NHS Surrey and Borders Partnership Foundation Trust:

Surrey and Borders Partnership NHS Foundation Trust (SABP) provides health and social care services for people with mental illness, drug and alcohol problems, and learning disabilities across Surrey and North-east Hampshire. It employs more than 3,400 people who work across 127 sites serving 1.3 million people of all ages.

Like many trusts, Surrey and Borders Partnership NHS Foundation Trust (SABP) had a pressing need for a single electronic records system. And when BT’s contract relating to the NHS National Programme for Information Technology (NPfIT) was extended in 2009 to cover deployment in the south of England, SABP seized the opportunity to implement a radical overhaul of its system.

"Our Trust is a merger of three previous trusts, which in turn were made up of numerous mergers,” said Simon Martin, SABP’s project manager leading the RiO implementation. “We had 19 core IT systems, not forgetting our paper-based processes, and we had the most complex legacy environment in the south. We had a myriad of different ways to do the same thing and we couldn’t share information electronically between departments.”

The scale of the challenge that faced SABP explains, in part, some of the drivers for change felt by the Trust. SABP was also particularly keen to be an early adopter not least because it understood that RiO was key to its ongoing success.

"This project wasn’t just about replacing 19 systems,” said Simon. “It was about the realisation at Board level that we needed to change the way in which we serve our community. By being able to share information more intelligently we would be able to empower clinicians to have a complete view of the people they look after. We could only do this with a single electronic care record system.”

RiO is the IT system for community and mental health provided by CSE Healthcare Systems and implemented by BT as part of the NPfIT. The RiO system replaces paper-based systems and is used for community and mental health services including social work, and covers a broad range of clinical and administrative functions. It allows staff to access electronic case records and to allocate, share and reassign caseloads and record treatments.

Electronic patient records can be shared by a number of clinicians, spread across a number of sites making it easier and faster to access up-to-date information regardless of where the person using our services was last treated.

The latest version of RiO provides a number of enhancements including single sign-on using a smartcard, which helps staff and improves security. It also connects to the Spine – the secure database of key information about a person’s health and care, which forms the core of the NHS Care Records Service – which BT built and manages on behalf of the NHS.

The roll-out of RiO across SABP was part of a large- scale deployment that over time will be used by some 3,000 staff across the Trust’s mental health, learning disability and drug and alcohol services.

Aside from the obvious benefits, Simon is convinced that the success of the implementation project was rooted in the professional approach taken by SABP and BT that helped foster a solid working relationship. Having the two project teams (SABP and BT) together throughout the project was essential to its success,” said Simon. “We weren’t just in the same building, we were in the same room. BT brought structure and discipline to the project, which was welcomed by the Trust. They also brought with them a wealth of experience around implementing RiO, of driving the benefits from RiO and implementing best practice use of RiO. That experience ensured our ‘go live’ was successful.”

He went on: “Our relationship with BT worked very well. Crucially, we were honest and transparent with one another from day one. BT had issues, we had issues – but together we worked through them all. We retained the same vision between us throughout – and we got there.”

After months of detailed planning and preparation, SABP switched to RiO in December 2009. Said Simon: “One of our senior clinicians called me on day one to say he had already seen a benefit of RiO. He’d been treating one person for years but didn’t realise that they were also being seen by another service as well.”

For clinicians, having access to a person’s complete set of notes has been an eye-opening experience. The restrictions imposed by multiple IT and paper-based systems meant that this was an almost impossible task. With RiO, it’s the norm and this is helping to create a culture of sharing information, assessments and observations.

Said Raja Mukherjee, consultant psychiatrist at SABP: “The single major benefit is to track the patient journey. It’s brilliant in terms of being able to see what’s happening across the board and to see who’s doing what with them. This is something you wouldn’t necessarily get with one set of case notes. To have a single place that’s accessible is very useful.”

The evidence emerging from SABP is that the RiO implementation is allowing clinicians to make more informed decisions about care. They are better able to collaborate with one another even if they work for different services in different locations.

Clinicians are not the only ones to benefit. By switching to electronic patient records SABP will in the future be able to reduce the cost of storing and transporting paper notes. Of course, these still need to be retained but this can now be done at lower cost storage facilities. SABP is also exploring mobile working through RiO to enable the use of real-time electronic records in community settings.

The result could lead to a reduction in SABP’s property estate enabling redundant buildings to be sold and the money reinvested into the Trust. The introduction of RiO has also led to an increased standardisation of some working practices across the organisation. For instance, we can now ensure that every person using our services is processed in the same way ensuring consistent delivery of care,” said Simon. “Before, there were five different ways of referring a person. Now there’s just one way and this has helped to improve efficiency.”

In fact, there are scores of areas that are already seeing improvements. For instance, the child and adolescent mental health service (CAMHS) used to operate five IT systems alongside its paper processes across three geographical areas. RiO now underpins a completely transparent system that provides a single point of access for everyone involved. Elsewhere, it’s now possible for all staff dealing with a person using our services to access a single risk assessment, improving care, increasing efficiency and reducing risk to staff. And RiO now provides staff with instant, real-time access to bed occupancy across the whole Trust. Before, it would take two hours to ring around to see if there was a suitable bed available.

Simon is convinced that RiO is going to transform the way that SABP operates: “From a clinical perspective the implementation of RiO means we can provide improved, more seamless care to the people who use our services. From a Trust perspective we’ve got a much improved ability to track and manage our provision of services and also to reportour activity.

"So it’s a win-win situation. The people who use our services get a better service and as an organisation we can manage ourselves infinitely better than before. And in the future we can look forward to the additional functionality that RiO will bring. For me, this has been about providing clinical staff with as much care-focused time as possible. RiO helps us achieve that,” he said.