The Information issues for supporting quality standards

for Mental Health

Dr Jonathan Richardson Consultant in Old Age Psychiatry

Clinical Director of Informatics Northumberland Tyne and Wear NHS Foundation Trust

andChair Royal College of Psychiatrists Informatics Committee

”

Overview

• Background• History of the electronic patient record in Newcastle• Clinical dashboards• Current provision• Progress in Newcastle• Future approach

“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

Brief history of RiO in Newcastle

1997 – Trust completed clinical information system procurement – began implementation of InteHealth

2002 – Migrated from InteHealth to RiO 2003 – Started clinical rollout in Community Mental Health and Early

Intervention In Psychosis teams2006 – NTW Trust formed through merger  -

• One of the largest MH Trusts in the country• Direct contract with supplier

2010 – Trust achieved Foundation Trust status2011 – Currently

• 3500 users covering a population of 1.2 million• At peak approx. 900 concurrent users• Complete coverage by March 2012 including a diverse range

of services.

Good quality information is a driver of performance for clinical teams and helps ensure the best possible care for patients.

• providing timely, relevant information for clinical teams, presented in easy to understand formats, with high visual impact

• utilising multiple sources of existing data, even across organisational boundaries

• providing clinical information across multidisciplinary teams• displaying information in ‘real time’ without delay for data cleansing• allowing local configuration and comparison against national data sets• permitting regular changes to displays, as required by the local teams, to

keep the information relevant and up to date

Clinical Dashboards help to drive this process by:

Clinical Dashboards

Northumberland, Tyne & Wear NHS Trust Mental Health

South East Coast Ambulance Service NHS TrustAmbulance

The Homerton University Hospital NHS Foundation TrustCardiologyAnaestheticsAcute Admissions Unit

Norfolk & Norwich University NHS Foundation Trust ObstetricsOncology

Portsmouth City PCTGeneral Practice Portsmouth Hospitals NHS TrustElective OrthopaedicsTrauma OrthopaedicsMedical Admissions Unit

Bradford & Airedale Teaching PCT& SurgeriesGeneral Practice

Bolton PCT & SurgeriesGeneral Practice

Salford Royal NHS Foundation TrustRenalCare of the ElderlyGeneral Surgery

Mid Staffordshire NHSFoundation TrustHaematologyGastro-intestinalRespiratory

Wiltshire PCT (St Mellor Surgery, Amesbury)General PracticeSalisbury NHS Foundation TrustUrologyStrokeENT

Nottingham UniversityHospitals NHS TrustEDDiabetes

Acute Mental Health Ward Dashboard

RCPsych AIMS-OP Accreditation

• MDT assessment

• Falls assessment

Recorded MDT

0

5

10

15

20

25

30

35

MDT recorded MDT not recorded

01-Dec

15-Dec

14-Jan

23-Feb

31-Mar

29-Apr

Number of patients with recorded MDT meeting

Early BenefitsBenefit Baseline 2009 September 2010

Length of stay 102 days overall for 01/12/2008 - 30/11/2009

90 days overall* for 01/12/2009 - 31/10/2010

Falls assessment recorded

19%** 77%

Risk assessment recorded 17% 93%

MDT assessment recorded 54% 87%

*11 months **March 2010

Managing Transformation

IBPStrategicDirection

Continuous Improvement

System

Next StepsSafety

Core Programmes

Leadership

SLM

KnowledgeManagement

Enhancing RiO Access Data Collection

• Variety of data collection methods used

• Recurring themes raised in all areas

• Directorate• Medical• Trust

– All users email– Over 700 responses

Team / Ward Data

Medical Staff DataTrust Survey

Recurring

Themes

Issues identified

• Clinical Forms

• Data Entry/Mobile Access

• Clinical Standards

• Scanning and Document Capture

• Clinical Coding

• Northumberland/Partnership Working

• Speed of RiO

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 • Review planned in March 2012

Data Entry/Mobile Access• Vodafone mobile access solution available

Clinical Standards• Developed NTW Clinical Standards for Electronic Record Keeping

Scanning and Document Capture• Upgrade of the scanned document section to go live November 2011

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

NTW dashboards

©

Patient view

©

Lessons learned from Clinical Dashboards

Care Pathway

Access

Assessment &

Formulation

Treatment, maintenance

& support

Transitions between

services / pathways

Disengagement & Discharge

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

PDF

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

PDF

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

Future Approach

RiO Mobile Pilot

• 2 Mobile Solutions / BlackBerry and PC laptop & notebook devices

• RiO Store & Forward helps maintain existing assets

• Can work with RiO5 and later software releases

• Working with CSE to beta test RiO mobile for Blackberry and RiO store and forward.

Issues• Standards e.g. content of the mental health electronic

patient record, national care plan.• Clear recommendations on the functionality of systems e.g.

system usability scale.• Payment by results in mental health e.g. meaningful clinical

outcomes.

Opportunities • Patient/Carer involvement. • Facility to share information e.g. assessment documents,

care plans, procurements documents.• Clinical Leadership e.g. Clinical Directors and Chief Clinical

Information Officer.

Informatics Committee

Chief Clinical Information Officer

Acknowledgments

1. CFH

2. NE SHA informatics team

3. NTW team informatics, OPMHS