30 August 2014 15:11


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RiO’s grand

Camden and Islington NHS Foundation Trust has been using RiO since 2008 and was upgraded to Release 1 last July. EHI Primary Care reporter Rebecca Todd visited the trust to see how it is now using RiO as a clinical tool.
20 February 2012

St Pancras Hospital | Source: The Victorian Web

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.

 


Related Articles:

3 News: BT's London and South deals defended | 24 May 2011
3 News: London completes move to RiO 5.4 | 19 August 2010
5 News: BT announces first RiO in South | 23 December 2009

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NHS needs to mordernise its sharing methodologies.

Neelam Dugar 123 weeks ago

XDR or Cross-Enterprise Document Reliable Interchange (XDR) provides document interchange using a reliable messaging system. This permits direct document interchange between EHRs, PHRs, and other healthcare IT system.

Irrespective of vendors involved XDR will allow for point to point transfer of clinical documents between primary & secondary care--lab results, path reports, referral letters, clinic visit letters, ward discharge letters etc. It does matter which vendors are involved --XDR is a vendor neutral standard.


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UK path system suppliers and messaging

mrtablet 131 weeks ago

>as much down to what the Path Labs suppliers can provide as much as BT/CfH.<

Yes - but again I'd put some of the responsibility for this back at the door of the NHS.

We're still trying to patch and mend the NHS Primary Care Pathology Messaging solution

http://www.ychi.leeds.ac.uk/pmipunits/

NHS PMIP has no synergy/overlap with possible secondary care solutions. PMIP also has problems which Logical Observation Identifiers Names and Codes (LOINC) nailed in the late 1990s.

It's possible LOINC was too immature to adopt at the time of the outset of PMIP. However by the time NPfIT came around, ignoring LOINC was IMO a missed opportunity.


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What is the interface into RiO?

CertaCitrus 131 weeks ago

I presume (holds breath), RiO will have a HL7 interface for accepting lab results?

RiO 6 will have structures to hold these (groan... bets on a html view of the original report).

So our bespoke interface engine code will:

a. Provide an adaptor for accepting the messages

b. Load the mesage into our EPR (oops data ware house/portal)

c. Provide an html version to be viewed in RiO.

Finding the funding for an interface engine is another matter though


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The 1980's rang. They want their technology back

mrtablet 131 weeks ago

IIRC the construction of lab system interfaces were not funded under all (any?) LSP NPfIT contracts.

I almost hope managerial delays and haggling over who pays explain the use of flat files to transfer lab results, rather than limitations of technology or standards. If BT and CSE have actually been working on this solution for over half a decade this would be very disappointing.


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Path Lab Feeds

PMNG 131 weeks ago

I think it is as much down to what the Path Labs suppliers can provide as much as BT/CfH. Although you do make a very good point.

We have suggested in London that LPfIT sorts out a decent HL7 feed from WinPath (main path system used in London) so it is just done once for Trusts. But as this will probably require additional contract negotiation by LPfIT & BT - with huge costs attached - I'm not holding my breath.

So the C&I approach is the best option from a bad bunch...pragmatic realism unfortunatly.


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RIo Test Results - Interface Engine

PMNG 131 weeks ago

Hi

The Trust has an Interface Engine supplied by Graphnet.

We are taking a flat file extract feed from our Acute Sector Pathology Services supplier into our Interface Engine. We are then transposing it into the required format for BT for onwards routing into the BT Interface Engine. The message feed will then be sent into the RiO Stacks and our iteration of Rio.

The message feed is currently being built and should be available in 4 - 8 weeks.

It%u219s a model that can be replicated for other Trusts who are struggling without an IE to get flat file pathology test extract into Rio.

Peter


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Interface Engine

Daniel Defoe 131 weeks ago

Ah, the wonderful world of "standards" in relation to messaging and integration... As the old song goes "...it all makes work for the working men to do...".


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Interface Engine & Flat File Extract

PMNG 131 weeks ago

Hi

The Trust has an Interface Engine supplied by Graphnet.

We are taking a flat file extract feed from our Acute Sector Pathology Services supplier into our Interface Engine. We are then transposing it into the required format for BT for onwards routing into the BT Interface Engine. The message feed will then be sent into the RiO Stacks and our iteration of Rio.

The messaging interface is currently being built.

It%u219s a model that can be replicated for other Trust who are struggling without an IE to get flat file pathology test extract into Rio.

Peter


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Which bits are core RiO and not BT?

CertaCitrus 131 weeks ago

Have seen the medication section of RiO and understand the lab results requires an integration engine but most the article doesn't appear to be RiO - just IT trusts are using alongside it??


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