RiO delivers significant benefits at Lambeth Primary Care Trust
As part of the NHS London Programme for IT, Lambeth Primary Care Trust adopted RiO Community Health as its system for patient care records. The trust went live with RiO version 4 in March 2007, supported by BT, the local service provider for London.
Lambeth PCT is a demonstration of how embracing change can deliver valuable benefits to both staff and patients.
The trust initially started with a programme to use the RiO system in four areas: in-patients, supported discharge, podiatry and customer services. This was followed by universal and specialist child health services in September 2007.
In January 2008, the trust added its remaining services to the system: haemogolobinopathies, community nursing, adult therapies out-patients, housebound podiatry, community dietetics and complementary therapies clinic.
Lambeth PCT’s benefits success story
Lambeth PCT has adopted a rigorous approach supported by the London Programe for IT (LPfIT) benefit methodology. Some of the trust-wide and service specific benefits experienced so far are described here:
Benefits achieved by all services
- The trust has achieved NHS number coverage in excess of 95 per cent, resulting in a two percent reduction of duplicate records and the ability to quickly and easily locate client records.
- Managers are able to access accurate workload information within 24 hours of each staff intervention using the Health Care Profession (HCP) diary outcome function.
- The weekly and monthly planner has allowed team managers to plan workload more effectively and caseloads are re-allocated as workload demands arise.
- Customer service teams have access to all clinics and most of the HCPs diaries which means they can pro-actively contact every patient about their appointment. This has resulted in a positive move towards a target of a 50 percent reduction in ‘Did Not Attend’ (DNA) rates within six months of go-live for RiO.
- All referrals are entered into RiO by the customer service team to capture appropriate and inappropriate referral information for each service. Referrals are processed within 24 hours of receipt and are ready for clinical triage and allocation into a specific team or HCP.
- Using the care planning function means clinical audit information is available to managers within 24 hours of each intervention. Each patient has a care plan within 48 hours of being allocated to a HCP.
- The interactive worksheet has allowed service managers to monitor service capacity challenges as they occur and realign priority cases as per clinical need.
“Within two months of using RiO I found myself wondering how I ever did without it.”
Staff Nurse, Elderly Care Unit
“Now that we have access to all the PCT clinic schedules, we were able to help a distressed patient after she had accidentally missed her appointment. We found an empty appointment at another PCT clinic, with the same podiatrist the next morning. Before RiO we only knew about our own clinic appointments.”
Receptionist
Benefits achieved by specific services
In-patients units
Bed management across three sites is easier as the bed layout function supports monitoring, target data, bed state reports, planning single gender wards or bed closures.
Podiatric Clinics
The clinic schedule allows the customer services team to book the clinic location best suited to the client’s specific needs and choice.
Using Subjective, Objective, Assessment and Plan (SOAP) means full progress notes are entered for each appointment within five minutes.
“It took several weeks getting used to RiO but now having the patient’s whole record available at the press of one button is excellent - we no longer have to pull and re-file folders.”
Podiatrist Child Health
Every two weeks the immunisation scheduler is run which supports fast and efficient targeting of children who have not been immunised. It highlights children who may be at risk during an outbreak and allows a timeline of two weeks delay from immunisation intervention.
The BCG protocol allows for all new births to be offered a hand-delivered BCG appointment during the new birth visit by the health visitor.
Staff can locate all mothers and siblings records of a specific child who may need to be contacted with a ‘child at risk’ or during the drafting of a common assessment framework assessment using the maternal link.
“RiO means that we can now see contemporaneous records and progress notes from each others caseloads and it is so useful having the ‘Alter’ function. It will give us a useful flag to ensure looked after children are cared for better.”
Team Lead - Looked After Children
“Having our new birth feed within 24 hours helps us support ‘at risk’ and child protection children much easier - it used to depend on internal mail system which was not always efficient.”
Health Visitor Community Nursing
The HCP diary allows our operational teams to understand where each practitioner is at any time to limit their risk.
Freezing of appointments / clinics prevents booking of clients during practitioner’s leave dates by aligning it with the clinic appointment schedule.
Full progress notes can be entered for each appointment within five minutes when using SOAP.
“RiO will help us find out important details about our new patients and learn what is happening to them with other teams or disciplines, such as outpatient physiotherapy or podiatry - a holistic system at last.”
District Nurse
Going forward and beyond
Lambeth PCT has already achieved many benefits of using RiO. To ensure all staff groups at the trust use the system consistently and data entry is optimal, the trust implementation team expects users to be able to do a series of activities within the timeframe outlined below.
Week 1 - caseload allocation and active referrals
Week 2 - HCP diaries and progress notes
Week 3 - out-coming appointments and scanning documents
Week 4 - care plans
As part of the ‘working in the field’ strategy, the trust has adopted the use of digital pens, allowing staff to leave original copies of assessments with clients and record the details in RiO after their visits.
The implementation of the Management Information System (RiO Data Warehouse) means routine, regular and ad-hoc reporting is available for all levels of management and staff using the Business Objects reporting tool.
Transformation
Business transformation, one of the BT deployment team work streams, needed to complete a series of activities as outlined in the deployment process and framework to achieve go-live.
The role of the business transformation work stream was to understand the business change element of the deployment, focusing on:
Care process redesign - understanding the current processes and redesigning these in line with RiO.
Benefits realisation - understanding the benefits associated with implementing RiO.
Stakeholder and communications planning - identifying stakeholders and developing a communications plan to meet their needs.
The BT team consisted of a transformation lead and a consultant. Part of the transformation lead’s role was to build and maintain senior management relationships which included the chief executive and director of informatics.
The business transformation consultant assisted the trust in completing the activities outlined in the deployment framework. The lead provided support as necessary.
