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 and Chair 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

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“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, , Medical History, 2001, 45:

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9th November 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

Differences within and out of the national programme for IT RiO in NPfIT Clinical and risk management information in one place Available to multiple users at multiple sites at all times Changes often in a challenging time frame RiO out of NPfIT Local configuration Enables a sociotechnical approach Changes made in a realistic time frame

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 teams 2006 – NTW Trust formed through merger - One of the largest MH Trusts in the country Direct contract with supplier 2010 – Trust achieved Foundation Trust status 2011 – 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 Trust Ambulance The Homerton University Hospital NHS Foundation Trust Cardiology Anaesthetics Acute Admissions Unit Norfolk & Norwich University NHS Foundation Trust Obstetrics Oncology Portsmouth City PCT General Practice Portsmouth Hospitals NHS Trust Elective Orthopaedics Trauma Orthopaedics Medical Admissions Unit Bradford & Airedale Teaching PCT & Surgeries General Practice Bolton PCT & Surgeries General Practice Salford Royal NHS Foundation Trust Renal Care of the Elderly General Surgery Mid Staffordshire NHS Foundation Trust Haematology Gastro-intestinal Respiratory Wiltshire PCT (St Mellor Surgery, Amesbury) General Practice Salisbury NHS Foundation Trust Urology Stroke ENT Nottingham University Hospitals NHS Trust ED Diabetes

Acute Mental Health Ward Dashboard

RCPsych AIMS-OP Accreditation MDT assessment Falls assessment

Number of patients with recorded MDT meeting

Early Benefits BenefitBaseline 2009September 2010 Length of stay102 days overall for 01/12/ /11/ days overall* for 01/12/ /10/2010 Falls assessment recorded 19%**77% Risk assessment recorded17%93% MDT assessment recorded54%87% *11 months **March 2010

Managing Transformation IBP Strategic Direction Continuous Improvement System Next Steps Safety Core Programmes Leadership SLM Knowledge Management

Enhancing RiO Access Data Collection Variety of data collection methods used Recurring themes raised in all areas Directorate Medical Trust –All users –Over 700 responses 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

Kolb’s experiential learning styles are in black, Honey and Mumford’s in red. Jennings S F Postgrad Med J 2007;83: ©2007 by The Fellowship of Postgraduate Medicine

Learning to be Professional through a Life-wide Curriculum University of Surrey, Guildford Tuesday 31st March & Wednesday 1st April 2009 Accessed online 17/10/2010

Newcastle Care Pathway

Care Pathway Access Assessment & Formulation Treatment, maintenance & support Transitions between services / pathways Disengagement & Discharge

GOALPRIMARY DRIVERS SECONDARY DRIVERS CHANGE PROJECTS Improve value to patients by improving outcomes with reducing resource Next Steps Clinical Engagement IM and T Patient experience Safety Service line management Care Pathways Leadership Knowledge management NTW IM and T strategy Technical capacity Continuous improvement Productive ward series SUI Prescribing QIPP Links with directorate Lead Nurses Definition of metrics Benchmarking Informatics Sustainability Produce clinical dashboard Produce Q + P dashboard Data quality Processes Points of you Safeguarding POMHS Shared care

Quality Standards Care Pathways EPR RiO

Quality Standards Care Pathways EPR RiO Data Warehouse

Quality Standards Care Pathways ESR Safe guarding Acute Trust EPR RiO Data Warehouse

Quality Standards Care Pathways ESR Safe guarding Acute Trust EPR RiO Clinical Dashboard PDF Spreadsheets Data Warehouse Standardised Quality outputs Q and P Dashboard Data Quality

Quality Standards RiO Champions Care Pathways ESR Safe guarding Acute Trust EPR RiO 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

Future Approach

Sociotechnical principles ‘moving away from a too-narrow focus on IT developing a better balance between national requirements and local flexibility for grassroots adaptability establishing the capacity and capability to support effective handling of critical human and organisational issues undertaking systematic reviews and evaluations’ Ref Peltu et al How a Sociotechnical approach can help NPfIT deliver better NHS patient care May 2008

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.

North East Clinical Health Information Forum A body of health informatics focused clinicians who will act as a specialist resource for organisations, present and future. Assistance in consultation and delivering recommendations A forum of clinicians to share best practice. where clinicians can find out about current local and national information initiatives. An opportunity to promote clinical involvement in IT enabled transformational change. An open, supportive environment for clinicians to discuss issues and concerns.

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

Summary Information Communication Documentation Integration Continuous improvement Transparent

Acknowledgments 1.CFH 2.NE SHA informatics team 3.NTW team informatics, OPMHS