4 Volume and breakdown of prescription line items The number of line items processed by NHS Prescription Services has grown by an average of 5 per cent a year
since 2009-10 NOTES 1. The difference between the two CIP processes is explained in Figure 3. 2. The actual number of prescriptions processed through EPS were:
16 Part Three NHS Prescription Services: the impact of legacy ICT Figure 5 Performance against accuracy target The legacy system consistently met the accuracy target in 2011-12.
and other customers to send prescriptions for payment by the fifth working day of a month.
NHS Prescription Services: the impact of legacy ICT Part Three 17 Financial analysis Expenditure on the prescription pricing service 3. 6 The Authority spent £40. 7 million on operating the NHS prescription
services in 2011-12, equivalent to £42. 18 per 1, 000 prescription line items processed. 9 Of this,
This would reduce the expenditure in 2011-12 to £38. 1 million or £39. 48 per 1, 000 prescription line items processed. 18 Part Three NHS Prescription Services:
Amounts have been adjusted for inflation using the retail prices index. Source: NAO analysis of Authority data 3. 10 The business case envisaged that a further 1. 13 pence (27 per cent of the actual 2011-12 cost) per prescription line item could be saved by the adoption
based on headcount, from a NHS Prescription Services: the impact of legacy ICT Part Three 19 central ICT contract
This represents a programme of investment, funded by the Department of health, to improve the CIP system.
and the cost of internal staff supporting the ICT system. 20 Part Four NHS Prescription Services:
the impact of legacy ICT Part Four Our enterprise analysis of the NHS Prescriptions Service and the management of the legacy system 4. 1 In this part, we summarise the findings of our enterprise analysis
and the scores we have allocated the NHS Business Services Authority (the Authority) as part of our assessment.
The enterprise analysis framework can be found in Appendix Three. Strategy and business model Our assessment Key finding Now Future The Authority is taking steps to improve efficiency and accuracy.
EPS provides the best potential benefit but the Authority is unable to affect uptake. 4. 2 In 2005,
and then a phased roll out, targeting the bulk of the transactions for first migration in 2007.3 3 NHS Prescription Services:
for example, by migrating selected accounts into CIP. 4. 4 Other demands continue to take priority over the completion of the transition.
It is likely that other projects will continue to take precedence without effective engagement with stakeholders such as the Department of health,
Responsibility for remuneration policy in relation to dispensing contractor services and the EPS service was transferred to the NHS Commissioning Board from 1 april 2013.4.5 The Channel Islands
or make alternative arrangements. 4. 6 Another aim of the Authority is to continually improve the level of service provided to customers in terms of information accuracy
and automation in the processing of prescriptions by reducing the complexity of the rules used to price drugs. 10 NHS Business Services Authority Business plan 2012/13, available at http://www. nhsbsa. nhs. uk/Documents
/NHSBSAANNUALREPORTS/NHSBSA BUSINESS PLAN -2012-13 -Final. pdf 11 NHS Business Services Authority Strategy 2012-2017, available at http://www. nhsbsa. nhs. uk
/Documents/NHSBSAANNUALREPORTS/Strategy 2012-17. pdf 22 Part Four NHS Prescription Services: the impact of legacy ICT 4. 7 We consider that the paper-based scanning process is a legacy process,
This ensures that the Authority is monitoring its exposure to risks related to technology that is approaching end-of-life in current systems. 3 4 NHS Prescription Services:
the impact of legacy ICT Part Four 23 4. 11 The Authority has adopted an enterprise architecture approach to ensure alignment of IT and business services,
and the ICT strategy is in the process of being refreshed to improve consistency with the corporate strategy and business plan.
so customers currently handled by the legacy system will need to adopt that standard prior to moving to CIP and EPS.
transfer the customers and decommission the legacy system. 4. 14 The intention is to eventually decommission the legacy system
and move all customers to CIP but we were unable to establish the existence of plans for the transition of customers
transfer the customers and decommission the legacy system. 12 Information Standards Board for Health and Social Care, ISB 0052, available at http://www. dmd. nhs. uk/3
24 Part Four NHS Prescription Services: the impact of legacy ICT 4. 15 Platform support is outsourced to the IT service provider (Capita),
test and release cycles on dedicated development and user acceptance testing environments, for both the CIP and legacy systems.
and meets the current needs of the fee-paying customers and internal system users. Service definitions and service level agreements between the Authority
We found that the prescription processing systems met their 99.5 per cent target availability in all but two of the preceding 12 months to January 2013 (Figure 8). 3 3 NHS Prescription Services:
National Audit Office analysis of service delivery reports 4. 19 The arrangements in place to manage the supplier services are adequate, with regular service review meetings taking place between the Authority
The legacy Mcdonnell douglas hardware is supported by Northgate on a'best endeavours'basis. 26 Part Four NHS Prescription Services:
There are no dedicated environments for end-user training but the systems are straightforward and intuitive to use,
and circulated in a controlled manner. 4 43 4 NHS Prescription Services: the impact of legacy ICT Part Four 27 4. 25 The IT service provider is responsible for the disaster recovery and perimeter security arrangements and for carrying out regular disaster recovery
but there are questions regarding its ability to cope with future demand. 4. 27 Drug tariff information
for example, CIP cannot currently handle prescriptions that are submitted later than the current processing cycle. 4. 29 The Authority has embarked recently on a technology refresh programme-replacing the physical server environment with virtual servers,
and upgrading the desktop environment. The new virtual server environment is expected to provide scalability to respond to the increase in demand,
although the capacity of the application has not been measured sufficiently to be able to predict the impact of the anticipated growth in demand. 13 NHS Connecting for Health, Information Governance,
available at http://www. connectingforhealth. nhs. uk/systemsandservices/infogov (accessed November 2012) 3 4 28 Part Four NHS Prescription Services:
NHS Prescription Services: the impact of legacy ICT Part Five 29 Part Five The lessons learned from the impact of legacy ICT on the Authority's prescriptions service 5. 1 In this final part of the report,
financial and enterprise analysis to draw out the key lessons the NHS Business Services Authority (the Authority) has learned from the impact of legacy ICT on prescription services (Figure 9
performing a valuable role for the remaining customers but the environment is changing; demand for NHS Prescription Services is growing
and there is pressure to reduce costs and improve the efficiency of the prescription service. 5. 4 The Authority intends to decommission the legacy system.
which to engage stakeholders and customers. 5. 5 The best potential for accuracy and efficiency improvement appears to rest with the Electronic Prescriptions Service (EPS),
the adoption of which is dependent on other organisations. 5. 6 While the Authority is taking steps to improve in some areas we believe it is not in a position to improve its overall position
unless practical plans are developed to transfer the remaining customers to CIP and decommission the legacy system,
and the proportion of prescriptions submitted via EPS increases significantly. 30 Part Five NHS Prescription Services:
the impact of legacy ICT Figure 9 Enterprise analysis summary assessment Source: National Audit Office analysis based on the enterprise analysis framework in Appendix Three NHS Prescription Services:
the impact of legacy ICT Part Five 31 Figure 10 Lessons from the prescription pricing service Lessons Commentary Senior management ownership of IT risk leads to proactive decisions
but it is likely that the full benefits are contingent on the completion of the transfer of the remaining customers from legacy to CIP or EPS.
which makes it difficult to build a robust case that can be used to engage with stakeholders
The inability to scale the system to meet demand; the lack of flexibility to adapt to changes of business rules;
National Audit Office analysis 32 Appendix One NHS Prescription Services: the impact of legacy ICT Appendix One Timeline History of prescription pricing systems Source:
National Audit Office analysis NHS Prescription Services: the impact of legacy ICT Appendix Two 33 Appendix Two Methodology Our methodology centred on the application of our business analysis toolkit.
and the application of our enterprise analysis framework (Appendix Three). Method Financial and performance analyses including:
Interviews with financial and operational staff Analysis of investment and spend Data analysis of service performance
and contract management staff, technical stakeholders and representatives from suppliers Document review of ICT and contracting strategies, reviews of the ICT estate,
technical descriptions and publicly available service information Application of our enterprise analysis framework including: A workshop of key stakeholders where they self-assessed
and scored themselves against the components of the framework Semi structured interviews with corporate service leaders, senior technical staff,
risk registers and service impacting incidents A'wash up'workshop where the results of National Audit Office fieldwork findings were played back to senior stakeholders
and compared with self-assessment 34 Appendix Three NHS Prescription Services: the impact of legacy ICT Appendix Three Enterprise analysis framework Good practice in the management of legacy ICT Strategy and business model Strategy and business model There is a clear strategy in place for the service,
which the organisation regularly reviews and updates to reflect changes in its business environment and/or exploit new technologies.
Business case and funding Business case (s) for replacement reflect good practice (e g. HM Treasury Green Book), are reviewed regularly
and opportunities are exploited and managed. Ongoing costs Costs of the services are understood fully and managed against a budget and prioritised business demands.
Costs are challenged and optimised and the value of asset/investments is exploited fully. Governance, architecture and standards Technical governance Technical governance arrangements provide strong and effective oversight and direction on the ICT portfolio and the lifecycle of the legacy system.
Regular meetings take place between business and IT to identify and prioritise changes in business requirements and legacy ICT capabilities, risks and issues, opportunities and threats.
Enterprise architecture There are clear links and strong alignment between the IT strategy and business strategy,
and the legacy system is supported by a documented comprehensive technical architecture. Data quality and assurance A clear and consistent strategy for data standards and architecture ensures a coordinated approach to continually improve the quality of information provided by the legacy system.
The sources of data are understood well and business users have trust in the information. Risk management Risk management processes ensure that the business risk appetite is documented
Key stakeholders have clear visibility of the level of risk exposure. Implementation Lifecycle management The system is readily adaptable to changing business needs
NHS Prescription Services: the impact of legacy ICT Appendix Three 35 Decommissioning legacy All legacy systems have been identified and effective transition arrangements,
and improved in partnership with the end-users and/or customers, and service delivery performance is compared regularly with target performance and good practice benchmarks.
The dependency of the legacy system on service performance is known, with risks and issues managed effectively.
Management of supplier services Outsourced services are managed actively and regularly market tested to ensure value for money,
which inputs to management decisions about future direction and investment. There is a tailored organisation wide training programme with clear success criteria being monitored.
Recruitment, retention and development activities are aligned with the needs of the service and its customers.
and there are agreed solution roadmaps are in place. 36 Appendix Three NHS Prescription Services: the impact of legacy ICT Process Business processes Development or improvement of business processes is hindered not by the capabilities of the legacy system,
Technology Applications The legacy ICT system fully integrates with the wider ICT environment using standard protocols or common application programme interfaces.
Test facilities exist that replicate the production environment exist or can easily be created and removed as required.
National Audit Office enterprise analysis toolkit NHS Prescription Services: the impact of legacy ICT Appendix Four 37 Appendix Four National Audit Office reports on government ICT NOTE 1. For published client reports focused on ICT see next
National Audit Office 38 Appendix Four NHS Prescription Services: the impact of legacy ICT Published client reports, focused on ICT Online services 1 HM Revenue & Customs:
Shared services in the Research Councils, October 2011. Infrastructure 10 Department for Environment, Food and Rural affairs:
Geographic information strategy, July 2011.11 Home office and National Policing Improving Agency: Mobile technology in policing, January 2012.12 Department for Culture, Media and Sport:
The rural broadband programme, July 2013 NHS Prescription Services: the impact of legacy ICT Appendix Four 39 People delivering and operating government ICT 13 Department for Business, Innovation and Skills and Skills Funding Agency:
Policies and strategies for information and technology and business 14 Department for Environment, Food and Rural affairs and the Animal Health and Veterinary Laboratories Agency:
Improving the delivery of animal health and welfare services through the Business Reform Programme, July 2012.
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