On a brilliant summer’s day at the top of the iconic BT Tower in central London, it was easy to be filled with optimism. And optimism was the prevailing mood at the formal launch of the EHI CCIO Campaign.
With more than 70 people from the NHS, industry, professional bodies and the medical royal colleges in attendance, this was a gathering with one idea in mind: that clinical leadership is crucial to the success of healthcare IT projects and appointing highly skilled chief clinical information officers will help to achieve it.
Getting good work implemented
For Professor John Williams, director of the Royal College of Physicians’ health informatics unit, the case for the CCIO role was a “no brainer”. Not just for the RCP and not just for England, he stressed, but for the other medical royal colleges that have started to line up behind the campaign and for the whole UK.
“We are totally behind the campaign and will do everything we can to support it,” he said. But he acknowledged just how hard it will be to get results and drew on the experience of the health informatics unit to illustrate his point.
The RCP set up the HIU ten years ago – just as EHI itself was launching. The unit has concentrated on creating building blocks for health informatics; for example by setting standards for the documentation of the patient record that is at the heart of patient/professional interaction.
Professor Williams said: “It’s a fundamental document that underpins the safety and quality of healthcare and underpins communication between professionals and increasingly between professionals and patients.”
Yet despite setting standards, and despite these being endorsed by organisations from the Academy of Medical Royal Colleges to the Care Quality Commission, General Medical Council and NHS Litigation Authority, uptake has remained patchy. As a result, Professor Williams said, record keeping is in many cases poor - to the detriment of patient care.
“The appointment of CCIOs will be essential to ensure that this sort of work is picked up and used,” he argued. “I hope that this initiative will result not only in CCIOs in every single hospital but in a network of CCIOs who can together take forward these national initiatives and implement them at local level.”
Foundations to build on
The NHS is not without CCIOs, although very few go by the title, as yet. Scotland already has a network of ehealth clinical leads and there is a growing number of clinicians with a passionate interest in healthcare IT in England too; notably at hospitals undergoing Cerner implementations.
One such is Paul Altman, health informatics clinical director for Oxford, where the Oxford Radcliffe NHS Trust is heading for a go live with Cerner Millennium in November 2011. He works four days a week on informatics and the other day as a consultant nephrologist.
The case for moving to digital healthcare was now unanswerable, he told his audience at the BT Tower. The NHS has to move away from paper-based systems that rely on “memory-based care”. It is no longer tenable for doctors to have to write themselves a note to remind them to check a test result, for example.
Clinical IT systems have the capacity to improve the patient experience, to make care safer and high quality, to deliver improved revenue and increase productivity as well as aid research and development.
“The basic concept is that we need clinical leadership to make this shift,” he said. “It is an idea that is ten years overdue.”
But moving to digital healthcare is a huge cultural shift, he pointed out. “It is one that a small group of people can torpedo quite easily. In that context, clinical leadership is about taking on these individuals and literally going through a process of converting them. It’s hard work and incredibly tiring but it is usually successful.
“If you do not achieve that kind of voluntary conversion then you have to start talking about sanctions such as removing access to the system. If you cannot access the system, you cannot work for the organisation. Usually you can have the discussion without having to go there.”
He described some of the effective CCIO roles he had seen in action abroad. Typically, they were held by people working on them near full time, but with clinical credibility, he said. “They have to be credible practicing clinicians as opposed to burnt-out clinicians,” he said.
They were people with a profound understanding of the organisations in which they worked and of the clinical systems being deployed. They were part of the strategic structure and able to make the bridge between clinicians and IT professionals.
These are all attributes that CCIOs in the NHS will need, he added. The right people with the right backing can achieve an enormous amount. But he warned that if NHS organisations did not understand this fully, then CCIOs will find it hard to deliver.
More work to do
This means there is a job to be done in identifying not only the clinicians who already have the skills to become CCIOs in the UK, but those in whom they might be developed.
Justin Whatlin, CCIO at BT Health and BCS Health’s vice chair for strategy and policy, explained why the campaign mattered to young doctors who had an eye on a career in informatics.
“It is important to me personally,” he said. “As a junior doctor it was obvious to me that IT would be fundamental to improving patient care. But I could not see how I could choose informatics as a career path. We have to change that.”
Too many doctors viewed informatics and IT not as a help but as an irrelevancy, he said. The NHS needs professional informaticians to transform that view, so that IT and information are viewed as fundamental to improving care.
“It’s time for us to step up and start taking informatics very seriously,” he said. “It is time for the people who understand healthcare to start to take control.”
But new CCIOs will need support. Advocates for the role will need to consider how to skill CCIOs, how to give them organisational and professional accountability, and how to make sure they have the influence to do their jobs.
BCS Health is going to be working on these issues over the summer. EHI will be reporting on and supporting the work as part of the campaign.
As EHI co-founder and editor Jon Hoeksma noted, the EHI CCIO Campaign is an ambitious one, and its impact might not be fully felt for five or ten years. But it is important. As all those enjoying the views from the BT Tower took time out to recognise.
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