LUCI (Locating Useful Clinical Information) is a digital platform that draws data from a variety of sources within electronic health records and presents it back to clinicians to help decision making at many levels.
It brings population health information down to an individual level by honing in on the patient-clinician’ relationship and asking the data the question ‘what would I like my clinician to know?’
“I think LUCI really democratises data,” says David Codling, Clinical Co-Lead of Clinical Informatics Service at NIHR Maudsley BRC. “Usually we use data in a very top down way with the organisation or institute deciding what it would like to know and then interrogating the data. In our approach we focus on what makes data useful at the coalface of healthcare by working with clinicians and patients to decide what is meaningful. This way it can be used directly to improve patients’ health as well as being translated up to inform decisions about service provision.”
LUCI currently works with data from South London and Maudsley NHS Foundation Trust within the CRIS system – another NIHR Maudsley BRC informatics initiative which holds data from electronic health records (electronic health records (EHRs)) in a de-identified format. It applies natural language processing and open source visualisation tools developed within the CogStack platform which is also supported by Maudsley BRC in collaboration with NIHR UCLH BRC and partner trusts.
Current challenges
With the expansion of information within patient records, clinicians face an overwhelming amount of complex raw data. Alongside this, there is agrowing demand for exchange of health information between partners.
This challenge is particularly apparent in mental healthcare, where patients often require ongoing mental health support and coordinated care for physical health conditions and social support, creating a complex landscape of data and partnerships.
EHR systems focus on recording information for individual patients at a certain time with limited capability to highlight trends in disease progression, reveal similarities within a team’s caseload, or facilitate health monitoring over time and on a population scale. In addition EHRs in mental healthcare hold more information within free text and notes which can be difficult to summarise and pull together. As such psychiatrists, psychologists, pharmacists and nurses in mental healthcare services can spend valuable time assembling disparate data.
What we have done so far?
The approach was initially called VIEWER (Visualisation & Interaction With Electronic Records) and was first launched supported by our BRC. It was co-developed through a participatory design approach by clinicians, informaticians and researchers at South London and Maudsley NHS Foundation Trust and King’s College London.
In the pilot, the VIEWER platform was evaluated for the support it provided for healthcare professionals across various clinical workflows, such as patient health checks, medication reviews, and caseload management, including:
- “Population Health” – an overview of the whole population served by the Trust to discern specific needs
- “Clinical Pathways” – a set of dashboards designed to facilitate proactive care by identifying patients who have not received interventions, who need a medication review and who are showing early signs of relapse.
- “Caseload Management” – a visualisation of case risk and complexity across team members, identifying contributing factors and highlighting potential unmet needs.
- “Patient Chart” – detailed, individual-level information, offering insights into the current state of a specific patient (eg, recent interventions and outcomes) as well as historical data.
These types of dashboard are still used in the LUCI platform but have evolved in their content.
The pilot showed VIEWER efficiently processed more than 1.7 million documents daily from EHR systems, and supported information retrieval and visualizations across more than 551 million documents for more than 1000 users across the Trust.
The pilot assessed VIEWER in its contribution to three clinical applications and the results were published in a paper in the Journal of the American Medical Informatics Association.
Physical Health Monitoring – VIEWER supported a team of 6 members in overseeing physical health checks for the entire active caseload of over 51,000 patients. Through interactive visualizations, team members could identify patients who require a physical health assessment, streamlining the process and resulting in an increase in completed assessments.
Medication Review – VIEWER facilitated medication review for 164,819 patients. It identified 100% of the medications identified in the human reviews and identified 4 extra medications that were not mentioned. Furthermore, the time spent per review was reduced from 1 – 2 hr to 10-20 min by using VIEWER.
Caseload Management – VIEWER allowed team members to access consistent and unified information about their caseloads with just a few clicks. This has enabled the Trust to meet CQC requirements and deliver results for an annual inspection within just 6 months.
From VIEWER to LUCI
Having demonstrated how VIEWER can contribute to healthcare, the project was funded £1.7M by Maudsley Charity for wider adoption across the Trust in 2024. Renamed Locating Useful Clinical Information (LUCI), this second stage of development was tasked with achieving three main aims: releasing time to care, motivating action on inequalities and addressing unmet need. The following are examples of success in these areas:
1. Releasing time to care – Clinicians have used LUCI to review, query and make decisions about medication, which is reducing the time taken for this process from eight hours to about an hour.
Maariya Din, Clinical PharmacistAs a pharmacist, I want to know which medications kept the patient out of hospital and stable in the community... I use LUCI to provide a snapshot of the patient’s medication history and service useand it provides a complete list of medications that I can go through systematically. Some of our patients have been with the trust for many years and, without a tool like LUCI, I would sometimes need to manually review 20 years of medication notes. The way we did this before could take days to complete but now can be done within a few hours.
2. Motivating action on inequalities – LUCI has helped to address inequalities behind the delivery of psychological interventions, particularly CBT for psychosis. Working with psychologists they developed a tailored psychological intervention for black men which has resulted in an increase in the uptake of CBT for psychosis, for example during a week there was an increase from 21 to 35 % of black me accessed sessions of CBT.
Yogini Sawjani, Clinical PsychologistI currently work in community mental health teams, supporting service users living with psychosis. I use LUCI to identify inequalities in access to and engagement with psychological therapies by age, gender and ethnicity. For a recent audit, I was able to gather all the necessary data from LUCI in about an hour.
3. Addressing unmet need – The team have also addressed unmet needs in the area of physical health care for those with mental health conditions by using data to highlight where and in order to take a more preventative approach.
Bella Ifeanyi, Healthcare Support WorkerThe Health Check Liaison Team work with Community Mental Health Teams (CMHTs) to reduce health inequalities for people with severe mental illness by monitoring the six core physical health checks. LUCI immediately shows which CMHT and GP a service user is under, helping the Health Check Liaison Team to proactively contact service users who have struggled to engage with physical health care. Regular contact with service users helps to identify physical health problems early, allowing intervention to take place before the condition worsens, and ensures that their physical health needs are consistently monitored and addressed.
LUCI has developed a programme of training, implementation and awareness raising activity to increase clinical staff engagement. This includes a network of champions with over 100 members from the Trust’s clinical staff who have received training to support their colleagues using LUCI. in person training has been delivered to over 200 people, and online training to a further 500. It now has regular users in 47 community teams across the trust including in all 15 long term general adult teams.
Looking to the future
The LUCI team are hoping to shift to more data-driven healthcare across the Trust, taking a more population health approach to enable service provision to become more needs based and address inequalities. Frontline clinicians are already using it to provide a more responsive way of working that is aligned to patient needs.
The team are planning to work with clinicians from all professional backgrounds and service users as they redesign LUCI over the next two years. They have established a service user involvement group to identify what questions we should be using our data to answer.
Phuong, service userOne of the most frustrating parts of getting help for my mental health has been having to repeat the same information at every appointment. LUCI could make a big difference by giving clinicians quick access to my medication history and pulling up notes from previous appointments. It could also help clinicians see patterns over time, such as negative side effects with certain medications, and use that information to tailor care more effectively. By making key information easier to find, LUCI could help make every appointment more focused, productive, and person-centred.
The team will continue to develop new releases twice a year, looking to expand scope from community teams and prescribers to consider how they can support inpatient services. Work with academic colleagues will translate innovative clinical informatics research into frontline care, exploring working with partners within King’s Health Partners to share data and develop use cases that address population health.
Impacts
- Using data to reduce the time for medication reviews in the largest mental healthcare trust in the UK.
- Identifying inequalities in uptake of interventions such as CBT among black men with psychosis and enabling these to be adapted for better, more relevant service provision.
- Increasing the proportion of patients with mental illness receiving all 6 physical health checks from 17.7% to 33.6% in the community.
- 1900 users of LUCI with 1381 using the caseload management pages and 921 using the medications review pages.