Dr Jonathan Richardson Chair Clinical Health Informatics Forum, Consultant in old age psychiatry and Clinical Director o

1. Dr Jonathan Richardson Chair Clinical Health Informatics Forum, Consultant in old age psychiatry and Clinical Director of Informatics, Northumberland, Tyne and Wear NHS Foundation Trust

2. Introduction • Programme • Background • Electronic patient record (RiO) in NTW • Clinical Dashboards in NTW • Lessons Learned

3. Programme • 9.00am Registration and Refreshments • 9.30am Welcome & Introductions • Dr Jonathan Richardson, chair clinical health informatics forum, consultant in old age psychiatry and clinical director of informatics, Northumberland, Tyne and Wear NHS Foundation Trust • 9.45am The Campaign • Jon Hoeksma, editor eHealth Insider • 10.00am What clinical leadership can bring to informatics in the NHS • Bill McAvoy, Deputy Transition Director, Patients and Intelligence,NHS Commissioning Board Authority • 10.30am The business benefits of clinical leadership in informatics • Dr Daniel Birchall, consultant neuroradiologist and chair of the Information Systems Strategy Board, the Newcastle Upon TyneHospitals NHS Foundation Trust • 11.00am Breakout session with refreshments • Facilitated discussion groups • 12.00pm Breakout group session feedback • 12.45pm Concluding remarks • Dr Jonathan Richardson, consultant in old age psychiatry,acting chair clinical health informatics forum, Northumberland, Tyne and Wear NHS Foundation Trust • Jon Hoeksma, editor eHealth Insider • 1.00pm Lunch

5. Information strategy to give people more control over their care • More efficient, with more time • Sharing information safely to improve care • Recording real time, accurate data and sharing it with people • Ensuring patients are fully involved in decision making • The information system

7. 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 The purposes of the clinical record Improving standards in clinical record-keeping,Ian Pullen & John Loudon,Advances in Psychiatric Treatment (2006), vol. 12, 280–286

8. 15% of outpatient appointments were affected by missing clinical information • In 20% of these cases patients were exposed to risk (as judged by the doctors involved).

9. 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.

10. 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 Recurring Themes

13. 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

15. Clinical Dashboards Good quality information is a driver of performance for clinical teams and helps ensure the best possible care for patients. Clinical Dashboards help to drive this process by: • 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

16. Lessons learned from Clinical Dashboards

17. Quality Standards Care Pathways EPR RiO

18. Quality Standards Care Pathways EPR RiO Data Warehouse

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

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

21. NTW Caldicott and Health Informatics Groups Urgent and Planned Care Caldicott and Health Informatics Groups Quality Standards RiO Champions External Communication Standardised Quality outputs Care Pathways EPR RiO Q and P Dashboard Data Quality ESR Data Warehouse Clinical Dashboard Acute Trust PDF Data Quality Safe guarding Spreadsheets

22. Clinical System Content Build Maintenance Clinical requirements Core Documentation (inc national core headings) Workstream A Workstream B Workstream C <<------------------------------------------------- RiO --------------------------------------- >> Contract\CQUIN e.g communication with GP Workstream D Audit enhanceents Business requirements = major change = minor change = Design/Build/Test/Train

23. Clinical System Content Build Maintenance Clinical requirements Core Documentation (inc national core headings) Unplanned Work Workstream A <<------------------------------------------------- RiO --------------------------------------- >> Contract\CQUIN e.g communication with GP Audit enhanceents Workstream D Unplanned Worlk Business requirements = major change = minor change = Design/Build/Test/Train

24. Benefits of a Clinical Director of Informatics • Engagement • Clinical validation of systems • Education and training • Links with professional bodies • Networks • Promoting innovative practice