Development and implementation of the Client Assessment Register

In support of various data collection requirements for service outcomes, evaluation and research trials, we have developed and implemented a clinical surveillance system to identify and electronically record all cases of clinically relevant psychotic states. This information has been gathered through predetermined sets of assessment batteries that can be modified according to clinical or research requirements. The system integrates with the central care records system of the trust to avoid data redundancy. This process synchronises with the centralised system’s basic sociodemographic data on a daily basis. The data are only editable in the central system and several data validity checks are built into the system to ensure improved data quality.

The CAR system consists of a front-end application interface designed according to industry-acceptable development standards. The front end was developed in a Visual Basic Integrated Development Environment and works on a client–server topology (Figure 2). The database side of the system was developed in Microsoft Transact Structured Query Language (Transact-SQL) database format (Microsoft Corporation, Redmond, WA, USA) and uses an Open Database Connectivity (ODBC) client to connect and transmit data.

FIGURE 2

Screenshot of the CAR constructed for the programme and available from the authors.

As a reporting function the CAR system also allows for data to be exported from the database into external data sources such as Microsoft Excel, for analysis and manipulation for statistical analysis.

To ensure that the system stays in line with future technological development we also created a mobile module for remote capturing and reporting of the CAR data. The enhancement allows service users and staff to remotely capture a specific battery of assessments on an iPad or any tablet device that can connect to the internet and have browsing capabilities. This is achieved through a web-based application that is enhanced using the Visual Basic.NET framework. The system also allows service users to enter data. Through the scoring system, staff can immediately access the outcome of particular self-assessments, which may have clinical implications. They can then act accordingly by putting the necessary procedures in place.

During the LEGS cRCT the system was supported and maintained by an appointed IT development and project manager. This staff member was also responsible for training members of staff and service users to ensure the best quality of data capture.

The team also had access to a trust-wide data library that stores the clinical documents of trust service users. The Clinical Documents Library is a bespoke web-based solution that provides a user-friendly, secure single point of access for all authorised users throughout the trust. The library stores clinical letters, reports and assessments against service user records.

An initial requirements report recognised that existing ways of sharing clinical documents at various locations presented inefficiencies and the recommended approach is consistent with the trust’s strategic vision and principles within the Way Ahead Programme [see www.wayaheadcare.co.uk/quality-assurance.php (accessed 20 January 2016)]. The following details some of the features of the new system:

1. enables service user records to be held at a central location
2. enables a single standardised way of storing and sharing clinical documents
3. provides a secure library of clinical documentation
4. is available to all authorised clinicians throughout the trust
5. reduces time spent by staff looking for documents
6. reduces data redundancy
7. provide electronic versions of clinical information.

As stated earlier, our final goal was to implement our CAR information system at a trust-wide level, not funded through the programme, to support routine clinical measurement at baseline and outcome. In common with virtually all mental health trusts and most NHS trusts of any type, the implementation of a new IT system capable of supporting clinical work, management and research was problematic and protracted; it became clear early on that our plan would not be possible as our host trust decided to invest in the RiO EPRS to meet its clinical and business needs.

However, the NIHR BRC for mental health at the SLAM NHS Foundation Trust developed a prototypic system, the CRIS system, to provide regulated access to anonymised data from electronic patient records systems (see www.slam.nhs.uk/about/core-facilities/cris). Although the CRIS system was initially designed for SLAM NHS Foundation Trust systems, it has now been implemented as D-CRIS in several mental health trusts, including CPFT, our host, where it is running on and shadowing the RiO EPRS. Thus, we were not able to extrapolate this element of our programme, which itself was a significant IT development that was already completed and significantly contributed to the success of this programme, especially the LEGS cRCT and the PAATH study. Nevertheless, this ambitious objective has been achieved through larger investments in CRIS/D-CRIS by the NIHR BRC for mental health.