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CASE STUDY

Birmingham and Solihull Mental Health NHS Foundation Trust has overcome obstacles to deliver a highly effective and tailored electronic patient record that meets the specific needs of its staff and patients. Apira led the project
by working as an integral and embedded part of the trust’s team, taking the project from a stalled position to a full deployment that is benefiting clinicians and patients today and will meet the trust’s needs into the future.

Background

Deciding to deploy RiO outside of the National Programme for IT (NPfIT)

When Birmingham and Solihull Mental Health NHS Foundation Trust sought to replace its outdated ePEX Patient Administration System (PAS) and to move away from a mixed economy of largely administrative paper based and electronic records, it decided that the national programme could not deliver a new electronic patient record (EPR) that would serve the needs of the trust’s large mental health environment. A decision was made to implement the RiO electronic patient record independently.

Initially, the trust chose to adapt an existing London configuration for RiO that was being used in NPfIT deployments. Part way through, the project encountered obstacles.

This pre-existing configuration had been written for the working processes of London community and mental health trusts and proved to be unsuitable for the complex processes and organisational needs of the second largest mental health trust in the country. Internal project leaders had also moved on since the beginning of the project.

New direction was urgently needed to get the large project and significant investment back on track, so that where appropriate, access to patients’ records could be securely shared by clinicians in different roles and across different parts of the trust for the benefit of the patient.

 

Dr James Reed, chief clinical information officer, Birmingham and Solihull Mental Health NHS Foundation Trust

We have a functional RiO PAS system trust wide that works far better than our previous system. We have a RiO structure that has continued beyond Apira’s involvement. Having a single electronic system that is used by everyone is a huge benefit, it gives everyone in the trust a common language and is joining up the patient’s journey and care.

We have a lot of people working in different areas of the trust who would otherwise not necessarily know that another member of staff is involved. An emergency can take place in one area, and day to day care somewhere else entirely. Before these activities would have taken place completely independently of one other. Now, a clinician can see notes someone else has entered immediately. This allows for continuity of care that otherwise wouldn’t be possible

Nigel Barnes, director of pharmacy and medicines management, Birmingham and Solihull Mental Health NHS Foundation Trust

We are in a better place having grown our own solution. Apira was there to support the implementation of the project, did it well, professionally and had the end solution in mind all of the time. There is only so much time I can devote to a project. That is what Apira brings, they co-ordinate individuals with a lot on their plates and focus all of their efforts on the project.

It certainly increases efficiency for doctors and nurses. There are no longer handwritten records that could be illegible. For the patient this means a more up to date record, accessible by all clinicians on a multi-disciplinary team. There are also more rapid updates of patient records, with more accuracy and completeness, which helps to achieve better patient treatment and improved patient safety.

From clinical frustration to clinical contribution

Apira recognised there could be no top down or forceful approach of telling staff what was needed. Instead, senior staff believed Apira helped the trust to move from a situation of clinical frustration to clinical contribution, so much so that clinicians gained confidence that the new plan would deliver a system that would work for the trust into the future.

A series of workshops were carried out to gain input from clinicians, many of whom worked in different ways. These workshops provided a structure to help clinicians define what needed to be recorded in relation to their associated processes and ways of working. A clinical focus group was also created that allowed propositions around the development of RiO to be aired. Clinicians saw that if they lent their involvement to the design stage, the end result would look much more like what they needed.

With a detailed understanding of both RiO and of the trust’s needs, Apira was able to offer the trust options. Project governance was improved, with the introduction of clear lines of responsibility and an assurance framework was also put in place.

Ultimately a plan was produced that was achievable. It had been robustly challenged by the trust’s chief information officer and refined to deliver to tight time pressures, with solid assurance provided by Apira that the plan would deliver on its objectives within the time that was promised.

New direction – clinical engagement, robust project governance and a new action plan

Apira was engaged to help provide this new direction and was asked to take leadership, filling a capac- ity and experience gap for senior trust staff who were faced with other pressing demands and did not have the internal resource to lead the project with the same dedicated focus. Specialists from Apira with experience in RiO and delivering EPRs into mental health trusts became immediately embedded in the trust.

Procuring RiO outside of NPfIT gave the trust freedom but it also led to the challenge of redesigning the configuration from scratch. A significant proportion of the project’s budget had already been spent, but this essential redesign had yet to be started, and so a new action plan was needed to drive the implementation quickly, whilst still enabling the trust to exploit the potential of the new system.

Apira set about creating a plan that would deliver what the trust actually needed based on what the RiO product could do. This plan needed to bring credibility and assure clinical staff, whilst also providing fiscal assurance and a roadmap to recovery.

Creating this plan in partnership with stakeholders from across the trust was key to ensuring strong clinical engagement and the drawing together of different parts of the organisation. Apira’s extensive experience helped to guide the project through its challenges, allowing the trust to exploit the potential of the system and deliver a clinical record.

 

The move to implementation

With time and capacity pressures facing senior team members, the trust continued to draw on Apira’s lead for the implementation, for which a joint team of trust staff and Apira worked together.

Apira project leaders were onsite and oversaw the handover. They managed 95 per cent of the implementation, with the need for minimal input from the CIO, exceeding any expectations that the trust had. Specific instructions and directions were not required and Apira was committed to the end goal throughout. The team leadership managed all elements of the large-scale project. It carried out continuity planning, ensuring the IT was in place, that the correct people were available, that sign- offs were obtained to close down the paper system and that forms were available, whilst managing any challenges as and when they arose.

Implementation was a significant undertaking to keep to time and to keep people on board but
staff remained engaged. Implementation began with early adopters, before being deployed to adult services and then to smaller cohorts, such as drug and alcohol services, which had specific additional requirements. On completion, RiO was deployed to staff across the trust.

Benefits and outcomes – a shared patient record across the trust for the first time

The trust now has a shared electronic patient record, configured specifically to its needs, which enables a much more joined-up approach to patient care. Instant access to records is saving clinicians’ time and helping to improve patient safety and care. There is also now collaboration between different teams and specialists in a way like never before.

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