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

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

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