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RIOs (Realistic Input-Output Opportunities)

(adapted from original EEPD Volume 6).

What is a RIO?

RIO is an acronym for Realistic Input-Output Opportunity.

The definition of a RIO is a time when, in the process of medical (e.g. maternity and neonatal) care, it is likely to be practical for a health professional to interact cost effectively with a reliable and accessible electronic computer system (VDU, keyboard & printer) of gradually increasing complexity.

Computers in a hospital setting will only reduce the workload, stress and fear of litigation of health care workers (and thus be cost effective) when they provide “Individual Patient Care,” especially “Patient Encounter Assistance” of a high standard.

It is essential to identify when it might be truly practical for data from paper records to be efficiently input into a computer terminal without too much extra work for staff.

The computer can then be used to create an automatic output of sufficient use in the most appropriate format (expert suggestions, printed patient information leaflets, staff guidelines, letters and memos, laboratory requests etc.) as to make the work at data entry worthwhile in assisting the health worker with the care of that individual patient.

To be welcomed by staff, the majority of such RIOs (especially “Patient Encounter Assistance” RIOs) will need to include at least the following:

a) Presentation of important data already on the computer on a “White Board” (but only data which is currently relevant, e.g. Rubella Status only after the end of a pregnancy), then
b) an opportunity for Flow-Patterned Data Entry, without re-entry of data already entered elsewhere on the electronic record. Next,
c) a presentation of context-relevant Risks of various adverse outcomes (e.g. postpartum haemorrhage), followed by
d) Expert Action Suggestions or “Signposts” (never rigid rules, protocols or guidelines: the art of professional judgement is far too complex for such simplicities) based on electronic “Trigger Data” items or combinations.
e) proposals for Paper or Electronic Outputs. Such outputs will include not only Memos, Letters and Proformas and Summaries but also individualised Patient Information Leaflets, incorporating plain English consent forms specific to any proposed procedure.

The Components of a RIO

A1. S.IN.B.A.Ds (Standard INter-program Bundles of Associated Data”)
Joined up medical computing will only be practical when standardised sets of medical data can be passed automatically from one specialised system e.g. Haematology or Primary Care, to another specialised system e.g. Maternity or Theatre. To this end, Rupert Fawdry has coined the acronym S.IN.B.A.Ds to denote this type of electronic data interchange.
Therefore, it's essential to identify any relevant S.IN.B.A.Ds that may need to have been received. This requires careful documentation of exactly what data needs to have been transmitted already from other computer systems; in other words, Identify the common Questions and All Allowable Answer Options in the different computer systems... and make sure they match!
Who does what to whom and who records it on the computer?
What paper documents are needed?
Use the EEPD Data Resource Document to identify relevant items that may be collected during the RIO.
C1. Document in careful detail the Flow Pattern required to ask the correct questions in a given situation.
C2. Provide a full list of all relevant Possible Risks identified, plus Action Suggestions together with the Trigger Items which should lead to each action suggestion. Make use of relevant "evidence-based" material and sources such as NICE, SIGN and RCOG Guidelines. There are various grading systems for clinical evidence[1] [2] [3].
D1. Pregnancy Status Screen - gives Summary of Status of Pregnancy so far (e.g Estimate of Current Gestation, Patient’s Age, Diabetic etc.)
D2. Currently relevant Risks identified, together with Action Suggestions with Trigger Items.
The computer will need to be able on request to set out on screen and / or on paper a list of all the "Risks Identified", on the basis of "Trigger Items" which are already in the patient's individual computer record, e.g. Trigger item: country of origin of the mother might identify a risk "TB in baby" (Rule Based "Expert" systems). There needs to be an opportunity to add to but not to subtract from the list of risks identified by the computer.
D3. Currently relevant "Alert" Management Proposals
e.g. an Alert Proforma to Paediatric Department if a Scan shows something relevant to the care of the Baby after the Birth. Most relevant to action to be taken immediately after the birth of the baby.
E1. Actual Maternity System Data Input (Questions, Answer Options, Definitions, Help Text)
written by a health care professional
E2. Actual Computer Program to allow the above
written by a computer programmer

RIOs in Detail

See Rupert Fawdry's R.I.O.s in Maternity Care - last updated August 2007 (PDF file - 60 pages)

RIOs listed in the EEPD Data Resource Document


  1. CEBM (2009)
  2. CEBM (2011)
  3. RCOG
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