Mike Lundy
IT Project worker, Mental Health Development Project/ICPP Facilitator, Dumfries and
Galloway Primary Care Trust, MLundy@dg-primarycare.scot.nhs.uk
Summary
Within Dumfries & Galloway (a large rural region in the south west of Scotland), the development of an electronic shared care record is essential. Given the geography and rurality of the region it is extremely difficult to provide accurate, up-to-date clinical information unless this is accessible electronically and regionwide.
For this reason, in November 2001 Dumfries & Galloway Primary Health Trust undertook to develop an electronic care record that would be accessible across the whole of the region for their Mental Health Services. Following almost 1 year of consultation and programming we had a system that matched current clinical practices and was ready to be rolled out across the region to all 9 Community Mental Health Teams.
The rollout of the system has proven to be much more difficult than initially imagined, and has taken approx. another year to complete.
Given that all of our Community Mental Health Teams are co-located and multi-disciplinary there was also the need to develop an information sharing protocol to allow us to share clinical information on an inter-agency basis.
Numerous problems/issues were encountered during the consultation, rollout and subsequent use of the electronic system. Most of these could be envisaged beforehand.
Approach
The approach that was taken by Dumfries & Galloway was to identify that there was a necessity to develop an electronic information system for its Community Mental Health Services. Then to undertake a comprehensive consultation process (involving all major stakeholders and potential user's), To write up a detailed specification identifying the contents, processes and structure of

the system. Consideration was given to the possibility of purchasing an off the shelf product, but given that there were financial constraints this proved not to be an option at that time.
Given that we had identified both a need and a detailed specification, a decision was made to attempt to reproduce the specification electronically, in-house. We undertook a further 4 months of programming/testing/reprogramming. We managed to produce a user-friendly electronic system, that matched current practice, that was networkable and within an affordable budget.
Rollout
We planned a staged, incremental rollout of the system to all of the 9 Community Mental
Health Teams across the region. Very quickly it became evident that there were numerous issues that would also need to be addressed, these issues included:
• Infrastructure issues
• Training
• Hardware
• Staff resistance
• Technophobia
• Reprogramming
• Roles & Responsibilities
Because of these other issues this has meant that the initially planned rollout has taken much more time than initially envisaged and ultimately has taken one year to reach the point where all
9 teams are now connected.
Conclusions
We probably under estimated the amount of work that was involved in the development of the system. There have been many more issues to deal with throughout the rollout phase than were initially estimated. Financial savings were made by developing the system in-house, which means we do not incur licensing costs or maintenance/support costs, it also means that where there are changes in practice/legislation then these changes can be matched/reprogrammed

quickly and easily at no significant costs. Use of myself as a clinician to help develop, rollout, train and support the system has probably meant an easier acceptance of the system for clinical staff. Other clinical system developments have been less readily accepted when not supported by a clinical link person.