Post on 29-Oct-2014
transcript
The use of information in mental health
Dr Jonathan Richardson Clinical Director of Informatics
Chair Royal College of Psychiatrists Informatics committee
“By all means keep a … for amusement,but keep the more reliable ….. for work".
BMJ,..99.
“By all means keep a car for amusement,but keep the more reliable horse for work".
BMJ,1899.
Ref Loudon I, Doctors and Their Transport, 1750-1914, Medical History, 2001, 45: 185-206
The purposes of the clinical record• To record risk assessments to protect
the patient and others• To record the advice given to general
practitioners, other clinicians and other agencies
• To record the information received from others, including carers To store a record to which the patient may have access
• To inform medico-legal investigations• To inform clinical audit, governance
and accreditation• To inform bodies handling complaints
and inquiries• To inform research• To inform analyses of clinical activity• To allow contributions to national data-
sets, morbidity registers
• To act as a working document for day-today recording of patient care
• To store a chronological account of the patient’s life, illnesses, its context and who did what and to what effect
• To enable the clinician to communicate with him- or herself
• To aid communication between team members
• To allow continuity of approach in a continuing illness
• To record any special factors that appear to affect the patient or the patient’s response to treatment
• To record any factors that might render the patient more vulnerable to an adverse reaction to management or treatment
Improving standards in clinical record-keeping,Ian Pullen & John Loudon,Advances in Psychiatric Treatment (2006), vol. 12, 280–286
• 2011 National Mental Health Informatics Network Congress
• Royal College of Psychiatrists• Department of Health Informatics Directorate• NHS Information Centre• British Computer Society.
• British Computer Society- Hosting• Royal College of Psychiatrists- sponsored• Executive committee• Links to the National Mental Health
Information Board
National Mental Health Informatics Network
RCP Clinical Documentation and Generic Record Standards Project
• Continuation of AoMRC clinical record keeping project
• Commissioned by CDSA• Phase 2 and 3 2011-2013
– Core clinical headings and model– Outpatient summary and GP referral– Editorial Principles– Review and adjustment of the whole set of
standards
*PRESENTING ISSUE
*DIAGNOSES
CURRENT PROBLEMS AND ISSUES
*OPERATIONS AND PROCEDURES
FAMILY HISTORY
INVESTIGATIONS AND RESULTS
MEDICATIONS
ALLERGIES AND ADVERSE REACTIONS
Core InformationReferrer
Admission
HandoverDischarge
By agreeing a ‘core’ information standard we can allow individual systems to share information
This ‘core’ information can then be saved on each individual system
The core information is enriched at each step
NursesDoctorsAHPsSocial care
Suppliers3rd sector
Research
Identified Stakeholders
Public Health England
Adult Social Care
Patients
NTW Background
•We work from over 160 separate sites.
•7 large sites and numerous smaller sites.
•Cover rural and affluent areas – including Alnwick voted best place to live in Britain
•To dense towns and deprived areas including Easington – in the top 10 worst towns in Britain
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RiO in NTW
• Today RiO is fully supporting the Trust’s business:
Calendar YearTotal Progress Notes Entered
2006 97,9682007 139,6012008 154,8362009 541,5282010 1,525,7292011 1,840,082
Over 4,000 regular users – concurrency peaks around 900 per dayOn target to record 2,000,000 progress notes during 2011
RiO in NTW – a foundation for innovation
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Team / Ward Data
Medical Staff DataTrust Survey
Enhancing RiO Access
• At the end of 2010 when we had “critical mass” of users on the system we undertook a survey of users.
• Variety of data collection methods used
• Recurring themes raised in all areas
• Directorate• Medical• Trust
– All users email– Over 700 responses
Recurring
Themes
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Clinical Forms• Lean workshop over 80 clinicians and
patient user groups• Went live with core documentation for
3500 users in October 2011• Care Programme Approach
Association National Award • Currently in the process of a further
review
Data Entry/Mobile Access• Vodafone mobile access solution
available• 300 deployed• To deploy 1000• Great feedback• Improved usability
Clinical Standards• Developed NTW Clinical Standards for
Electronic Record Keeping
Scanning and Document Capture• Upgrade of the scanned document
section has gone live
Clinical Coding• Work stream planned during 2012
Northumberland/Partnership Working• Access Newcastle Social Services
summary of risk, directly from RiO
Speed of RiO• Upgrade to v6 included full hardware
upgrade
Progress on issues
Acute Mental Health Ward Dashboard
NTW dashboards
©
Patient view
©
Lessons learned from Clinical Dashboards
Quality Standards
Care Pathways
EPRRiO
Quality Standards
Care Pathways
EPRRiO
Data Warehouse
Quality Standards
Care Pathways
ESR
Safe guarding
Acute Trust
EPRRiO
Data Warehouse
Quality Standards
Care Pathways
ESR
Safe guarding
Acute Trust
EPRRiO
Clinical Dashboard
Spreadsheets
Data Warehouse
Standardised Quality outputs
Q and P DashboardData
Quality
Data Quality
Quality Standards
RiO Champions
Care Pathways
ESR
Safe guarding
Acute Trust
EPRRiO
Clinical Dashboard
Spreadsheets
Data Warehouse
Standardised Quality outputs
Q and P Dashboard
NTW Caldicott and Health Informatics Groups
Urgent and Planned Care Caldicott and Health Informatics Groups
Data Quality
Data Quality
External Communication
Smart Phone & Tablet AppSmart Phone & Tablet App
Help & Advice
• The Cost of Technology, Elizabeth Toll, MD • JAMA. 2012;307(23):2497-2498. doi:10.1001/jama.2012.4946
‘For growth, we need a new strategy
which will focus on how to promote the capabilities of younger people – turning the
• IPOD (Insecure, Pressured, Overtaxed and Debt ridden) generation
• into the ACES (Adaptive, Capable, Enterprising and Secure) generation’
Ref IPOD to ACES,Nick Bosanquet, IPODS to ACES, Reform, The next 10 years http://10years.reform.co.uk/essays/IPOD-to-ACES.pdf
The value of clinical leadership• Engagement
– Patients/carers– Individuals/Teams
• Clinical validation of systems– ERA
• Education and training
• Links with professional bodies– RCPsych
• Networks– Local/Regional/National
• Promoting innovative practice– Patient view dashboard