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
In 1997, Tony Blair announced that ”if you live in Birmingham and you have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you.”
In 2007 when I stated as a consultant patient from Benton being admitted to a hospital in Benwell 2 2 2

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
1.00pm Lunch

4. Linkages between the main elements of an information revolution
Ownership
Our patients
Together
Active best results
Tell family mbers

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
More efficient, with more time
Greater and better use of IT will help you improve the efficiency and quality of your practice of care, and you will be able to prioritise more of your time for those who need face-to-face care.
Basingstoke and North Hants NHS Trust have a system that allows clinicians to access and update a patient’s information without leaving their bedside.
Sharing information safely to improve care
You will recognise that it is your duty to ensure people can access their records online if they wish and have the support they need to understand information in their records.
Patient RenalView and Graham Care Homes are already allowing patients greater control over who they share their personal records with.
Recording real time, accurate data and sharing it with people
You will better understand the needs of the people you work with and understand more about the impact your care is having on them. This will rely, in turn, on your recording data directly into their care records and sharing it.
Midwives in Portsmouth record patient notes straight to a blackberry device, halving time on administration and ensuring the hospital are near real-time data.
Clinicians and managers involved in stroke care can use the StrokeNav system to share information across a multidisciplinary team and across locations.
You will record accurate information, as close to the point of contact as possible, in line with national information standards, and linked by the person’s NHS number.
You will share it with other professionals along care pathways and with the Health and Social Care Information Centre, where it can be held and linked securely to support broader health and care improvements. IT will support safer handling of medicines in care homes.
The introduction of barcode technology has transformed processes in a number of Bristol care homes
Ensuring patients are fully involved in decision making
Your patients and service users will be increasingly well informed about their conditions, needs and the services available to them, what good quality care looks like, and the experience of others like them. You will be able to recommend information resources available via the national portal to the people in my care, being confident in their quality.
Online decision aids produced by NHS Direct are available to health professionals and can be used when discussing treatment preferences with patients.
The information system
You will have an increasing appreciation of how recording high quality data record in care records not only benefits the individuals concerned, but also contributes to improvements in the care I provide or commission, to population level health and to research.
You will increasingly be drawing on data held and made available by the Health and Social Care Information Centre to benchmark the care you provide or commission against others and to improve that care.
The Health and Social Care Information Centre has launched a new portal to make primary care data easily available
You will also be able to see how that information is driving more efficient care and reducing burdens across the health and care system. You will be able to compare your practice against Quality Standards that define key elements of a high quality service.
 All cancer diagnoses are registered by a cancer registry which then allows clinicians and commissioners to benchmark services and outcomes.
You will know who your local board level information champion is, and will have an appreciation of the contribution your local information and IT specialists play in helping to improve care.

6. More efficient, with more time
Greater and better use of IT will help you improve the efficiency and quality of your practice of care, and you will be able to prioritise more of your time for those who need face-to-face care.
Basingstoke and North Hants NHS Trust have a system that allows clinicians to access and update a patient’s information without leaving their bedside.
Sharing information safely to improve care
You will recognise that it is your duty to ensure people can access their records online if they wish and have the support they need to understand information in their records.
Patient RenalView and Graham Care Homes are already allowing patients greater control over who they share their personal records with.
Recording real time, accurate data and sharing it with people
You will better understand the needs of the people you work with and understand more about the impact your care is having on them. This will rely, in turn, on your recording data directly into their care records and sharing it.
Midwives in Portsmouth record patient notes straight to a blackberry device, halving time on administration and ensuring the hospital are near real-time data.
Clinicians and managers involved in stroke care can use the StrokeNav system to share information across a multidisciplinary team and across locations.
You will record accurate information, as close to the point of contact as possible, in line with national information standards, and linked by the person’s NHS number.
You will share it with other professionals along care pathways and with the Health and Social Care Information Centre, where it can be held and linked securely to support broader health and care improvements. IT will support safer handling of medicines in care homes.
The introduction of barcode technology has transformed processes in a number of Bristol care homes
Ensuring patients are fully involved in decision making
Your patients and service users will be increasingly well informed about their conditions, needs and the services available to them, what good quality care looks like, and the experience of others like them. You will be able to recommend information resources available via the national portal to the people in my care, being confident in their quality.
Online decision aids produced by NHS Direct are available to health professionals and can be used when discussing treatment preferences with patients.
The information system
You will have an increasing appreciation of how recording high quality data record in care records not only benefits the individuals concerned, but also contributes to improvements in the care I provide or commission, to population level health and to research.
You will increasingly be drawing on data held and made available by the Health and Social Care Information Centre to benchmark the care you provide or commission against others and to improve that care.
The Health and Social Care Information Centre has launched a new portal to make primary care data easily available
You will also be able to see how that information is driving more efficient care and reducing burdens across the health and care system. You will be able to compare your practice against Quality Standards that define key elements of a high quality service.
 All cancer diagnoses are registered by a cancer registry which then allows clinicians and commissioners to benchmark services and outcomes.
You will know who your local board level information champion is, and will have an appreciation of the contribution your local information and IT specialists play in helping to improve care.

8. 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
Key fi ndings
Th is study was commissioned by the Health
Foundation to examine the extent, type and
causes of failures in reliability in diff erent
healthcare systems: failures which have the
potential to create risk or cause patient harm.
Th e research shows that:
Failures in reliability pose
a real risk to patient safety
A signifi cant proportion of the reliability
failures were associated with risks to patient
safety. For example, we found 15% of outpatient
appointments were aff ected by missing clinical
information at our study sites. In 20% of these
cases patients were exposed to risk (as judged
by the doctors involved).
Important clinical systems
and processes are unreliable
Fully reliable systems would function correctly
under expected conditions. Th e four clinical
systems for which reliability could be measured
had an average failure rate of 13%–19%.
Th ere are wide variations
in reliability
Diff erent organisations varied signifi cantly in
their reliability: problems such as faulty or
missing equipment aff ected 37% of operations
at organisation D but only 12% at organisation F.
Unreliability is the result
of common factors
Across the fi ve systems and organisations,
unreliability was usually the result of the
same factors. Th ese included: a lack of feedback
mechanisms for both individuals and systems;
poor communication; and a widespread
acceptance on the part of clinical staff that
systems are going to be unreliable, and that
this is not their responsibility.
It is possible to create highly
reliable systems
Th e variation between and within organisations
suggests that it is possible to create systems that
are more reliable.
HOW
Improving standards in clinical record-keeping,Ian Pullen & John Loudon,Advances in Psychiatric Treatment (2006), vol. 12, 280–286

9. 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).
Key fi ndings
Th is study was commissioned by the Health
Foundation to examine the extent, type and
causes of failures in reliability in diff erent
healthcare systems: failures which have the
potential to create risk or cause patient harm.
Th e research shows that:
Failures in reliability pose
a real risk to patient safety
A signifi cant proportion of the reliability
failures were associated with risks to patient
safety. For example, we found 15% of outpatient
appointments were aff ected by missing clinical
information at our study sites. In 20% of these
cases patients were exposed to risk (as judged
by the doctors involved).
Important clinical systems
and processes are unreliable
Fully reliable systems would function correctly
under expected conditions. Th e four clinical
systems for which reliability could be measured
had an average failure rate of 13%–19%.
Th ere are wide variations
in reliability
Diff erent organisations varied signifi cantly in
their reliability: problems such as faulty or
missing equipment aff ected 37% of operations
at organisation D but only 12% at organisation F.
Unreliability is the result
of common factors
Across the fi ve systems and organisations,
unreliability was usually the result of the
same factors. Th ese included: a lack of feedback
mechanisms for both individuals and systems;
poor communication; and a widespread
acceptance on the part of clinical staff that
systems are going to be unreliable, and that
this is not their responsibility.
It is possible to create highly
reliable systems
Th e variation between and within organisations
suggests that it is possible to create systems that
are more reliable.
HOW

10. 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.
In 1997, Tony Blair announced that ”if you live in Birmingham and you have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you.”
In 2007 when I stated as a consultant patient from Benton being admitted to a hospital in Benwell 10 10 10

11. 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
Team / Ward Data
Medical Staff Data
Trust Survey
Recurring
Themes

14. 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

16. Differences within and out of the national programme for IT
RiO in NPfIT
RiO out of 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
Local configuration
Enables a sociotechnical approach
Changes made in a realistic time frame

17. 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 17 17

18. Lessons learned from Clinical Dashboards18 18 18

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

20. Quality Standards
Care Pathways
EPR
RiO 20 20

21. Quality Standards
Care Pathways
EPR
RiO
Data Warehouse

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

23. Standardised Quality outputs
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

24. Data Quality ESR Data Warehouse Acute Trust PDF Data Quality
Urgent and Planned Care Caldicott and Health Informatics Groups
NTW 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

25. 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
= Design/Build/Test/Train
= minor change
= major change 25

26. 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
Workstream D
Audit enhanceents
Unplanned Worlk
Business requirements
= major change
= Design/Build/Test/Train
= minor change 26

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