EHI CCIO: Sources of my malcontent

The EHI CCIO Campaign's new columnist, Carl Reynolds

As a technology enthusiast and junior medical doctor, the frustration of dealing with hospital IT on a daily basis has been painful, but also incredibly gumption building.

Contrary to the claims of detractors, the simple proposition that usable health IT can deliver real patient benefit seems to me to be at least logically possible. I also think that it’s reasonable to expect that technology at work, like that at home, should be user-friendly and efficient.

Unfortunately, these twin, not unreasonable, notions sometimes seem to cast me in a disruptive role when it comes to the topsy-turvy world of healthcare IT.

About Carl Reynolds

To better understand the source of my malcontent, and learn how things might be improved, I enrolled in a Health Informatics MSc at University College, London. To develop my leadership skills and learn how to navigate the politics, I became an NHS Medical Director's Clinical Fellow.

To begin to practically make a difference, I also started trying to write software that solved some of my problems, teamed up with a willing developer, and founded Open Health Care UK (www.openhealthcare.org.uk).

Big is the wrong approach

In general, there are very many ways for large government programmes to go awry. In particular, the National Programme for IT (NPfIT) in the NHS, cost far too much and almost universally failed to deliver the goods that patients, clinicians, and policy makers were after.

Whilst the precise reasons for this abject failure are hard to locate there is widespread agreement that a lack of clinical leadership and engagement featured prominently.

‘Make the care of your patient your first concern’

The General Medical Council has 'make the care of your patient your first concern' as the primary duty of a doctor, and doctors take this very seriously. The unit of our work is the individual patient and we want to give every individual patient good care.

So it’s not difficult to get doctors engaged in technology: give them tools that enable them to better care for patients.

Doctors are quick to lead change and embrace technologies that demonstrably support the delivery of good care. This is especially so when the technology also reduces the administrative burden and allows greater efficiency.

The rapid adoption of electronic prescribing for repeat prescriptions in primary care, and the use of picture archiving and communications systems in secondary care, are good examples of this.

Secondary care health IT ‘lag’

As workplace technology in general seems to lag behind consumer technology, so secondary care health IT seems to lag behind primary care health IT.

An 'economic man' argument appeals here, whereby clinicians practising in primary care behave in a rational self-interested fashion and, given the choice, invest in the best tools they can find; because they can.

It seems that the rational agent, acting in the absence of the coercive implementation seen in secondary care, is protected against poor quality software.

Clinical leadership and clinical engagement go hand in hand since without the presence of clinical leadership the motivation for engaging, and the possibility of meaningful engagement, disappears. Unfortunately, in secondary care the lack of clinical leadership and engagement has been marked.

It is easy to find hospital clinicians who are both highly dissatisfied with the technology they must use, and yet feel helpless to change it. Indeed, at present, it is rare to find a secondary care institution where this is not the case.

Why CCIOs matter

The EHI CCIO campaign is a welcome development that has, and deserves, widespread support. The chief clinical information officer role is an attractive solution to the current deficit of clinical input evident in secondary care health IT.

The need for major change in secondary care health IT is great, there is a widespread failure to adopt systems that improve patient safety, quality of care, and efficiency. Doctors, patients, and policy makers expect, and demand, better health IT.

Time ripe for clinicians to take the lead

The time is ripe for clinicians take the lead and accelerate health IT innovation. Clinicians must be responsible for, and have the authority to change, health IT systems for the sake of patient care.

The current model of health IT procurement, and support, occurring outside of the clinical sphere of influence has to change. Perhaps not unsurprisingly we have seen that those who lack knowledge of both medicine and computers are not best placed to choose health IT systems.

Going forwards, clinicians in the CCIO role will work to ensure clinically focused usable health IT systems by playing an active role in strategic procurement decision making, and representing the clinical viewpoint at the highest level.

Fusing health and technology knowledge

I would like to see CCIOs with a deep understanding of both health and technology giving existing systems a much needed shake up, securing better value for money, better end-user experience, and delivering greater functionality.

Don’t treat health as a special case

Without wishing to prejudice the decision making of the existing CCIOs and the CCIOs to come I very strongly suspect that health IT will not be, and should not be, a 'special case' with respect to wider trends in software.

Indeed, while there is much to be learnt from CCIOs working abroad, like those who have achieved such impressive results in the US Veteran Affairs hospitals for example, there is much mileage to be had in looking outside of health IT and appreciating the generality of the underlying technologies.

In future columns I will explore this and some of the wider trends in software such as the adoption of open source software and the unique opportunity this offers to health IT in the NHS.

He is currently working for Sir Liam Donaldson at the National Patient Safety Agency and for the Medical and Education Training Programme at the Department of Health as part of the NHS Medical Director's Clinical Fellows Scheme.

In addition to these roles, he is the director of the health care software company Open Health Care UK, and sits on the FMLM Trainee Core Working Group.

He trained at UCL Medical School and went to King's to intercalate a Philosophy degree before beginning an academic foundation program and a part time Health Informatics MSc at UCL.