The secret to the success of a hospital chief clinical information officer is a strong partnership with a good chief information officer or IT director.
This was a central message from the first joint EHI/BCS Chief Clinical Information Officer event held in London at the beginning of May.
The half-day event, attended by almost 100 delegates, focused on the professional development of CCIOs in the NHS and how to make the new role work
Dr Jack Barker, CCIO at King’s College Hospital NHS Foundation Trust, said that he had been doing CCIO-like roles under different names for ten years.
Now formally appointed his trust’s CCIO, he spoke of what he believed was needed to make the new role work. “You need a partner or wing man in the IT director, and mine is Colin Sweeney [King’s IT director].”
King’s is working to becoming a paper-free teaching hospital with real time quality reporting, and is nearing the end of a major multi-year e-prescribing roll-out, now moving into ICU, as part of a long-term electronic patient record programme.
Big clinical implementations take time, said Dr Barker, who has been King’s lead on its EPR development since 1999. In that time he says he and his IT director have seen chief executives and governments “come and go”, providing a high degree of continuity.
As well as continuity, a CCIO must be a clinical leader and champion and be willing to sound the retreat where necessary.
In King’s case, this proved necessary after the 2011 introduction of a new e-prescribing initially created howls of protest from clinicians.
“The software kept losing drugs, so we immediately stopped and we took as long as was needed to fix the problem.”
At other times, they must be able to recognise that the problem is with the cultural change and hold the line.
Dr Barker said this was the case when the trust “stopped filing all paper clinical notes in patient notes” as part of its EPR implementation.
“Someone has to tell staff that we won’t file a copy of their clinic notes in the patient notes.” And it comes a lot better from a trusted clinician.
“You’ve just got to be logical and reasonable,” said Dr Barker, who replied to 165 email complaints on the day of the switch.
He added that a CCIO needed to be fairly thick skinned. “Don’t expect to always be popular."
He said the essential skills of a CCIO were around clinical credibility, leadership and communications.
“You have to get on with people, be persistent and be able to convince pretty influential and powerful people, most of them, consultants.”
Having meaningful responsibilities, be it for a project, system or implementation is also crucial, said Dr Barker, who added that, at present, the CCIO role takes him two days a week.
Dr Barker said that in his view CCIOs didn’t have to be technical but it helped if they could “speak the language."
“But I question how many IT skills are needed if you have a good IT director as your partner.”
CCIOs also have to be versatile and able to respond to a variety of challenges. To illustrate his point, he gave a snapshot of two weeks in the life of a CCIO from his calendar.
Meetings ranged from: IT strategy group, performance management, speciality systems, external consultants and implementing IV line control.
He explained why he believed in the potential of clinical information systems. “IT is likely to do more for patients’ health than any drug prescribed.”
Dr Barker added that one of the central arguments for better information systems is to identify and address the huge variability in clinical outcomes and help ensure a much more widespread take-up of best practice and proven research.
“If we applied everything we know right now we wouldn’t have to do any research for a while,” he joked.
© 2012 EHealth Media.
The CCIO (CMIO) here in the US, serves to bridge the gap between the IT and clinical sides. More often than not, these members have utilized the systems frequently pushed down to the end-users and experienced the frustrations first-hand. From this frustration they arise to fulifill a much needed role, most often without additional compensation.
It is imperative that health-care organizations, serious about their success in implementing any IT solution, creates a role and fills it with a qualified, competent individual who can guide them through this process articulating the needs of both the clinical and IT technical side. Good Luck EHI! I am behind you too from across the pond.
There is still some way to go to persuade some people in key positions that Health Informatics is a discrete profession. At the same time, information systems are becoming a more complex and interventional part of healthcare. Translation between technical possibility and clinical need is an important role that CCIO CT/IO pairs can provide. This translation is best underpinned with some common training and professional standards. There is no time to lose in uniting the UK's activities in Health Informatics professionalisation and investing in training, including sub-specialist accreditation.
EHI's CCIO Campaign is something we think has the potential to help move things along in NHS IT, by focusing on the central role that end users, clinicians, have to play in ensuring the success of IT projects and use of information. We think that championing the development of more local clinical information leaders will benefit to local NHS organisations.
Too many past IT projects that have disappointed or struggled have suffered from not having adequate clinical leadership or engagement. Similarly, many projects that succeeded have at their heart strong clinical involvement.
Another problem is that NHS IT professionals and clinicians have often been cast as adversaries, rather than partners, and having experienced clinicians leading on information projects should help overcome this divide.
Clinical information champions and eventually CCIOs are not a magic bullet or panacea, but we hope that it will help build up local skills and grow confidence in the full potential of IT and information to deliver significant improvements in the quality of patient care.
