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
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
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
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