CSE Servelec’s RiO electronic care record system is being delivered to community and mental health trusts in London as part of the National Programme for IT in the NHS.

In this column from NHS Connecting for Health, Dr Hashim Reza, consultant psychiatrist at Oxleas NHS Foundation Trust and mental health clinical lead for the London Programme for IT, and Kenny Gibson, primary care and IT information manager at Lambeth Primary Care Trust, discuss is use and benefits.

CSE Servelec’s web-based electronic care record system, RiO, is designed for health and social care organisations that need a single source of information about their clients.

BT, the local service provider for London, selected the system to meet the immediate business needs of mental health and community trusts in London. It was first deployed to trusts as part of the National Programme for IT in the NHS in 2006.

Six mental health trusts went live in October 2007; with Oxleas NHS Foundation Trust one of the first to complete the switch to electronic records. It serves three London boroughs with a combined population of about a million people.

RiO in a mental health trust: Dr Hashim Reza

Traditionally, keeping track of records for mental health patients has been a complex and time-consuming process. One of the key challenges is that these patients are often treated by a wide range of healthcare professionals, including psychiatrists, community nurses, clinical psychologists and occupational therapists.

Until fairly recently, each professional discipline maintained its own patient records separately, within the same NHS trust. Some mental health trusts had started to merge these records, to reduce the clinical risks that this situation had created.

The RiO electronic records system takes this further – with an additional benefit that patient records are available at multiple sites in real time to those who need to consult them. This has resulted in more secure, efficient communication between different teams and improved risk assessment, resulting in better patient care.

Critical decisions are taken more quickly because key staff from different teams can review notes, discuss clinical problems and record their conclusions. Until two years ago, this process would have taken at least a few days, as notes were transported from building to building or selected pages from the notes were faxed.

Around 20,000 mental healthcare professionals across six London mental health trusts – including 2,000 in Oxleas – now routinely use RiO. The system has also brought greater patient involvement with their care.

All clinicians involved in the care of a patient write into the same care record, which enables a care plan to be created more quickly. Clinicians review the care plan with the patient and their carer on a flat panel screen – or even, in some teams, by projecting it onto a wall through a media projector – giving a totally new meaning to patient involvement.

This has been reflected in improvements cited in a recent mental health service users’ survey, conducted by the Healthcare Commission.

When approached to help configure this system in 2005, I took it as a unique opportunity to improve the clinical care of mental health service users. Initially, I was involved in long discussions with a group of multi-disciplinary colleagues, reviewing each others’ assessment schedules and record keeping methods to agree a single set of specifications that all London mental health trusts could sign up to.

The fact that a multi-disciplinary group of clinicians from six different NHS trusts could agree to a single record keeping system, after only five days of discussions, is probably a unique event in the history of NHS. This first group of clinicians and administrative colleagues is now the pan-London RiO mental health user group, which meets with BT every two months to oversee developments in the system.

There have been challenges – the time taken to input information into the computer based record system was initially a challenge for most teams – but in Oxleas we have allowed clinical teams to evolve local solutions depending on their resource base.

RiO in a community trust: Kenny Gibson

In our primary care trust we manage a whole range of services, including intermediate care in-patient units, out-patient clinics, foot health, health visiting, school nurses, speech and language therapy, reproductive and sexual health, community nursing and end-of-life care.

With patients potentially receiving healthcare from so many different teams and practitioners within these settings, it is vital that we have a patient record that allows everybody to keep records in one secure system.

For us, RiO has brought continuity to the patient record that wasn’t there before – the podiatrist can see what the physiotherapist did last week, and the school nurse can see the child’s full childhood immunisation regimes – all of which results in better, safer patient care.

Initially implemented in 2006, RiO collects both demographic and clinical data, improving the quality of immunisation information held on each child in Lambeth.

When we started RiO within our children’s services in August 2007, we quality checked and aligned our immunisations with the data from GPs. Using RiO has improved our immunisation data recording from around 24% to 80% in some cases, strengthening our recent Measles Outbreak Plan, which is targeting non-immunised children.

Under RiO, the clinic appointment system is also now available across the whole of Lambeth and appointments are open to all patients, at any clinic, helping to reduce waiting times.

Lambeth currently has 1,054 staff now using the RiO system. When it was first implemented, there were some concerns about accessing it on laptops in community settings. Laptops have limited battery life and the extra weight to carry also presented some ergonomic issues.

In Lambeth, we rethought our IT strategy and we have successfully piloted digital pens – a system where practitioners write their notes using a special pen and paper which records their notes in PDF format, which is uploaded onto RiO in just seven minutes, instead of several hours spent copy-typing the assessment.

We worked to engage clinicians and administration staff by encouraging them to produce their own screen-shot crib sheets for various RiO functions, and by providing individual coaching for those unfamiliar with using computers.

We also have a 24/7 on-call system which is manned by users, so that healthcare professionals are able to ask for assistance from someone who knows their role and needs – even at 3am on Sundays. It has been an incredibly steep learning curve for everyone – both BT and NHS staff – but the benefits are now there for all to see.