- Smart Healthcare, Wednesday 4 February 2009 09.00 GMT
Time to change: Oxleas NHS Foundation Trust, which includes Greenwich, started moving to electronic records in 2003. Photo: jiunlimited.com
The notion of a single, electronic patient record for every NHS patient might be some way off. But there are areas of the service where there has already been significant progress.
In London, the transition to electronic records is happening quite rapidly within the capital's community healthcare and mental health trusts. Already, seven out of London's 10 mental health trusts are up and running with electronic records, and take-up in community healthcare is growing too.
London's mental health trusts, in particular, have seen some significant benefits from moving from paper based records to RiO, an electronic system for which BT, the capital's local service provider, is the lead integration partner. According to clinicians the new electronic systems are delivering more effective patient care, more efficient use of clinical resources and – in the most extreme cases – improved public safety.
"Clinical safety has vastly improved with the availability of clinical information everywhere you have contact with the patient," says Dr Hashim Reza, a consultant psychiatrist and clinical director at Oxleas NHS Foundation Trust in south-east London.
"In theory, there was one [paper] folder for each patient, but in practice we've always had teams with separate needs, whether they are doctors, nurses occupational therapists psychotherapists or social workers."
The need for clinical staff to refer back to paper records, held in a hospital, clinic or other team base, inevitably led to delays – sometimes of several days. In addition, if a clinician treated a patient, it might take several days for the information to reach the patient's paper file and be available to other case workers.
Inevitably, this has caused serious problems across NHS trusts. "When things go wrong the cost is huge whichever way you look at," says Dr Reza. "There can be significant injury or damage to a human being, and the administrative costs of investigations and reparations and damages is phenomenal. A lot of that has been due to information not being joined up, or not being available in one place when clinicians are delivering services to the patient. The clinician and patient are both disadvantaged."
In Oxleas, which started work on electronic patient records in 2003, Dr Reza says that anecdotal evidence suggests that now RiO is up and running, "the patient journey is smoother". But it is in the worst case scenarios, such as dealing with a patient at risk of harming themselves, or others, that RiO has brought the most significant benefits.
"In really serious situations of clinical safety, when people need to make a major decision we have been able to use conference calls," with data provided by RiO, Dr Reza says. As everyone involved has access to the same information on screen, they can discuss cases over the phone without leaving their home base. The improvements, both in quicker and better decision making, and in saving clinicians' time, have been significant, he says.
Disconnecting, for health
According to the London Programme for IT's clinical lead, Dr Phil Koczan, one reason the system has been successful so far is the decision to decouple community and mental health (CMH) from acute hospitals. London's large number of specialist acute services means that a single patient record system in that area is a more complex project than it is in CMH.
There have been challenges. One, Dr Koczan says, has been persuading clinicians to record data in the system. At Oxleas, Dr Reza also experienced data entry issues, but in a different way: he found that too many clinicians were entering verbatim notes, as they would have done on paper, for each consultation. This, he concedes, is an inevitable downside of a system that supports the flexible access to notes and free form text entry that is essential for record keeping in mental health.
However, with electronic records the audit trails are in place to allow a clinician to read a patient's notes and concur with a colleague's diagnosis or simply record any new treatment, or that the patient's condition has not changed.
"We are now at the stage where RiO is working quite well, so we are now looking to enhance it," says Dr Koczan. "We are now looking at how we can encourage people to use more of its features, and go paperless."
There have also been benefits from improved multi-agency working and better information sharing across London's boroughs, although aside from a patient's summary care record, national data sharing is not yet part of RiO.
"RiO has certainly enabled records to move more easily across boroughs and it has improved multi-disciplinary team working," explains Jill de Bene, RiO product manager at BT Health.
"Having RiO in front of them gives clinicians real time updates. They know that everyone who is involved with the patient knows what the clinicians have reported, and what they are going to do next. And mental health is a significant issue: it will affect one in four of us, at some point in our lives."
