Lancashire & South Cumbria NHS FT

Lancashire & South Cumbria NHS FT

CITO Deployment


Briefly describe the initiative/ project/service; please include your aims and objectives

LSCFT (The Trust) is a large NHS Community Trust providing services to the people of Lancashire and South Cumbria. We provide a range of services from acute and forensic Mental Health services for adults and older adults, Primary Care Mental Health, Physical Community services and a range of Childrens services, both Physical, developmental and Mental Health. Patients of the trust will be in contact with one or more of these services. Some patients may have multiple services open to them concurrently. As such the need to collaborate and share a mutual understanding of the needs of the patient is key to the delivery of efficient, effective services.

We deployed an Electronic Document Management System (EDMS) in 2007. Prior to that we held many legacy and current records on paper. The digitisation of paper case notes, along with the deployment of an in house built ePR, enabled near paperless working in our Mental Health Services but also maintained some barriers whereby colleagues in our Physical Community and Childrens services did not have access to these records, and vice versa. During 2020, as part of or GDE Programme, we deployed CITO a new EDMS.

Our Aims and Objectives in this were to:
– Build infrastructure for the new system which would be fast, highly secure and resilient
– Migrate all documents from the old EDMS (WinDip) into the new CITO EDMS
– Systematically subject each document to Optical Character Recognition (OCR) so that individual or phrases words can be searched for. (it takes time and is still going on, but it’s worth the effort)
– Ensure that all users had access to all relevant records for the patients they see.
– Train all staff in the retrieval of documents
– Build and Deploy technologies that enable seamless upload to CITO from RIO
– Re structure the Metadata for each record to reflect the current structure of the trust and improved document labelling
– Allowing staff to retrieve information in a safe and timely manner

Once the new infrastructure was in place, we had the opportunity to redesign the metadata and create a much more open, accessible but highly secure system. Over 8 million records were migrated from the old system to CITO and, following detailed discussion and debate with a Document Management Working Group, all he existing metadata was remapped to a new structure taken largely from an NHS Scotland Document Management Standard. CITO is closely integrated with RiO, the Trust EPR and we have also built a Microsoft Word Plug in which facilitates direct upload to the system from Word, where this is required.

What are the key achievements?

– The information is now stored in a patient centric manner allowing each clinician access to all the records for a specific patient.
– Staff access the system via the main EPR (RiO) which ensures that the correct patient is selected.
– The Word Plug in, when used in RIO, automatically uses the Patient NHS Number taken from RIO, thus improving data quality.
– The system is significantly more user friendly and quicker than the old system and is being used by many more staff.
– Customizable filters allow for user defined, specific and pertinent searching.
– Due to the constrains of the Pandemic, training using e learning and remote classroom teaching where required but this has been both effective and efficient.

What are the key learning points?

– Embrace the concept that information is there to be shared, unless there is good reason not to do so.
– Integrate Systems where possible. Make the end user experience as seamless as possible.
– If there is an opportunity to improve something, take it.

Additional Comments

Enhanced security (missing from old system) fully protected folders The process of migrating the records has offered opportunity to cleanse the master index, address.