Mental health it: defining ‘exemplary’

In his review of NHS IT, US ‘digital doctor’ Robert Wachter recognised that American efforts to digitise healthcare had focused too much on hospitals.

His report, published in September last year https://www.gov.uk/government/publications/using-information-technology-to-improve-the-nhs, said at the start that: "An effort should be made to wire the entire UK system, leaving no sector – including mental health and social care – behind."

So, there was some surprise when the government’s response, the global digital exemplary programme, initially applied only to acute trusts.

Mental health trusts had to wait for a second round, announced in the Next Steps for the Five Year Forward View report https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/harne..., just before the general election was called.

Even then, the seven exemplars were promised a maximum of £5 million each to get their IT up to ‘international’ standards and help others to follow. That’s half of what the acute GDEs have been promised, subject to Treasury approval.

Building a new model

One reason for the delay is that there isn’t an accepted idea of what ‘excellent’ looks like when it comes to mental health IT. In the acute sector, there are several digital maturity models that trusts can follow.

They tend to focus on electronic patient record systems, and it’s sometimes argued that they are unduly geared towards US vendors. However, they are well understood; and there’s nothing like them in mental health.

Also, mental health trusts also have fewer IT suppliers to work with. All but one of the GDEs use a version of Servelec Group’s RiO electronic patient record; which was rolled out to London and other parts of the country as part of the

National Programme for IT.

At least one of the exemplars, Mersey Care NHS Foundation Trust, would like to see some innovation in the market.

Jim Hughes, its director of informatics and performance management, told a recent event: "We want to put pressure on the systems providers to improve what is in

place and perhaps create the building blocks of an open system.

"We also want to push on openness; mental health suppliers need to be open to working with others, and we want to encourage that."

The seven mental health global digital exemplars are:

• Berkshire Healthcare NHS Foundation Trust
• Birmingham and Solihull Mental Health NHS Foundation Trust
• Mersey Care NHS Foundation Trust
• Northumberland, Tyne and Wear NHS Foundation Trust
• Oxford Health NHS Foundation Trust
• South London and Maudsley NHS Foundation Trust
• Worcestershire Health and Care NHS Trust

Extending the reach of EPRs

When it comes to hospitals and inpatient facilities, the mental health and acute GDEs have similar agendas. Both need to build on existing IT systems, to get them onto mobile devices, and to make better use of their information to digitise patient pathways.

For example, Birmingham and Solihull Mental Health NHS Trust said in a press statement that it would be looking to "be more efficient through introducing digital technology across wards, to streamline processes and become a paper

free organisation."

South London and Maudsley NHS Foundation Trust said it would be looking to complete its move "from paper to digital technology", for instance by giving staff mobile devices running an e-observation system and mobile clinical app.

In a similar vein, Berkshire Healthcare NHS Foundation Trust said it would be looking to create "paperless wards and services" by "digitising observations" and "creating patient safety and early warning systems."

A push for mobility

However, the mental health GDEs probably have a bigger focus on mobility. After a decade of mergers and reconfigurations, many of England’s acute trusts are huge organisations.

They employ thousands of staff and they don’t just work at hospitals or other inpatient facilities. They also work out of clinics, offices, and less formal care settings – ranging from custody suites to patients’ own homes.

This means they need their systems to run on secure, mobile platforms. Some of the mental health GDEs have already tackled this agenda.

In a statement, Darren McKenna, director of informatics at Northumberland, Tyne and Wear NHS Foundation Trust, noted that its plans would be "underpinned by previous innovative digital projects that include the introduction of secure, remote access allowing our staff to work from anywhere."

Others will be using their exemplary status to get into it. In the press release announcing the programme, NHS England flagged Worcestershire Health and Care NHS Trust has a case in point.

It said the trust had "moved from multiple patient record systems to one system across the organisation" and would now be looking to "roll out mobile access to the

patient record, to enable staff in the community to access and update a patient’s records."

Digital patient services

The mental health GDEs also have a significant focus on new services for patients. Mental health trusts are legally obliged to share some paperwork with patients and are often in touch with them for many years.

This has made some pioneers in the creation of personal health records. South London and Maudsley, for example, is known for the development of my healthlocker; an online service that enables patients to access their care plan, keep notes on how they are feeling and share information with clinicians.

As an exemplary, the trust ­has said that it will continue to "exploit the potential of digital technology to ensure care is more personalised and responsive to patient need."

Berkshire Healthcare has said it wants to create "a health and social care solution for all providers that patients, families and carers can access" that will "allow for two-way communication, automated and paperless appointments and online treatments."

And Birmingham and Solihull has said that it wants patients "updating directly into their care record, and being able to interact with clinicians at the trust using the latest digital technology, including a secure online patient portal and

smartphone apps."

In its press release, NHS England indicates that these are also ambitions for Northumberland, Tyne and Wear, which is particularly keen to add instant, online feedback, and Oxford Health NHS Foundation Trust.

Oxford Health will be "working in partnership with the University of Oxford to develop an online platform for people experiencing a range of conditions (including post-traumatic stress disorder, anxiety and depression) to receive tried and tested psychological therapies on their computer or mobile phone."

Lessons for others

Some of the mental health GDEs are located in healthcare communities that already have acute GDEs. At a recent event, representatives of both said they were keen to work together.

As James Reed, the chief clinical information officer at Birmingham and Solihull pointed out: "Patients don’t necessarily see our services as different; to them, we’re just the NHS. So we need to make sure that we are working together."

They were also keen to learn from each other. Jim Hughes from Mersey Care, said: "One of the big differences between mental health and acute care is recovery and the idea of recovery. Many people go into hospital and come out again, but many patients will be in mental health services for the rest of their lives.

"That makes the co-production environment rather different." David Walliker, the chief information officer of two of Liverpool’s biggest acute hospitals, Royal Liverpool and Broadgreen and Liverpool Women’s, said it wanted to learn from this long-term experience, and also translate this into a research environment.

"We want to learn from mental health about longitudinal data," he said. "Our episodes of care are very short, but if you want to do the research you need longitudinal data, and mental health is more used to handling that."

In the end, though, like James Reed he argued: "I do not think it matters that there are electronic patient records at Royal Liverpool and at Mersey Care; it is just a patient record, held in different places, and one measure of success will be for us to work as one system."

Defining international excellence in mental health IT

The announcement of the mental health exemplars programme was a late response to an acute sector initiative, and that funding gap still rankles. When asked about the difference between the acute and mental health exemplars, Joe

McDonald, the CCIO at Northumberland, Tyne and Wear, and chair of the national CCIO Network joked: "Well, the answer is £5 million for a start!"

Yet, the mental health GDEs have a palpable ambition to shift IT in their sector, to work closely with other parts of the NHS, and to drive faster in some areas than their acute sector colleagues may be able to manage.

If nothing else, they are breaking new ground. As NHS England’s head of technology strategy, Paul Rice, told a recent meeting: "Since we do not have international benchmarks for what excellent looks like, there is a real opportunity to define that."