Plymouth hoes the way

On a chilly winter’s day, the IT department at Plymouth Community Healthcare is looking as sparse as the leaves on the trees in a nearby park.

Graham Sykes, the head of IT at the community interest company, explains that the organisation is in the middle of a go-live for its orthotics service, with staff and floorwalkers currently out and about providing support to clinicians and other staff.

However, the calm reflects the fact that the roll-out is just the latest in an 18-month process that started in December 2013 and is scheduled to finish this June.

Replacing legacy systems

Plymouth Community Healthcare was formed in October 2011, after primary care trusts were told to divest themselves of their community provider arms as part of the ‘Transforming Community Services programme.

The social enterprise provides children’s and adult mental health services for Plymouth and its population of 270,000 people, as well as community and physical services for the city, and some specialist services for those living in Devon and Cornwall.

Plymouth’s previous clinical system, ePEX, had been in use for 23 years, and Paul Fry, the CIC’s head of business intelligence, says it had become difficult for clinicians and other staff to use it effectively.

“Although we developed the front end of the system to make it more up to date, the system was very old and it made data very hard to get to.

“Clinicians found it very disjointed. There was no flow to the data; you needed to know where to put various things, and the reporting mechanisms were clunky to use.”

The CIC is now one of nine child and community health providers in the South rolling out TPP’s SystmOne as part of a £32 million project backed by central funding.

None of the organisations involved got anything from the National Programme for IT in the NHS, so almost any system might have been seen as an improvement.

However, Sykes says TPP stood out during the procurement process because of its high level of integration and its ability to cover the diverse services provided by the organisation. “When we looked at it, it had the best fit across everybody’s needs; and it gives us much more control.”

The challenge and opportunity in mental health

Of Plymouth Community Healthcare’s services, mental health presented the biggest challenge, and the biggest opportunities.

The trust went live as a first-of-type site for SystmOne’s mental health module, deploying it across its 33 mental health and learning disabilities teams in July.

The module includes the ability to record Mental Health Act information, a care programme approach, mental health clustering tool assessments and reviews, and the ability to collect the mental health and learning disabilities data set.

The CIC had to migrate all 500 users on the same day, contributing to far higher stress levels among the IT team than those visible today. “It was a scary moment, going live in a big bang,” Sykes says. “I wouldn’t advocate doing it unless you have to do it.”

However, he says the system is now functioning well, and that the organisation’s work with TPP has led to a solution able to meet the unique requirements of mental health records and data.

“In terms of the process and things built in, all of that functionality is quite different, and they’ve done well with understanding the Mental Health Act in a short space of time.”

Going for mobile

SystmOne comes with mobile working capabilities. Angie Kerley, Plymouth’s clinical change manager, says these mean that clinicians can download their full caseload onto mobile devices, giving them access to a patient’s electronic record in the event of an unplanned visit.

“This way, when you get a call from someone – when it’s not planned work but you have to go see them – you can have your case notes on you whereas, in the past, you’d have to go back to collect the notes.”

Plymouth has handed out about 700 mobile devices to clinicians who need them for their work, as part of a drive to make sure they are properly equipped.

 “In a traditional NHS programme, we might have seen more difficulty with getting the funding, but we know that for this to work, we’ve got to give the people the IT kit they need,” Sykes says.

The organisation is also implementing wi-fi across its sites to provide clinicians with on-site access to patient records as they move around in the course of a day.

Integrated services built around integrated IT

Plymouth’s ambitions for SystmOne extend far beyond the organisation itself. Sykes says the social enterprise has been talking to neighbouring acute NHS trusts about taking the core SystmOne EPR module so their staff can see the system and patient records.

It is also in discussions with the NHS Northern, Eastern and Western Devon Clinical Commissioning Group about implementing “something like” the Medical Interoperability Gateway so its staff can see GP records.

In addition, the adult social care services provided by Plymouth City Council are being moved into the organisation on 1 April, and the plan is to use SystmOne for social care and to improve information sharing between the two services.

“Most patients do assume that there is sharing within the health community – there are only one per cent who don’t want to share their records, generally speaking,” Sykes says.

While future plans for shared records and integration are still being fleshed out, he says the organisation does have a vision of any clinician treating a patient being able to see their entire record, provided it will help their decision-making.

Roll out, roll on

However, Sykes says the roll-out of the TPP system remains its number one priority. About 900 mental health staff use the system at the moment, along with another 500 staff working in other areas.

Several hundred more users will join them this year as the CIC goes live with functionality for specialist nursing, therapies and wellbeing, district nursing and community hospitals.

TPP and Accenture are providing integration, data migration, and other support services for the implementation process, which is expected to finish in June, with the roll-out of SystmOne in the physical health inpatients department.

The organisation is also planning to go live with a mental health e-prescribing pilot in the spring, and is working with TPP to adapt the e-prescribing system to specific mental health needs and the requirements of the Mental Health Act.

Once the roll-outs are completed, Sykes says the organisation’s focus will shift from deployment to delivering change and making sure that staff get maximum benefit from the system.

He is particularly keen to see the mental health module taken up by other NHS organisations and trusts, allowing it to share its own experiences and benefit from the establishment of a wider community.

“The more people who use it, the more benefits there are for us because it’s a wider community and we can get shared learning,” he argues.