EHI CCIO Campaign: UK pioneers

Paul Altmann at the CCIO Campaign launch event this July

This autumn, one NHS consultant has been given the title of chief clinical information officer. Another consultant and a physiotherapist have taken up CCIO roles. CCIOs are here.

The pioneering three

The consultant to take on the job title is Paul Altmann, otherwise clinical director for health informatics at Oxford Radcliffe Hospitals NHS Trust.

The consultant to take on the job in all but name is Ian Bailey, clinical director for information technology at South London Healthcare NHS Trust.

And the physiotherapist is Kim Ashall, who has just been appointed director of service transformation and IT at The Rotherham NHS Foundation Trust, working to a model CCIO job description.

When eHealth Insider spoke to Dr Altmann and Dr Bailey earlier this year, they were each working part time on their IT role – Dr Altmann four days a week and Dr Bailey one day a week (although he wanted to do more) – while working as a nephrologist and a chemical pathologist respectively for the rest of the time.

Both are based in hospitals undergoing a Cerner implementation - Oxford is a Southern ‘greenfield’ site for Millennium, while South London is extending its use of Millennium from one hospital to three.

And both came to the role with a passion for information and from specialties at the leading edge of IT and informatics. So there is a lot of common ground between them. Ask them about their roles, however, and they cite different aspects first.

Big projects, focused on safety

Dr Altmann speaks about ensuring clinical support for the trust’s new system by demonstrating the clinical benefits.

He says: “At the moment we are going through a massive implementation (of Cerner Millennium) so most of my time is spent explaining to the organisational structure how this is going to work when we go live and what benefits it will bring them – while warning them that initially it will be hard.”

By “organisational structure” he means the ten clinical divisions – each with a budget of around £150m – and the clinical directorates that sit beneath them. That implies a lot of talking to a lot of doctors.

It is not always easy, he says. Some doctors expect to see the benefits overnight; others are sceptical that the new system will lead to anything other than disruption.

“Interestingly, people are at either end of these of these extremes and I am there to give them a road map as to the benefits we can expect.”

Dr Bailey, meanwhile, sees his role as a clinical and safety champion at a senior level. “Some of my role is driving things forward and making sure that there always a clinical insight into what we are doing,” he says, being careful to point out he is speaking in a personal capacity.

“We are going through a massive change at the moment, both in pathology where we are rolling out the Clinisys system, and with the roll out of Cerner Millennium on three hospital sites.

“Where I come in, and right at the top of my agenda, is the safety aspect. “We have got to test our systems properly before we go live with them.”

Reporting lines

Perhaps this difference in emphasis explains a core difference in how they view the CCIO role. While neither reports to their trust’s medical director for their IT role, they have very different views on whether this should happen.

Dr Altmann is sanguine. “Certainly there is a link with the medical director on the more clinical aspects but I am accountable to the chief executive. I see my role as bridging the gap between the clinical and the IT at executive level.”

Dr Bailey, meanwhile, feels passionately that a CCIO role should report to the board through the medical director.

“Speaking personally, I do think information should feed into the board and I think it should be through the medical director. In turn, the medical director needs to be supported by the likes of me.”

They come back together again on the importance of CCIOs knowing their onions. For Dr Altmann it comes back to the clinical engagement issue. He knows Cerner Millennium well enough to be able to pinpoint the clinical benefits that really make clinicians sit up and take notice.

“A typical light bulb moment is when doctors realise that the system will do away with the need for memory based care,” he says, referring to the current system in which doctors have to remember to look up test results. “It’s almost a salesman’s role,” he adds.

Again, Dr Bailey is looking up the chain rather than down and talks about the importance of his role in making sure systems do what clinicians need them to do in order to improve care.

He cites some early work he led to ensure clinical correspondence was integrated appropriately into the electronic health record.

“[Because of my clinical IT role] I was able to say that having basic clinical correspondence available improves what we can do for patients.”

They also agree that a role such as theirs is indispensible in a hospital trust undergoing a major IT implementation. And that if every hospital trust were to advertise for a CCIO tomorrow, there would not be enough people with the skills to fill the new posts.

Career paths needed

Dr Bailey says: “You do need to know your techie stuff and you do need to be able to talk to clinicians. We have got to start giving doctors proper education for these roles.”

Dr Altmann says he has visited numerous hospitals around the world that have digitised their systems.

“And every chief executive I have ever met at one of these sites has always said that the most important factor in their success was a clinically-led project and that the number one critical success factor in that was a strong CCIO or CMIO (chief medical information officer).

“The interesting thing is that they always go on to say that the CMIO has to be an enthusiast, they have to be credible clinically and from an informatics point of view they have to be able to communicate between clinicians and IT.

“And right now, there are not enough people in the NHS with that specification and we do not have a career path that invites them to go down that route.”

A different model

Ashall, meanwhile, comes from a different background and is taking on quite a different role. She was appointed in September 2011 to a job description that was developed with Dell.

And where Dr Altman and Dr Bailey are medics, Ashall is a physio, Her immediate past professional experience is in change management, rolling out choose and book at regional level and then implementing lean management within Rotherham,

Ashall is also working full time on her new job, which will see her take the lead on implementing Meditech v6 at the trust and developing the strategic plan for IT as acute and community providers merge.

She told EHI: “My new role here makes me the operational lead for EPR and IT. I am not responsible for informatics and data but for the software that you put into place to collect the data and for the improvements to services and processes that come as a consequence of the data coming out of the other end.”

Unilke Dr Altman and Dr Bailey she does report to the CMO and says: “I have always been of the view that you do not need to be a medic to talk to medics, although it does help to be a clinician because you have credibility and you can understand what they are talking about. But being in the chief medical officer’s portfolio will add to the credibility.”

Vive la difference

The fact that such very different CCIO roles are emerging could be seen as confusing – or it could be viewed as trust’s developing the right person in the right role to suit them.

The EHI CCIO Campaign is calling for every NHS provider organisation to consider appointing a chief clinical information officer to lead on NHS IT projects and the use of information to improve patient safety. Back the campaign by signing the petition on the EHI CCIO Campaign pages, or read the model job description that was published last week by BCS Health.

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