EHI Awards 2010: Dancing on the Strand

London and the South of England won the ‘major healthcare IT development’ category at the EHI Awards 2010.

Accolades for the National Programme for IT in the NHS may be few and far between. But the programme to deliver RiO to mental health and community trusts across London and the South of England won the ‘major healthcare IT development’ category of last year’s EHI Awards.

The judges were impressed by a programme that, at that time, was on track to complete its contracted delivery to eight out of ten mental health trusts and 29 out of 31 PCTs in London and 25 trusts in the South. It has since gone on to finish the job.

Morfydd Williams, programme director for community and mental health at NHS London, is clear that the programme has achieved its original objective of providing community and mental health trusts in London with an IT system that can support their clinical and business needs.

She adds: “For many organisations, the RiO system has become central to the delivery of clinical care by providing a single patient record which all authorised healthcare professionals can access and contribute to.”

Williams says notes are now available to clinicians in real time, the risk of lost notes has been eliminated, auditing of care has been made much easier, and information is increasingly shared between multiple services and locations.

NHS London cites usage statistics as evidence of its popularity. A study of 17 community providers in 2009-10 showed that for each trust, on average, 122,000 progress notes had been recorded, more than 65,000 patients were having their managed through RiO and more than 6,500 healthcare professionals were using the system; a 20% increase on the previous 12 months.

Another survey of London trusts found RiO had made a significant impact on waiting times for community services, with an average improvement of 43%. Trusts also benefited from more accurate record keeping, with one PCT increasing its immunisation rates from 24% to 83% within 12 months of implementing the system.

Williams adds that RiO has also enabled some organisations to move from administration dominated by paper to running paper-lite. As more functionality is introduced, “we can increasingly see how RiO can transform the delivery of clinical care,” she says.

Constant change

As a product, RiO – which is supplied by CSE Healthcare - offered some advantages to the London Programme for IT and local service provider BT. For a start it is an application developed in the UK, unlike its acute counterpart, Cerner Millennium.

BT launched RiO as its solution for mental health trusts and community service providers in 2006. It was part of the ‘best of breed’ approach the company adopted after the original vision of one, all encompassing care records system was abandoned and its contract with the Department of Health was renegotiated.

Implementations began immediately and by March 2008 RiO was being used in six mental health trusts and by 20 PCTs.

A further renegotiation of the BT contract in 2009 and 2010 resulted in additional RiO functionality being secured for London trusts. It also saw BT contracted to supply RiO to 25 trusts in the South, which had been without a local service provider since Fujitsu exited the programme in May 2008.

Williams says the South ran separate governance structures for deployment, but has a single structure for management of the BT contract. She says that for all deployments, trusts sign up to a deployment slot and work with BT and the London or Southern Programme for IT to make sure they are prepared to take the new functionality.

She adds: “This includes looking at the impact on business and clinical processes and ensuring that all staff are trained in the new way of working as well as the new software.”

Williams identifies support and buy-in from the trusts as key to the success of the programme. One of its most significant challenges has been the overhaul of NHS community services.

This has seen the provider side of PCTs split from their commissioning functions, with community services becoming managed by acute or mental health trusts or, less commonly, becoming autonomous organisations.

The reorganisation introduced 11 new organisations in London into the RiO programme. But Williams says the transition has been successful, with workshops planned to bring new trusts up to speed.

The programme has also had to carry on while the NHS braces itself for a massive overhaul to implement the government’s ‘Liberating the NHS’ reforms.

Williams says this has inevitably had a big impact on staff supporting RiO in trusts and those using the system on the ground.

She adds: “These staff have worked really hard to ensure RiO services were not disrupted. BT has also shown the trusts a lot of support during this period, which is another positive example of the benefits of collaboration and partnership.”

Coming up next

Williams says the RiO programme will be “very busy” over the next couple of years. The increased functionality agreed in the 2010 contract renegotiation includes results reporting, order communications and electronic prescribing.

These will be delivered in Release One and Release Two (previously versions six and seven of RiO) in summer 2011 and June 2013. Trusts will also have a choice of non-mandatory functionality from Release One.

Williams says a new configuration service will also deliver NHS defined changes three times a year, such as new forms and reports, drop down menus, radio buttons, simple text and boxes.

The configuration service will also cover new immunisation rules, letter templates and workflow to generate notifications.

In addition, an improved maintenance release service will provide updates and fixes every six weeks. And an improved Information Standards Notice service will allow ISN changes to be developed and deployed at the next best release point.

As all of this gets underway, Williams identifies the first deployment of Release One, which is scheduled for Camden and Islington Mental Health Foundation Trust in July, as the next key milestone for the programme.

Her advice for others implementing a major healthcare IT development is simple; and yet something other parts of the national programme appear to have struggled with.

She says: “The programme must be led by the NHS and fundamentally the IT system must bring benefit to the service. Collaborative working is the key, developing a strategic partnership between the supplier and the NHS.”