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 datasets, morbidity registers To act as a working document for daytoday recording of patient care To store a chronological account of the patients 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 patients 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, 280286

National Mental Health Informatics Network

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

 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

RCP Clinical Documentation and Generic Record Standards Project

Core Information Referrer

*PRESENTING ISSUE *DIAGNOSES

Admission

The core information is enriched at each step CURRENT PROBLEMS AND ISSUES By *OPERATIONSa core information standard agreeing AND PROCEDURES weFAMILY HISTORY can allow individual systems to share This core information can then be saved on each individual system information INVESTIGATIONS AND RESULTS
MEDICATIONS

Handover

ALLERGIES AND ADVERSE REACTIONS

Discharge

Identified Stakeholders

Research

Nurses Doctors AHPs Social care

Adult Social Care Public Health England Suppliers 3rd sector 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 a foundation for innovation Today RiO is fully supporting the Trusts business:

Calendar Year 2006 2007 2008 2009 2010 2011

Total Progress Notes Entered 97,968 139,601 154,836 541,528 1,525,729 1,840,082

Over 4,000 regular users concurrency peaks around 900 per day On target to record 2,000,000 progress notes during 2011
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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
Trust Survey

Team / Ward Data

Recurring Themes

Medical Staff Data

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Progress on issues
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

Acute Mental Health Ward Dashboard

NTW dashboards

Patient view

Lessons learned from Clinical Dashboards

Quality Standards

Care Pathway s

EPR RiO

Quality Standards

Care Pathway s

EPR RiO

Data Warehouse

Quality Standards

Care Pathway s

EPR RiO

ESR Acute Trust

Safe guardin g

Data Warehouse

Quality Standards

Care Pathway s

EPR RiO

Standardised Quality outputs Q and P Dashboard

Data Quality ESR Acute Trust

Safe guardin g

Clinical Dashboard

Data Warehouse Data Quality PDF

Spreadshee ts

Quality Standards

Urgent and Planned Care Caldicott and Health Informatics Groups RiO Champions

NTW Caldicott and Health Informatics Groups

External Communication Standardised Quality outputs Q and P Dashboard

Care Pathway s

EPR RiO

Data Quality ESR Acute Trust

Safe guardin g

Clinical Dashboard

Data Warehouse Data Quality PDF

Spreadshee ts

Smart 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

Links with professional bodies

RCPsych

Clinical validation of systems

ERA

Networks
Local/Regional/National

Education and training

Promoting innovative practice

Patient view dashboard