New Technologies in Forensic Mental Health
Fionnbar Lenihan & Alex Quinn
fionnbar.lenihan@nhs.net
Who Am We?
(and why are we taking up your time?)
• Fionnbar Lenihan
– Consultant Forensic Psychiatrist in the Orchard Clinic in
Edinburgh
– Longstanding Health Informatics interest - local and
national involvement
• Alex Quinn
– Consultant Forensic Psychiatrist in the Orchard Clinic in
Edinburgh
– Prison psychiatry – Saughton and Addiewell
Scope of Talk
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Not comprehensive
Not a manual
Overview
Breadth not depth
Aims & Objectives
• To provoke discussion and debate
• To encourage exchange of ideas
Cautions
• Services differ - what works one place may not
in another
• Consult your own IT experts before
implementing anything ambitious
• No conflicts of interest
Acknowledgements & Thanks
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Stella Clarke
Cathy Dorrian
Alex Quinn
Other colleagues in the Orchard Clinic
Information Technology Increases
Efficiency
• IT has revolutionised
other industries?
• Or has it?
• Solow's Paradox “computers are visible
everywhere except in
productivity statistics”
Some Industry Sectors
• Clearly increases efficiency within sectors
– Airlines
– Banks
– Publishing
But …
• Efficiency gains can be a
while coming but outlay is
upfront
• Not without pain
• Costs = people
• Fewer people / Cheaper
people or not …
• Systems have complex
responses ...
• Increased use to
compensate
• Services become different
• Expectations will change
Features of Forensic Mental Health
• Forensic psychiatry is
paper / document heavy
• Multiple information
sources
• Multiple health boards
• National / Regional
services => Distances
• Secure locations => time
wasted in transit
• High expectations
Grounds for Caution
• History of well-publicized
failures in public sector IT
procurement (NPFIT etc)
• Complex, poorlyunderstood business
processes
• Waterfall model of software
development
• Resistance to change
• Genuine need for tight
governance - safety critical
• High public exposure
Specific Technologies
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MS Exchange/NHSnet
Smartphones
Telepsychiatry
Paper/document management
Remote access
Thin clients
Voice recognition
Microsoft Exchange
Exchange/NHSnet
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Server rather than client product
Provides email, calendar, tasks
Most of you will have used Exchange
NHSnet/NHSmail largest Exchange install
Many (not all) Scottish health boards - the
only email/groupware system
• Secure, encrypted, endorsed by various
authoritative bodies (BMA, RCN)
Exchange/NHSnet - II
• Probably underused & under appreciated
• Secure patient email a godsend. Permitted to other
secured government domains eg. .gsx.
• Shared calendars incredibly useful.
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Delegated powers
Supervision
Appraisal
Team working
• Can be used to send text messages and faxes too (and
share files too large for email)
• Can be accessed via web or email clients in a variety of
locations
Smartphones
• Various types
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iPhone (3gs onwards)
Android
Blackberry
Some Nokia/Symbian models (with encryption)
• All can be securely linked to NHSnet and store data in
encrypted form
• Security enforced centrally (e.g. PIN and remote wipe)
• Provided by organization or BYOD
• Usual voice & SMS but also calendar, tasks, shared address
book, GPS, stored documents, access to network resources
(e.g. remote access to EHCR for mobile staff)
• iPhones expensive but some very economical Android
models (<£60 retail)
Telepsychiatry
• Telemedicine is “the remote diagnosis and treatment of patients by
means of telecommunications technology”
• Telepsychiatry is “the application of Telemedicine to the field of
Psychiatry”
• Excellent recent review Phil Crockett, Harry Millar and others
• Around a long time
• Limited uptake despite generally favorable evidence base
• Use in exotic locales
– Australia
– Antarctica
– Peterhead
• But distance not the only barrier to access …
Telepsychiatry Basics
• Simple telepsychiatry can be done with a
speakerphone
• Moving to video requires a SECURE video
connection
– Skype and a webcam will not suffice!
• NHS has a secure IP-based network (IP means
like the Internet)
• Gateways exist to allow older ISDN (like
telephone) systems to interoperate
Our First Equipment
Starting Out
• Our first kit was a hand me down from
management suite
• Gathered dust for a year before we begged
funding to connect it to an ISDN line
• Situated in our seminar room on ground floor
=> patient accessible => can be used for family
“visits” and CPA meetings for OC patients
• Initial suspicion gave way to enthusiasm
– “sneaky use”
Newer Developments
• 2nd, modern set thanks to good offices of Cathy
Dorrian, Stella Clarke and NHS 24
• Installed upstairs in staff-only area => can be used for
seeing patients at OTHER end
• Can be moved between rooms upstairs
• Overall kit has been used for a variety of purposes –
mostly CPA meetings and prison MDMHT meetings
• Has been used to give evidence in a court in Inverness
• Formal evaluation delayed by ethics process but just
now starting direct patient assessments in prison
Future Plans
• Review clinics in prison
• Emergency cover for
prison
• Initial assessments
police cells
Paper & Document Management
• We (OC) have too many
places for information
to hide …
– Paragon (basic electronic
patient record)
– Discipline-specific notes
– Ward notes
– Paper notes
– SCI store
– PIMS
– Shared network drives
Consolidation
– Paragon (basic electronic
patient record)
– Discipline-specific paper
notes
– Ward notes
– Paper notes
– SCI store
– PIMS
– Shared network drives
• New EHCR (TRAK or
whatever)
• Genisys/PIMS
• SCIStore
– All above contained
within a local clinical
portal
Electronic Health Care Record Systems
• Proceeding regionally
• Avoiding the centralized model that failed in
England
• This poses challenges for cross-regional
services like forensic psychiatry
– Best addressed with some kind of portal
functionality at a national level
Printers
• Small inkjet printers are cheap to buy but have high running
costs
• Color printers are particularly wasteful
• Administrative time wasted managing a dozen different
printer cartridge refills
• => consolidate on single large economical laser printer
which is shared out on network
• We had an existing large multifunction Ricoh machine for
which we had inclusive prints we were not using!
• There are features to protect sensitive documents etc
• Short breaks to retrieve print jobs are healthy and sociable
Scanners
• Flatbeds only good for fiddly photographs etc
• You want Automatic Document Feeder (ADF)
models
• Our big MFD already had an ADF
– Feed paper into the hopper and it will email a PDF
to an email address you select from a menu
• Reduced need to manage paper
• We also use 2 Fujitsu ScanSnap S500s
Remote Access Tools
• Let you access a remote
computer
• Remote computer appears as
a window on local machine
• Allows most normal activities
• Various products for home
users
• Security vital. Unapproved
remote access tool = hacking!!
• Firepass product used in
Lothian
Use Cases Remote Access
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Part time/home working
Multiagency working
Multi-site working
Resiliency e.g. flu pandemic or adverse
weather
• Support and training
• Reduction in travelling
Thin Clients
SunRay
Voice Recognition
Voice/Speech Recognition
• Was a high profile “official” project in the
acute side of NHS Lothian
• We looked at it and had some concerns
– Designed for medical/surgical outpatients
– Didn’t match our workflows
– Inflexible
• Now seems to have been discontinued
• Now our own limited use “in-house”
Dragon Dictate
• Purchased a few copies
• Price reasonable if not going for profession-specific
versions
• Generous licensing
• Very useful for text-orientated workers
• Helpful if reduced dexterity or if hands in use
• No substitute for either dictation skills or computer
skills
• We plan to get more licenses
• Hard to deal with commercial vendors from inside the
NHS
To Sum Up
• IT can contribute to efficiency and quality
• However, it’s not always a simple process and
expectations need to be realistic
• Simple, locally driven, initiatives more likely to
succeed
• We are interested in sharing ideas and
experiences