I think EHI's CCIO Campaign has the potential to help NHS embrace the power of information at the point of decision making by the decision makers and care providers. Information Technology in the NHS is constantly bringing many new clinical tools to the work environment of the end users and clinicians, but so far there are only a few Clinical Champions who are embracing these and leading the way.
Successful Healthcare Information technology (HIT) projects demand significant involvement and leadership from all Clinicians, ultimately they are the beneficiaries along with the patients they care for in impacting the care delivery and outcomes. In every healthcare organization there are many projects and often there are significant key roles played by administrators/managers etc, but the impact of a successful HIT project is totally different when that key role is played by a clinician assuming the role of a champion.
Many clinicians are interested in playing key roles in HIT projects, but I feel, not every clinician will make a good champion. Good Clinical Champion needs skills with a strong focus on people, policy and process, they need to come into the role with an open mind to learn from other stakeholders and lead.
I wish EHI and NHS every success in the CCIO campaign.
Clinically experienced managers must be deeply involved in choosing and managing information systems. CCIOs could help ensure the right technology decisions for clinicians are made during procurement, and can follow on to assist with clinically relevant implementation and to drive adoption among clinical users.
When plans for the vision of the future of healthcare in the UK were recently announced, one of its central aims would be to bring NHS resources and decision-making ‘as close to the patient as possible’, with the overriding objective of improving the quality of the patient experience and the quality of the way in which that experience is delivered.
With this in mind, it is crucial that the current architecture for health informatics in the UK is organised around these changes, starting sooner rather than later. Improving it is a collective responsibility; for clinicians, for NHS management, for back office suppliers, and, most of all, for patients, if we are to achieve the Nirvana of having the right information, in the right place and at the right time.
Until the market as a whole takes a holistic approach to the development of services to support these ambitions by engaging all key stakeholders and influencers, the potential for success is reduced.
The delivery of IT systems needs to be executed with the patient at the centre of the process, as opposed to the current expectation that they will just fall in line with the establishment they find themselves in. The NHS is constantly evolving and reform is rife in this sector; yet the patient remains the constant within it all.
It is here where technology suppliers can play a valuable role. They understand patients’ perspectives and how their use of healthcare IT is likely to grow in the future. Supplier expertise in providing packages for patient care is there to be exploited.
It is for these reasons that McKesson is wholly supportive of the CCIO campaign as being championed by E-Health Insider. The appointment of chief clinical information officers, who will act as the custodians within each NHS provider organisation, who must be appointed at board level and who must be given the appropriate authority to influence the systems and the processes in place, will signify a positive and pro-active move towards placing the patient at the centre of the development and delivery of healthcare services.
A CCIO at Trust level is key, however additionally; this is a critical role that must be incorporated into every organisation supplying healthcare systems to those Trusts, in order to reach a level of interoperability to allow consistency of information flow between the suppliers, the NHS and the patient.
It is time for a shift in our cultural mindset. For real change to take place, collective buy-in to the wider principles of the empowered patient must be achieved. Clinicians, suppliers and patients must engage and collaborate to identify the most effective and efficient ways to improve health outcomes. There is a missing link here; one that the suppliers can fill by turning to industry experts and using their knowledge and experience within the development of their solutions. This valuable insight from those who have been at the very forefront of clinical care would allow for more effective two-way communication with the clinicians, and indeed the proposed CCIOs, who are the link to each and every patient. The supplier has a role to play here too and a clear roadmap must be agreed up front before beginning the process of supporting it with an implementation. If we do things the other way around – as has often been the case in the past – we will not succeed.
Dr Foster supports EHI's campaign to boost levels of clinical input to information systems across the NHS. The appointment of a Chief Clinical Information Officer will strengthen the dialogue between technicians, data experts, professional coders and frontline clinical staff, which in turn will improve the reliability of the data and the intelligence the NHS can extract from it.
The importance of IT to deliver efficient healthcare did not hit Dr William Lumb in a “light bulb moment.” Rather, the necessity of good IT has always been “obvious” to the Cumbria GP.
Like many chief clinical information officers, Dr Lumb’s interest in informatics is not in the technology per se, but in how it can be used to improve patient care.
“My interest in informatics, computers, IT, is what it can do for us; that’s my interest, not the box or the wonderful things it does,” he explains.
“I did GP locums for a while and never really reflected on the use of IT; it was just something that I did. There wasn’t a light bulb moment when I suddenly realised ‘this is how we have to do it’; it’s just always been there as an obvious thing.”
As the work of GPs has become more complex and detailed, Dr Lumb argues that patient notes can no longer be kept effectively without an IT system.
“One of those things that’s been very clear in my head for two years is that you cannot deliver modern healthcare without an electronic patient record.
“I struggle to understand why some acutes still have paper notes or have no plans to move away from paper records; maybe I’m missing something?”
Practical experience
Dr Lumb moved to South Cumbria in 2004, where he inherited two single-handed practices in the same building and amalgamated and upgraded their systems.
When the National Programme for IT in the NHS come along he could not help but notice that while all the knowledge and experience of healthcare computing was in primary care, its focus was on the acute sector.
“It was very frustrating. I realised I had to get involved somehow or we would all be going nowhere very quickly,” he says.
Dr Lumb got involved in practice-based commissioning, which allowed groups of practices to get together to plan services, pool funding, and secure any savings made. He persuaded colleagues to invest some of this money in integrated informatics.
In 2008, his PbC group had £400,000 “to play with” and looked to deliver integrated, interoperable systems for GPs and community services and to start moving them into hospitals.
He started with the South Lakes Locality of Cumbria, with a patient population of 110,000. There, he moved community services on to EMIS Web to allow for information sharing with GPs and acute trusts.
The project was seen as a success and in July 2010 he was effectively appointed CCIO of NHS Cumbria to do the same thing across the county.
Dr Lumb explains that the local primary care trust saw IT as essential and wanted someone to drive forward networks and hardware, amongst other things. “I was not delivering it, but part of the process that made sure these things went in the right direction,” he adds.
Internally, he is the clinical lead for informatics, but externally he now refers to himself as a CCIO. “When you look at the role and what I manage, I manage the PCT’s IT budget and the IM&T providers. I have support, but I’m responsible to a clinical executive.
“I don’t want to have to explain the title, the reality is I’m a CCIO. I probably have more role and responsibility than most CCIOs, but it’s the term most other people understand.”
Dr Lumb is also head of IM&T for the Cumbria CCG and lead on networks for the region. His team is in the second phase of implementing the “fibre to the practice” project, putting a community of interest network into every practice in Cumbria.
Retaining credibility
Dr Lumb still works three days a week as a GP and believes that remaining a clinician is critical to the success of a CCIO. “For a jobbing CCIO it’s absolutely critical, as it retains your currency.
“Operationally, it means you win arguments because as a clinician you have been there and you have done it; it’s your experience that can’t be argued with,” he says.
Because clinicians have the welfare of their patients at heart, the decisions CCIOs can influence will be patient-focused.
He also believes the job of a CCIO should be to push boundaries and those that do may become professional CCIOs, if they have 15-20 years clinical experience behind them.
“In my current role I make a big difference in Cumbria; far greater than I can as an individual GP looking after about 1,800 people. I can positively influence the health of 500,000 people; that’s a motivation.”
His CCG role is external to the board, which he reports to every three to four months. This arrangement is possible because the Cumbria board is made up of practicing GPs and they “get” the importance of IT.
“If you had an organisation that didn’t understand IM&T is absolutely essential then the CCIO would need to be on the board, but if they get it that’s a waste of your time,” Dr Lumb adds.
“Clearly provider organisations need a CCIO, they are essential, whether they are a board member or not depends on their maturity of the organisation.”
He believes primary care CCIOs can drive improvements as commissioners of care and that as working GP he can speak the language that means he gets more done than a manager in a suit might.
“We would have got GP record sharing into out-of-hours eventually, but it’s been faster and smoother because of my involvement and that’s a small thing, but you realise you can make positive change,” Dr Lumb explains.
“I realise that, but some colleagues are still suspicious of managers and of becoming a manager and they don’t want to give up the clinical side, but you need to get them to realise that being a manager isn’t such a bad thing.”
Dr William Lumb will be speaking at the first annual CCIO Leaders Network Annual Conference, which will run alongside EHI Live 2012 at the NEC in Birmingham from 6-7 November. Find out more and register.
EHI Live 2012 is the two day conference and exhibition where the eHealth community meets. View the full programme of events and exhibitor list on the EHI Live website or register free to attend.
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