RiO’s grand

Peter Gooch’s telephone starts ringing “off the hook” if the RiO system goes down for just a few minutes.

The associate ICT director at Camden and Islington NHS Foundation Trust says the electronic patient record system has become so central to its working that staff tolerance to not having it for even a few minutes is “zero”.

“To have that single record saves absolutely hours; and we have a complete record, not a partial record. You know the latest thing done to that patient, even if it was done several miles away just a few minutes ago,” he says.

Going mobile

Camden and Islington started using the CSE Healthcare system in 2008, when it was deployed as part of the National Programme for IT in the NHS. It was upgraded to the latest release – Release 1 – last July, again as part of the programme.

Gooch believes the recent upgrade has moved RiO away from being a patient administration system and into the clinical domain.

“With Release 1 it’s fair to say RiO has started to become a full electronic patient record system, particularly with medication management and test results.”

The trust has 2,400 RiO users. It has gone from issuing 80 laptops two years ago to 450 now; with another 200-300 due to go out to staff this year.

“I wasn’t planning on putting out 200 laptops,” Gooch says, “but people said ‘we are using RiO, but we want it where we are meeting our patients’ – so we put a lot of investment into making sure they could do that.”

Now, he is not surprised by demand. “If something works and works well then people want it,” he says. “The tyranny of being locked down to the desktop is going.”

To support the laptop roll-out, the trust has invested in wi-fi infrastructure at ten of its 40 sites. It has also deployed 50 web cameras along with 50 WebEx licenses to allow teams to hold secure meetings via video conferencing.

These tools are being used for remote RiO training, which Gooch says has “really taken off.” And staff have more ideas for using them.

Inpatient wards have a laptop and an overhead projector, which clinicians use for their end of ward round meetings. Staff have asked for more cameras and flat screens, so more people can join the meetings remotely.

“It’s not just RiO; it’s the bits you wrap around it to drive it forward and improve it for clinicians,” Gooch says.

Going to GPs and social care

The trust is also in the midst an eight-week implementation of electronic discharges using RiO; sending the documents directly to a patient’s GP practice via Docman.

Gooch says Docman-provider PCTI is working on configuring systems at GP practices to receive the discharges and two or three have already been sent to test the system.

Camden and Islington is a national Common Assessment Framework (CAF) demonstrator site and, as part of that, has also trialled sending RiO data directly into a social care system.

Some social workers in the area already have access to RiO through the N3 network, as part of a sharing agreement.

Improving nursing

Senior mental health nurse Susanna Hauru agrees that Release 1 has moved RiO into being a clinical tool.

She says the system means that if a patient attends A&E, crisis teams of trust staff can access the most up-to-date progress notes, prescriptions and care plan for the patient, and enter details of the incident – keeping everyone up to speed on their care.

A care plan library uses a locally produced template to pull together information on a single patient from all the services involved with them, allowing clinicians to get an instant overview of their care that was not available previously.

“That overall arc is fantastic and it makes it much safer for clinicians to have access to all that information,” Hauru says.

Release 1 also allows clinicians to see where their clients sit on any waiting list and to let them know how long they will need to wait before they are seen.

A medication record and e-prescribing functionality improves patient safety and saves time for staff, and the trust is working towards using RiO to view pathology test results that are embedded in the medical record, Hauru adds.

Driving on clinical dashboards

Tucked away in an office accessed by a back alleyway, the trust’s IT team has worked to produce a number of clinical and operational dashboards using RiO data. Daily reports reveal trends such as referral patterns or how many people are on different wards at any given time.

Managers can see a list of all healthcare professionals, how many clients they have and what stage they are at in terms of assessment and care planning.

The reports are in high demand. Gooch originally bought 200 licenses for clinical dashboards, but is having to invest in more.

“They (the dashboards) are very, very sophisticated – to the extent that neighbouring trusts are in dialogue to buy them – and they all use RiO data,” he says.

“The reason we can do these projects is the board invests above average in ICT infrastructure and technology, so we are starting to see the benefits of that foresight.” The trust is due to get Release 1.1 in the next few weeks.