All posts in Informatics Leadership

Becoming the new boy…

Becoming the new boy again is always a nerve wracking event isn’t it? Remember the first day at school, new faces, new places and new ways of working? I am in week three of being the new boy in Leeds and I have never joined anywhere that worked so hard to make you feel welcome and part of the team as much as Leeds does; and at a pace that is quite extraordinary.

Induction would send the fear of dread into many a health IT person. Fire safety, manual handling, corporate values and orientation… ’Just let me get to the job,’ most of us would be screaming inside, after all we came here to do this job, we don’t need persuading anymore. But not one single new staff member can start within the organisation without attending, therefore induction it is.

So the Monday morning comes around and just like the first day at school I have my best new tie, my new note book, my new pen and I am ready for anything. Coming back to what you know, Leeds, the city, means that one of my best friends is there to meet me for a coffee before the induction begins. But straight away it feels different. New colleagues come up to say hello and welcome, before the (what I thought would be scripted) induction even begins and straight away it made me, the new inductee, realise, hang on, this isn’t a scripted event, this is real people with real values, and actually, OMG, everyone really does care!

Entering a room with around 50 other new starters immediately creates something of a new collegiate group of professionals. We are in this together and in time to come we will remember starting on the same day. No matter what our role, the people in the room are connected to one new thing, the care of patients at Leeds and The Leeds Way.

A lesson in Leeds is the first part of induction: what is there to be proud of? Firstly you are already blown away by the sheer size of the hospital, and this is one of several sites. Then it turns out parts are over 250 years old. Remember the amazing work of Kate Granger. Personalising and making human the interaction with people who work in healthcare is also part of induction. Every one of the people on induction are using the ‘hello my name is…’ introduction line, instilling straight away the human nature of Leeds as an organisation.

The culture of the organisation is impressed upon a new person on day one. The brand of ‘#TheLeedsWay’ is distilled down to the key vision statements, not simply posters for all to see but real values that you quickly realise permeates everything that the team is here to do.

Leeds hospitals needs this team work, as the next realisation is just how busy the hospitals are. That week there had been between 550 to 600 discharges a day. If you didn’t realise before induction then it comes home quickly how important it is to every part of the organisation to be at the frontline of healthcare in the NHS, as Leeds is the centre for so many care initiatives, transplant scenarios and specialist care. As a new person working here you get the importance quickly of The Leeds Way and the Leeds Improvement Method in place across every job. Every ‘asset’ the trust has is asked to understand how to make the care journey of a patient a better experience.

Delivering care costs money, around £3m a day, and with over 1.5 million patients every year, you begin to build your own scale for the size and complexity of my new organisation.

Every induction group meets the CEO and gets to hear first-hand the vision for the future and understand how he believes every hand in the room is involved in building the Leeds Way. The leaders in the room also get to meet the Exec Team, truly making sure that the Exec Team is asked by every member of staff to model the values of the organisation.

I have worked in a number of health organisations over the last 20 years, yet never have I felt part of the team as quickly as I have at Leeds. The Leeds way of delivering induction means that I am a team member quickly and can help deliver the goals of the organisation as quickly as I possibly can.

Joining Leeds really does feel like joining a new way, #TheLeedsWay

 

Handover CIO

First published in CIO Magazine, November 2017.

In 1797 George Washington instigated the first handover period for the presidency of the USA, he handed his responsibilities to John Adams. Since the 1960s a 72 to 78 day handover period has featured in every transition of the presidential role, and yet in almost all other public sector and civil servant role changes a handover period simply doesn’t happen, in all the CIO roles I have had I have never had the opportunity to conduct a proper handover one that means you hit the ground running, rather than running to catch up.

In a few days time I will leave Ireland for Leeds after three years working in a country with a passion for what digital can do for healthcare. When I resigned from my post my boss, the director general of the health service here in Ireland could see that there was a need to have a careful, considered and informed handover process to maintain the pace of change that we have been working to. In a break from what would have been the easy decision it was decided to look outside of the Office of the CIO for an interim person to hold onto the digital healthcare business and to receive a handover. Appointing a progressive, digital business leader to the role of interim CIO eight weeks before my departure has meant we have been able to work through a handover of the business, we have been able to agree priorities for 2018 and at this time in the Irish political calendar we have needed to agree how the budget for next year should be spent.

CIOs need to get better at succession planning, I would suggest one of the reasons we have not been seen to be great at this so far is that we have very much an individual stamp on the businesses we run as CIOs. Our styles and how we work with the ‘business’ to achieve digital goals is one of our core values, handing that to another is always difficult.

With an interim CIO appointed we began to plan the handover, we broke the content down into areas that would make the most impact the quickest, what this did was highlight a prioritisation process for the work of the team and the office.

There were five themed areas that we agreed would be our area of focus:

1 – Delivery of Person Centred Care

2 – Trust and the Protection of the health systems assets

3 – Value add services – Patient focused innovation and proving the digital capability.

4 – Create Insight and Intelligence through data that is already collected.

5 – Connect the Care Delivery Network

The digital strategy has been in place since 2015 and the delivery plan for this was agreed in 2016. This means the interim CIO can move into the continued delivery of this, however what does need to be refreshed is a new operating model for the Digital team, an operating model that reflects changes in how service is delivered and how engagement can be brought from a digital responsibility to an organisational scalable way of working. This now becomes a priority for the new CIO, not always ideal, making changes in the early stages of taking on a new role but a necessity to continue to enable the evolution of the team.

Being able to instigate a proper handover has given the organisation the opportunity to really consider the way the team works as one function. In a recent Gartner presentation the idea of four digital accelerators was raised and how these are now being applied to the future of team working. These areas are; Digital Dexterity; Talent, Diversity, Skills and Goals; Network Effect Technologies and the Industrialised Digital Platform. The handover process with these as core values as to where and what is done next has helped hugely as we strive to put in place a robust way forward that continues to drive a new pace to digital in healthcare.

The handover process has included not just a new ownership of the digital agenda but a new face of the change being brought to healthcare through digital. Therefore involving the new interim CIO in all engagement events has been part of the process and one that has seen the new CIO move into the public eye. The handover has also been delivered in the public domain using social media as the platform to enable the team and our partners to see the process and to meet the new CIO in a virtual way. The #HandoverCIO has been used as a way for stakeholders to see the activities that are underway. The culmination of the handover process was a meeting of all partners to an open interview with me and the new interim CIO, the design of the session was to make it part of one of the quarterly Eco-System meetings but also to ensure that the partners could see that they were going to be able to continue to evolve the relationship they have from a traditional vendor relationship to one that continues to be described as a partnership.

The transition from Bill Clinton to George W. Bush in 2001 was a fraught process best epitomized by the Clinton prank of the removal of all of the ‘W’ keys from keyboards throughout the Whitehouse. The transition from CIO to CIO often does end up with a lack of knowledge of where ‘the bodies are buried’, a phrase used when I came to Ireland in 2015. A colleague offered his services on my first day to help me avoid digging up the bodies that had been carefully hid. By working on a handover process and a proper transition there can be no ‘buried bodies’, no surprises and no need to re-learn what has gone before.

Handover has been great, but now its time to let go as the quote suggests below…

Make yourself available for advice if they want it, but only if they ask for it – don’t stand in the shadows trying to hang on to something you’ve decided to stop doing. Professor Graham Moon

Giving up your ‘baby’ is hard to do but as a CIO in transition to a new role it has to be done smoothly and the new CIO empowered. As handover comes to an end please support a new CIO with advice and guidance, Jane Carolan is a digital leader that is now a CIO, she is excited to be in the role and can’t wait to engage with the wider CIO community, tweet Jane @janemcarolan

What is Pink Socks?

A simple pair of Pink Socks can change your world! Pair by pair pink socks have become the new paradigm in connectedness for healthcare IT professionals all over the world. To have a pair from Nick Adkins that you can gift on enables you to become the Network Effect Technology!

My first pair arrived from the Netherlands, from Ignar Rip, a simple gift of a few pairs to pass on, to create a little enclave of Pink Socks for an Irish health care conference, in this case the socks represented more than a new connection for technology people, they represented an awareness of improving Dementia care globally, they also created me a new friend who loves a variety of music and believes in the transformation of health care.

Being able to pass the socks on at the Future Health summit to such giants of the industry like Andy Kinnear and Rachel Dunscombe was a great pleasure, seeing the founders of One Health Tech Ireland in the socks as they began to formulate the plans for creating diversity in our industry was also a great thrill.

         In just three connections the socks were making more difference than Block Chain is yet to make on health care!

Next came the wonderful Roy Lilley and Shane Tickell at the first Irish HealthChat, live from sunny Dun Laoghaire, Pink Socks times three now made it on to live TV and still represented partnerships and friendships coming from working together. Over the last three years we have worked hard with team in Dun Laoghaire to try to ensure there are ways that an Irish company with an amazing idea can be supported by the Irish health care system that needs their amazing ideas. Pinks Socks in action for another reason!

Last but by no means least is the Pink Socks feature at Health Innovation week, a pair of the Pink Socks 2.0 gifted to every speaker at the main event ensured that they then featured in the whole week of events. It didn’t matter if you were the newest digital engagement expert from Samsung, the CEO of CHIME or the Minister for Health, in that week Pink Socks became the way to connect.

Nick finishes his recent TEDX in San Francisco by asking everyone in the audience to turn to someone they don’t know and with intent say, “I See You!” Three words that can make a connection.

   So for me Pinks Socks is…

…a new connection, a new way of seeing people, not roles, not prejudices, not functions, not end game goals, but real people, who, if we truly make the connection we will be able to have help in everything we do.

I want to be seen because I want to help.

The Liquid Hospital…

First published for KLAS research, republished here for completeness…

Liquid healthcare systems.

I was discussing a way to describe how eHealth can change the way in which hospitals deliver care recently with a learned colleague. He has come up with the phrase, the ‘Liquid Hospital’, which I have to say has grabbed my imagination completely. The concept of a Liquid Hospital is very much one not just supported by technology but actually made possible through technology and innovative ways of working. Its not that much of a stretch of the imagination to see it being possible but it will require a large amount of business managed change and can’t be made so ‘just’ through the implementation of technology. The thinking is starting to mature here and in November Ireland’s minister for health began to use the phrase a health system without boundaries, after all digital doesn’t recognise the ‘physical’ boundaries of a hospital or GP Practice.

Moving away from concepts of episode centric care will be a significant challenge for all considerations within any health care system worldwide. Let’s not forget even the concept of an Electronic Health Record (EHR) is based around recording the episodes of care that occur rather than around the patient. Breaking down the systemised walls for the provision of care will be key to the innovation that we describe here as the Liquid Hospital. Although as the concept evolves, we note a flaw in the name. The Liquid Hospital does not refer to one institution or hospital – the concept really is around the delivery of seamless care and wellbeing support to people (not just patients), however for the purposes of this article let’s stick with the name as a term.

Simple ideas

The idea is quite simple really; once the patient is in hospital the technology allows the episodes of care that the patient requires to come to them, rather than the patient being shipped around the hospital for different treatments and the risks that come with that. In other words, the system becomes clinical centric. I know from a stay in hospital in 2016 that being moved from ward to treatment room and back again is at the least uncomfortable and at worst darn right scary. The concept doesn’t just stop there though. It does also propose to achieve that panacea of eHealth – a truly paperless environment, as not only do treatments flow around the patient, so does information.

Imagine an outpatient visit to a liquid hospital. You arrive in reception and check in with a clinician who takes your identification and confirms back to you some details to allow you to confirm to them the reason for your visit. As a patient you have elected to collect information on your condition at home so you quickly synchronise the smart device you have with the hospital systems. This shares your medication record and real time recordings of how your condition makes you feel.

As your consultant comes to you they are fed this information to their tablet computer and are analysing the outputs in the lift as they come to meet you in your own personalised consultation room. As the consultant comes into your room your records are shared on the display on the wall for both you and the consultant to consider. You have also elected to share the consultation output with your primary care professional and therefore the actions the two of you now collectively take are recorded and made available to them digitally and directly into their system ready for next time you the patient are with them.

You elect to have a procedure related to your long term condition. Whilst with your consultant you choose when and where that procedure will take place and you are electronically introduced to the clinician who will be your key point of contact when you return for the procedure. Your consultant is then able to provide advice on what you need to do before coming in to hospital for the procedure and download this advice to your smart device for you to consider with your family when you are home.

You also consider a slight change to your medication. The consultant is able to provide you with advice and guidance from around the world and connect you to patients like you with a similar condition via a secure social media outlet. This allows you to consider the impact of a change in medication with a peer group over the coming weeks and access some key support.

Your clinician can provide you with a new prescription directly to the pharmacist of your choice and you can call there on the way home knowing your drugs will be ready for you. A copy of your prescription and your summary notes are also made available to you for your own health record as you have elected to keep this information in your own health vault solution in addition to the electronic record in the hospital.

A few days later your long-term condition takes a turn for the worse and you decide to drop into the primary care centre, which is in your village. You ring the centre and are asked to provide the information you have collected over the last few days via your smart device, which you can do whilst you are on the phone. The primary care centre advises you to up the dose of medication ever so slightly and alter the time you are taking your prescription and within one day your illness settles down and you don’t need to go in to the centre.

The time of your procedure and your short stay in hospital draws ever nearer. Rather than have to attend the hospital for a pre-op meeting you have decided to share your own collected data with your key contact in the week leading up to your visit and have a brief video conference with the clinician. All is looking well and the clinician does not need to see you face to face. Although you are a little anxious, the hospital has arranged for you to be part of a secure group on a social media site and you are able to communicate with patients from around the world who have been through a similar experience, and this goes some way to settling your fears.

On the day of your attendance at hospital you check in comfortably with very little fuss. You are provided with a secure tablet PC that is linked to the hospital’s WiFi, and all of your notes and updates will be on this device during your stay so that you have the comfort of seeing them as well as them always being with you during your stay. It’s your choice throughout your stay as to who you additionally share the information with, electronically. You elect to send all information to your own personal record and some of the key facts to your primary care centre. You also decide to email your nearest and dearest a summary of each day to help them feel less worried about your time in the hospital’s care.

After the procedure you are out of hospital very quickly. Your after care is already arranged and as you hand back the hospital tablet computer with your information on you can already see it has arrived both in your own personal record and at the primary care centre.

The social care provision you require in the first few days is arranged on line and again, as the patient, you have decided what information to share and with who. The social care clinician visiting you at home asks if they can view your record in more detail and you grant them access there and then. The information they are able to get from this satisfies any initial concerns they had and they are able to discharge you within three visits.

How much of a stretch of the imagination do you feel this is?

The technology is there to facilitate this. It has been available the last five years at least if not longer. The big change is perhaps twofold; investment in the aspects of technology to drive this (including training and development) and the change in how care is delivered at a business and service level. Healthcare provision and change related to it is often compared to changing the direction of a sea bound oil tanker, but, if the description of this kind of benefit can be brought to a wider audience (and bought into) by clinician and patient alike maybe this could be an innovation we can make reality, its certainly describes a system that puts the patient at the centre and yet is only just beyond our own reach. A tangible view, just over the horizon of eHealth in action.

Some countries across Europe are starting to put in place the building blocks to enable this change: in Scotland, a change to the commissioning model, facilitating health boards across all care delivery to allow the holistic delivery of care and here in Ireland, the HSE’s own integrated care programme and reform programmes beginning the concepts of change, the creation of the Individual Health Identifier and concepts like ‘money follows the patient’ will all start to enable this dream to become reality.

Technology and a business change programme truly can break down the physical walls of the care institutions of the country and allow care to flow around the patient in a manner as transparent as H2O.  Our 2020 vision sees health without walls made possible by digital.

 

 

Health Leadership (UK & Ireland, the coming together!)

In November and December I was lucky enough to spend time with the IT leadership of the UK and Ireland, I collated the responses to a series of questions for an interview that HIMSS would then publish in two parts, here is the whole thing to give you a feel for how close the concepts of cross country collaboration are really coming along.

Some of the blog is written in the third person, it just felt a little odd interviewing your self without doing that, I hope you don’t mind.

Digital leadership in health in 2017 will have two crucial elements to handle, how to keep the ‘ship’ stable in times of change and how to deliver innovation in large, public sector organisations. In November the UK and Irish leaders of healthcare technology were face to face at a number of events that had these traditional pillars as the themes. Whilst they all accepted these had been at the heart of their focus for a few years now they still observed that 2017 would see a still further push to get these right or potentially fail to deliver for health in the countries they are responsible for.

The events where these leaders came together were, the Irish Innovation Showcase where Will Smart provided a key note that caused a pause in the IT leadership as they stopped to understand if they had the strategy right; the HIMSS Executive Leadership Summit where Andrew Griffiths provided an opening comment that got the whole crowd energised; Richard Corbridge then provided an opening statement with George Crookes at the Scottish Annual Digital Health and Care Conference that entertained and delivered a key message on the future and then finally Sean Donaghy who opened the first Island of Ireland collaborative Eco-System.

During this period of time HIMSS caught up with each of these leaders to get their views on what 2017 holds for digital in health and what they thought of the statements being made by each other and how they could support each other into the new year.

We went first to Will Smart at the Innovation Showcase. Will, what do you believe is the key to innovation in healthcare in 2016?

“Strong collaboration between leaders, healthcare professionals and patients is of fundamental importance. We need to move away from a paternalistic view of healthcare to one which truly embraces engagement and co working. As well as fostering the trust that is vital to the data sharing innovations that put cutting edge insight in the hands of clinicians, collaboration has the potential to create a culture which encourages, accelerates and inspires technological excellence.

That is why, through our NHS Innovation Accelerator and Global Digital Exemplar initiatives, we are supporting the most technologically innovative people and acute trusts to help them connect with partners, make networks and accelerate their innovations. We want to enable these pioneers to inspire others by showing how information technology can deliver both improved patient outcomes and enhanced business effectiveness.

Our patient centred agenda, combined with this type of collaborative support and leadership gives us a once in a lifetime chance to innovatively set technology to work for a system that’s focused on patients and led by clinicians.”

The concept of no longer being able to stand still have become key to the delivery of healthcare, will digital innovation be the route to avoiding this do you think?

“Absolutely. The NHS is under real pressure. Not only is the occurrence of expensive to treat conditions such as obesity, diabetes, cancer and mental illness rising rapidly but we are all living longer and therefore need more care over the course of lives than ever before. So, to continue to deliver great care we must make our service as efficient as possible.

Innovation in information and technology is a critical part of almost all Sustainability and Transformation plans because it has immense potential ensure efficiency while making dramatic improvements to health and care provision, quality and outcomes.

Our planned new digital products and services will make health and care more accessible, more convenient and more effective for patients. As a result, patients will have more power to make better, more informed choices about their care which will also ultimately be more cost effective. Insight we can gain through shared information will also help us improve efficiency by ensuring that the right kind of care and treatment is given at the right time, from the start.

Standing still is not an option for the health and care system. Information and technology innovation has huge potential to help us provide more, and higher quality, care from the resources available to us at a time of increasing demand and this is an opportunity we must seize.”

Next to give us his views was Richard Corbridge from Ireland, Richard, this was Ireland’s first innovation week, what prompted Ireland to put such an event on? “First and foremost it was to bring the idea of Digital Health into the eye of the public. We have had over 3,200 individuals booked into the events in one week, all our events have been free and have garnered a significant level of interest from the people of Ireland. If the patient, the tax payer, wants to see digital in their health system to make it safer and more efficient then maybe an understanding of the level of investment that can be made can be got to. Secondly though the week of events has created a ‘platform’ to enable innovation in the Irish healthcare space to really begin to happen, and perhaps more importantly be supported, Ireland has an engaged clinical team, it is now starting to make the connections between clinicians and the technology leaders of the country.”

What do you see the blocker to innovation in healthcare being? “In Ireland it can be sheer resources, funding and time being the hardest to come by. More generally in healthcare I would say it is the concept of building the jumbo jet as it flies down the runway, as digital leaders we have to keep so many moving parts on the go, the temptation is to focus on these and we can’t, we have to keep an eye on the future. There is a story of a bridge built in Honduras I have been using in presentations recently, an amazing bridge, started in 1989, by the time it had finished due to environmental changes the river it was spanning had moved. We have to be mindful of this happening to our plans and enable innovation and new technologies to influence them.” We then caught up with Andrew from Wales at the HIMSS ELS; you spoke of ‘not checking the Daffodils too often’ which went down well as an analogy, can you explain what you meant? “First to explain the analogy, aside from playing to the Welsh stereotypes, if you keep digging up a plant in the garden because it’s not growing, the very act of checking everyday ensures the plant never grows. There can be a tendency in health IT to give up too quickly and declare the project a failure, spending all our energies on checking and explaining, when what’s needed are steady nerves, encouragement and the will to succeed.The most troublesome periods in any implementation can be the early days, people are not used to the system, support can take longer as training becomes practical knowledge and the IT hasn’t settled down. Inevitably the first period is also when most changes are happening and every change is an opportunity for a problem. Admittedly there are times when the plant is a weed and needs to be killed off quickly but in my experience more often it’s a plant that needs nurturing. If we “fail fast” at every perceived problem we might never achieve anything, some of the great achievements have needed great perseverance.” As digital leaders what do you think the key strategy for leading in these times of most unpredictable change can be? “I’m not sure there’s a simple answer to this and if there is, please someone tell me. However my thoughts for what they’re worth are that: we need to be clear about what we are trying to achieve and recognise that in achieving our goals “digital” is not an end in itself but the means to something greater.

We need to keep that vision in our heads and keep doing things that gradually get us there. That will inevitably mean spotting opportunities that occur and changing the plans so that we can take the opportunity. It would be great to be able to stop the world, design it, then start again but the reality is that we have to make running repairs that are actually leading to a complete rebuild. We need to be developing great people who know the right things to do because they share the vision. Finally, somehow we need to summonses the courage to create certainty for others so that they, unburdened, can confidently get on with the doing.”

George was the next of the group we were able to speak to, the idea of the UK and Irish digital healthcare leaders being able to share more seems new, what do you think can happen if this is enabled?

“The days when we not only had to own the problem but also own the solution are over. It was wasteful in terms of time and money and we do not have the luxury of either! The benefits of sharing thoughts and ideas as well as good practices, lessons learned and solutions is mutually beneficial. The challenges our health and care systems face are the same, the largest part of any technology supported solution is generic. So, it is not rocket science to suggest that collaboration is the correct path to follow.”

The annual digital health and care conference in Scotland had a great selection of speakers, Richard spoke about different ways to engage stakeholders, how do you see that influencing the way we deliver digital health in 2017?

“The need to involve stakeholders from all communities of interest is fundamental to securing sustainable and scalable solutions to the wicked problems we face. The perceived effort it takes to engage the public can be reduced and the outcomes magnified by using innovative methods to support the process. The need to use multiple digital channels for engagement is going to become the norm going forward and will transform how we plan, develop and deliver services.”

The ability for countries to come together is highlighted through these leaders willingness to share, perhaps no more so will this make an immediate patient difference than between the Northern Ireland healthcare system and the healthcare delivery of the Republic of Ireland. Sean Donoghue opened the first whole Ireland Eco-System meeting in this same week with a rallying cry for collaboration on the delivery of standards and the ability to share key lessons learnt.

Sean, seeing the start of an Irish cross country collaboration at the Eco-System this week, do you see this model evolving across the EU?

“Inevitably it will, the key issue is whether it is driven forward by public and private health systems, or whether systems and leaders have to be pulled reluctantly to the table. Collaboration across systems is a key support to better sharing of citizen information and best digital care practice in to support better health and wellbeing across the EU. 

We have that need right now, with a large land border that citizens of this island cross as part of their daily lives, including for health and social care. Too much of the approach up until now has had the feel of ‘make do and mend’, and that will not support our citizens to get the best from their own efforts and from health & social care resources. We have fantastic potential to build a shared digital fabric that can remove some of the worst impact of a land border on the experience of our citizens, and we’re determined to realise that potential. That means taking action now on shared citizen identification, and on shared standards.”

All of the leaders we have spoken to in the last week place the patient and clinician at the centre of the digital revolution, how does the Eco-System meeting do this and how do you ensure this is maintained beyond this initial coming together?

“The driver for sharing is the needs of citizens; that is very well recognised by health & social care staff, who voice their frustration at the barriers to communication, and thus to better care.

The Ecosystem meeting provides a place to check in, to celebrate successes, to remind us of what remains to be done, and to provide a public space for health and care systems and those who supply digital solutions to set out the agenda for further work. It is a visible and important signal of our intent to work together.

Sustaining this approach requires commitment from leaders, and of course, visible progress. The commitment is there, and the early signs of progress are encouraging. I am confident there is much more to come to inspire collaboration as the default way of working.”

In two weeks these five digital leaders have moved forward an agenda of collaboration, sharing and evolution in healthcare perhaps more than the UK and Ireland has seen in the last five years. The spirit of working together in times of change would often be described as the spirit of England, but, this collaboration shows that in digital health it has become a spirit of the five nations!

All of the leaders commented on the amount of change in 2016 being unprecedented, however they all spoke of ways in which they had built a strategy to cope, maybe what change will do is foster a degree of collaboration that the global healthcare system has not seen before. We asked a final question of the two leaders from the island of Ireland, what was their own predication for 2017 in digital health; the Republic of Ireland’s CIO said, ‘We will see the ability to deliver complicated care information digitally to the patients of Ireland and allow patients the ability to add information to their care record in such a way as to enable it to be useful to clinical staff.’

Sean’s final comment perhaps is a shining example of how this group are starting to think when it comes to the transformation of healthcare; “The most exciting development is the sharing of information with citizens, and building shared workflow to provide more flexible, tailored care. I expect tangible progress with all of my colleagues on this in 2017.”

Richard Corbridge finished off a number of the presentations over this period of time with what is becoming almost a trademark phrase of his, Imagine A World, the conversations with these five digital leaders allow us to imagine a world where the much promised future can actually become a thing of reality, where integrated care can be delivered through a digital platform and patients will feel that the care they receive is within their own context, a huge leap forward for how these countries enable innovation in the health care system.

Do eHealth agendas ‘need’ politics…

First published in HIMSS UK Journal in September of 2016.

 

The delivery of health is driven by politics by necessity. No matter where in the world you are the delivery of health and wellbeing to a population is an election winning and losing manifesto. We understand that the delivery of digital health could be as disruptive in its application as any other business arena globally and yet, maybe because of these intrinsic political links, eHealth has not been able to ‘just do it’ at the pace of say the tourism agenda or even the ever increasing connected cities agendas.

The Bob Wachter report, ‘Making IT work in Health’, was published in the UK in early September. Politics allegedly, is said to have even delayed its publication, an essential report that the NHS needed, a report that global health systems considering how to make the giant digital leap needed.

Why does health have to work to a political agenda and time line? As IT professionals it is frustrating. Innovation needs to be allowed to happen in an agile manner. In Ireland we are deploying solutions that are over 10 years old, we continue to deploy them because they have been backed politically but the digital landscape has moved on three generations since the inception of some of these solutions, and to be absolutely fair the solution, whilst ten years old, still makes the beneficial difference the healthcare system originally wanted to gain.

I tell a story when presenting at the moment, a second hand, legitimately stolen story I have to admit. In 1969, the ‘people’ of Hong Kong decided that they needed to create a business district. They came together and placed a mandate to develop the business district regardless of political persuasion, economic climate or technology change. Today the business district of Hong Kong is one of the most thriving globally. It is as shining example of what innovation, connected people and a clear, unambiguous and a-political mandate can achieve.

I am proud to be working in Ireland on the health care of a nation. Earlier this year our minister for health proposed that Ireland needed to move away from annual planning, annual stretch targets and annual budgets. He asked for a mandate to create a cross party commissioned group that would consider the future health of Ireland and report back to the people of Ireland what the options, and indeed solutions would be. How exciting. At last the health system of Ireland could have a plan that is longer than some repeat prescriptions!

By allowing health to be disruptive and creative, then it can consider how to catch up with other international business from a digital innovation point of view. We often ‘roll out’ the banking analogy. Citizens are happy to use mobile banking by and large, the expectation to get a real life letter from the bank has almost gone away and the bank manager is no longer recognisable on the high street as a person of status. Banking changed quickly, maybe because technology was enabled to be disruptive, not just because of the investment but because of the change in attitude and even the aptitude of the customers themselves.

Will any country ever be brave and allow a system to just do it. If clinicians and patients are engaged and want ‘IT’ then why not?

The suggestion is definitely not to do this without governance or engagement but to take away the political might, to empower the system, which is far more intelligently capable in this arena than the political system after all, to make the difference happen in clinical and technology settings! Attempts have been made in many jurisdictions to empower the public. The NHS tried the Healthspace experiment in the late 1990s and Estonia is mentioned in every EU eHealth meeting as a rising star of patient empowerment through access to information. The Danish health system is as close as it gets to a ‘Block Chain’ like health information system in 2016, where the patient truly has a level of control over the information about them. If we can make this happen then we should be able to find a way to enable the eHealth orchestration to step out from the political agenda somehow.

There is an additional moment of caution here though, which needs to be learnt and applied. The suggestion we make here is, yes to enable the politicians to take a step away and allow the agenda to deliver against a defined and agreed benefit set, it is not, and I can’t stress this enough, an ask to bring in a large group of people who do not know how health works and ask them to deliver large complex digital change agendas to health. Health is not just another business ready for change it is unique and that feared and fabled word, ‘special’!

Under the auspices of the then prime minister Tony Blair, health in the UK was labelled as a business that was ready to made like ‘Easy Jet’. Almost weekly a politician globally will reference the need to ‘Uber-ise’ the health system. I wish we could simply do that but health is huge, interlinked, has powerful and learned users that need to be taken on this journey of change. Uber-ing health would cause more of a fall out than the go-live of Uber in any city that has been globally seen so far.

Relationships with other government departments, wider politicians, parties and vendors obviously will need to continue to grow, and often politics will need to have a part to play in these burgeoning relationships. Perhaps this is the area where our digital agenda could benefit more from a political involvement. Whether it’s Mark Britnel from KPMG, David Beloff from Deloitte, Neil Jordan from Microsoft, Kaveh Safavi from Accenture or Robert Wah from CSC, Ireland has access to a wealth of advice and guidance from partners and prospective partners second to none globally. The knowledge in years alone from just the names above is so impressive, and yet there seems to be a fear from the political and civil service system to engage with these brains, which is a shame.  Partnerships with the these organisations are already in place, and of course each of them is hoping to get a larger bite of the Irish ‘cherry’, but whilst this is their end goal they have been very willing to share, to help us learn lessons and apply new ways of working and thinking. Ireland partnering with this kind of intelligence at all sorts of levels is exactly how it will implement an eHealth agenda and get it right first time.

So, if we persuade the politicians of the world to work with us to set a longitudinal ambition for eHealth, if we can persuade the same politicians to help each eHealth team agree the governance, the way in which they can be involved and the parameters and limitations of their involvement then, can we simply get on with it? Against an informed and educated back drop I really do think we can.

The avoidance of vendor led grey IT would be an area to watch. If we take away the political detailed mandate there is a risk that vendors could become a great deal more powerful in local micro-systems. National integration can be achieved without political ownership, through true engagement of clinicians and patients a final location for digital health can be agreed and reached. It can be agreed without clinicians becoming programmers as well I think. It’s entirely admirable the engagement that many other jurisdictions now have with clinicians. Initiatives like Code for Health and more widely acceptable open source solutions are great where clinicians want to get his involved but are not a prerequisite to clinical engagement or to eHealth being able to move away from short term political direction.

I do need to bring this back to Ireland though. As has been reported in the media, Ireland has an EHR business case it now believes in. The health system itself has approved it as a business case, clinicians, patients and the leadership of the system has made it clear that the 10 year direction in this business case is the right way for Ireland. The issue now though is down to the affordability, and that will always be a political prioritisation piece. A public health system such as Ireland’s can’t ask patients to pay for the IT it uses as a direct cost, although we know that the cost of an EHR in Ireland would be seventeen euro a year per patient. And that’s where the political elements has to remain, they have to be the pay master and therefore they have to be able to take credit and risk for delivery.

If Ireland can agree the 10 year journey, if Ireland can continue to deliver the digital fabric it is doing, with the simple support of an engaged minister’s office and political team then we truly could be the first country in the world to do this effectively in a timely fashion and with the patient at the centre.

A great result is coming our way, and this will be down to the efforts of the full system of support, civil servants, public servants, ministers, clinicians, patients and vendors – a true partnership as a facilitator for success.

The right questions…

First published in HIMSS UK in November 2016.

Answers to questions can change the world, of course they can! When I fly I so rarely check a suit-case in that I had forgotten the words that you are asked before every flight until this year’s summer holiday. Did you pack this case yourself, are any of these (dramatic wave over picture) items in the case, could this case have been tampered with?

Western, male, childish human behaviour always, always makes me want to answer different to how the desk operator expects at this point, but I don’t, I behave and move along the line. But this summer holiday season these questions did get me thinking about the parallels to healthcare. Are the questions the right questions, are they based on enough background information, are they asked at the right time and does anyone really consider what the answer could be?

In Ireland we have three projects known as Light House projects, specific disease areas of focus where we have applied investment that has delivered learning and solutions for the healthcare system. Interesting in the context of question asking in particular is the Bipolar Light House project; one of its early deliverables is a solution that allows the person suffering with the disorder to record their feelings daily. In time and with the patient’s awareness the questions will be prompted by other data, for example has the person been outside today, exercised, and interacted with others. The question and the context of the question is just as important as the answer in these circumstance! And yet current ‘best practice’ is to ask at each consultation, how have you felt over the last month?

And to match the current best practice we also have human nature, where the obvious answer in Ireland in particular is, ‘Grand, thanks’.

Cause no fuss, almost regardless of disease type is the patient ethos when it comes to the sharing of information, and perhaps even more so in complex mental health areas. If a patient wants to share information then it is our role, maybe even our main reason for being in the digital health industry in the future to enable this to happen.

Are the questions the right questions to ask, clinical practice knows because of the wealth of knowledge that clinicians have what the right questions are and how they need to be asked. This is fundamentally why we need clinicians involved in the design, build and test of every system deployed into our healthcare system. Seeking clinical support from the design phase onwards is not a simple task though, design comes with personal perspective and opinion and therefore getting to a point of consensus is always going to be difficult. Maybe then the arbitration vote on the design of an information system that is asking questions should be the patient, to truly deliver contextualised care where the right questions drive a type of care that is infinitely safer, more efficient and makes the care delivery feel like the fast lane for baggage check in and the first class lounge at the airport!

Questions in health need to be based on enough background information to make a difference to the care that the patient is going to receive in a short space of time in the initial consultation. Systems need to inspire the right question.

The airport questions have to be asked at the right time, in health we need to consider are our questions asked at the right time and by the right people. One of the most common perceived benefits to an EHR in an acute hospital is to remove the need to keep asking the patient the same questions over and over again, not just because, lets face it, it doesn’t instil confidence in the patient or the delivery of care but because it is simply inefficient and unsafe. But really an EHR in an acute hospital can do so much more than fix this issue when it comes to asking the right questions.

As Ireland prepares to go live with it’s first EHR in the maternity hospitals of the country we can see a huge enthusiasm amongst clinicians because the system is going to prompt them, based on data, to ask questions against early warning algorithms. The questions will be prompted because the patient is at the centre of a new type of ‘network’ where devices that measure are plugged into data and where the two spheres of influence, the measure and the data, can come together to inform the intelligence of the clinicians so much more than simple observational charts allow us to do today. That’s is why we, the health technologists, got into this business really, the connectivity of technology that allows us to create an Internet of Things that has the patient at the centre, maybe a new name for IoT in health, the Internet of the Patient, IotP!

If you did decide to answer the airport questions differently to the expected answer what would happen? I would hazard a guess a serious double take would be the first thing as the clerk behind the desk has probably never had anyone answer in any way other than to confirm the answers they expected to hear.

But when formulating the questions does anyone really consider what the answer could be? Imagine if a patient answered differently to expected, how much would it throw the care process. In 2006 I was seriously ill in hospital, no one knew why, no matter what questions were asked the team couldn’t get to bottom of it, so they put me in ICU and wired me up to every possible machine, turned down the lights and observed, when the questions fail observation and time are the only keys to unveiling the true nature of disease and illness. Questions answered can come from so many different quarters, in my case the fact I had travelled overseas was the key to unlocking what was wrong, but that took a more casual conversation than how are you feeling and could only be got to once I was stabilised. Somehow the ability to unlock that information needs to be a new focus for health if we are to deliver contextualised care. However the care that needs to be taken in unlocking the data and delivering it to the clinician needs to be significant, as Frank Buytendijk, a Gartner researcher has been describing for several years this could be considered to be ‘crossing the scary line’. The impact on care that data can have is phenomenal, but, two key actions need to be considered, firstly can the clinician handle the volume of data and second what privacy elements is the patient willing to give up to enable the clinician to have this information.

Imagine if we could give an answer that could cause a different question to be formulated! In so many other sectors digital information has already enabled business disruption to occur. If we can get to the point in health care where the question of the patient could actually move from how have you been for the last month to one where the clinician and patient already have the core data shared between them, the conversation can then move away from how to why and then to prevention. A clinician recently told me that the outpatient appoint for him, a psychiatrist, was as much a reminder to review the notes of key patients as it was an actual face to face appointment, with the right systems delivering the right information to all parties then that can become a shared responsibility and the mantra from the UK of no decision about me without me can be taken up even more strongly.

Next time I check a bag in at the airport I think I will have a little more time for the person asking the question, really they have an important job to do in simply asking the most simple of questions.

 

Digital fabric and the frayed jeans…

First published in Irish Tech News in September 2016.

In 2014 eHealth Ireland was introduced by Microsoft to the concept of a ‘digital fabric’. I personally love a good analogy as a story telling form and believe that it is perhaps the best way to get a message across. The concept of a digital fabric has now woven itself (pardon the pun) completely into all that eHealth Ireland are delivering. But now as we hit the back end of 2016 and we have the CEO of Microsoft visiting Ireland to see what that fabric has done I wanted to try to explain how the concept evolved and how we made it Irish.

In 2014 the decisions that needed to be taken about the type of fabric we were heading for were still in the earliest of stages. A newly woven fabric or a patched up solution of all our favourite old outfits really was what we thought were the core decisions. No healthcare system has ever been successful in ripping up the old and bringing in the new, it either hasn’t got off the ground or gets thrown away never to be brought out of the wardrobe again, let us call this type of fabric the ‘Shell Suit’ fabric! The shell suit was perhaps the worst fashion misdemeanour of my youth, and I am pleased to say it has never come back into vogue! For me the concept of simply adopting a monolithic digital system for healthcare just because others have was the worst decision we could have made. We had good advisors, vocal clinicians, seasoned experts and the ability to understand the history here to make sure we didn’t head down this route. Which is lucky as we now look around the world at the shell suit style mistakes that other healthcare systems are now recovering from. Primarily this would not have worked in Ireland because of the way in which the Irish clinician delivers care. Irish clinicians know how to make the system here in Ireland work, they are experienced to work within a system that has limited resources but a wealth of knowledge, they know how to manoeuvre a patient in the system through the complexities of a model where

Another type of fabric that has to be considered is that staple of every wardrobe the perfect pair of jeans! Let’s take this to be the operating model of eHealth Ireland. Like with trying to get hold of the perfect pair of jeans the operating model had to be all about the right fit, it had to take on board the references of the past and estimate the trends of the future and it also has to be built to last. Moving from a local operating model where functions were repeated and national standards were optional was a giant leap for eHealth Ireland but one, through consultation, Ireland moved to in March 2015. The issue now though as we move to the last quarter of 2016 is that the model was designed to be in place with a larger resource, the model then is becoming a little frayed at the edges because of this, also some of the ‘trends’ have changed and evolved at a different rate to the original thinking thought would happen, there is a fear we could be left with a pair of frayed boot-cut jeans when the original 501 is ‘de rigueur’ in 2017.

We are lucky here though, the digital fabric that we are moving towards is not so tightly wedded to the operating model that changes are impossible. The concept of clinical leadership of every project for example was something we thought would take time to get to whereas in reality in 2017 we truly will have got there. The idea that the Individual Health Identifier would be deployed as quickly as it can be in 2017 is another area the digital fabric will now need to evolve more quickly to accept, but again it has been built and agreed to enable that to be so.

I was once told that the easiest way to ensure that nerves don’t get the better of you when presenting is to be dressed just one degree smarter than you really need to be, that way you will have your ‘armour’ on. I think the best way to guarantee this is to be decked out in a Paul Smith suit personally. The eHealth Ireland digital fabric has driven hard the agenda of engagement, with the public, with clinicians, with other government departments. It has taken this part of the agenda very seriously and has worked to the ethos that if we are going to be successful then the whole of the fabric needs to be knitted around the person of Ireland. The engagement will continue on into 2017 with the novel way in which the Electronic Health Record market place will be tested, eHealth Ireland will create a series of Irish personas, we will give these personas names, conditions, characteristics and ask the market, ‘how does your system make these people better quicker?’ or ‘how does the system ensure that the role of the persona (a clinician) can be delivered more efficiently, more safely and in a more rewarding way?’

eHealth Ireland plans for this route to market so that the people of Ireland don’t get an IT system they get a reformed healthcare system supported by a person centric digital solution.

The open and transparent nature of eHealth Ireland is another element of the fabric that we are trying to ensure enables and facilitates a smooth journey to implementation. Jeffrey West shoes are some of the most original footwear I have ever seen and always get commented on and noticed. The social media and digital presence that eHealth Ireland has fostered is one of the routes to transparency and engagement that is quite different for the health system of Ireland but is a route that has been considered by organisations as eminent as the World Health Organisation as crucial in the way in which people can become engaged.

eHealth Ireland took the decision early on to use digital as a platform to engage the people of Ireland. A public consultation on what an Electronic Health Record could be in Ireland, the Privacy Impact Assessment conducted in draft in the public domain and animations explaining to patients how they can be eReferred are just some of the routes that have been implemented. In a similar way to the famous Northamptonshire cobbler every piece of communication has been tailored for a very specific situation which has enabled the success of these communications products and has seen eHealth Ireland rise up as a brand that the public are beginning to believe in and trust in.

The protection that the digital fabric needs to offer the patients of Ireland needs to be second to none, it needs to be steeped in history and reliability needs to be recognisable by the people of Ireland as affording a higher degree of information security and integrity than ever before, the Belstaff Motorbike Jacket is my reference point for this. First made in 1924 and considered to be the ultimate in protection when riding at speed in all the elements the jacket is also synonymous with cool, how to make people fans of information security and governance has been an ambition of mine for the last ten years in health technology at least. Those in the know as why wouldn’t you want to be interested in information security and governance and yet it is often the poor cousin. What eHealth Ireland has done by making it the ‘Belstaff Jacket’ of the digital fabric is try to ensure that we all understand what security and governance mean when it comes to data, how do we remain with a degree of preparedness for every eventuality and how do we utilise partners like Microsoft to help us deliver what we need.

Ultimately this digital fabric wraps around the patient like a silver blanket after running the Dublin marathon or a warm towel after the Boxing Day swim at forty foot! The delivery of the fabric will take on all sorts of directions and eHealth Ireland is there working through each direction as it reveals itself to us, enabling us to be agile and react in a way that keeps the patient at the centre of what we do and the clinical benefit at the heart of the design of every system we look to deploy.

In the shed at the bottom of the garden…

When a member of staff offers to put you in a shed at the bottom of the garden for the next 12 months, what does it mean I wonder? So far my time in Ireland has taught me so many new phrases. Most hilarious was learning what being ‘put on the long finger’ meant, however today on the eve of our all staff meeting the concept of asking the leader of an organisation to go and hide in the shed at the bottom of the garden for a little while I thought was uniquely Irish, turns out its not. It’s perhaps a bit unique to the style of CIO I aspire to be.

The all staff meeting occurs twice a year. It has become traditional to try to pull together a blog post for each of these on the eve of the event that sets some of the tone or theme for the day, gives us something to reflect back on and adds a bit to the conversation as the day progresses. The theme for the staff event this time is quite simply ‘Delivery’. We have had ‘Transition’, ‘Transformation’ and ‘Connectivity’ and now we move on to the ‘pointy end’ – delivery as a theme!

Delivery style applies nicely to the concept of the leader of any organisation being put at the bottom of the garden for a little while it would seem. In just under two years the team has moved mountains, to completely re-structure a function and put in place a national focus that organisations like the World Health Organisation are giving Ireland credit for. The credit for making this happen goes to every member of the team though.

But, when the team offer a ‘deluxe shed’ for a few months to the leader it is time to stop and ask why. Strategy and delivery go hand in hand. A CIO needs to be able to do both simultaneously, Grand plans badly executed will not change the way healthcare is delivered in Ireland nor will rushing at a problem head long without a vision in mind. It is well documented and in the public domain the distance Ireland has to travel with digital health. It has become a little too easy to move quickly without always the consideration needed for keeping the whole team on the same path.

One of the key principles as we moved to transition and transformation of the team was ‘don’t break anything’. We haven’t, but maybe on some days it feels like we have come really close. We are currently operating a resourcing style probably best described as robbing Peter to pay Paul. Not ideal and maybe one of the reasons why a proportion of the team wish I was away in the garden shed for a short while. A further principle though when we started this journey was to keep delivering new things, not to go away with a long term plan that had no new early benefits to the delivery of health. That requires a balance of strategy and operational delivery that isn’t always there for technology teams in health but Ireland has been able to make this work better than I have seen anywhere else.

The most successful of teams are really hard to create. They certainly do not come together ready formed and need a plethora of different elements to make them work. Sport is littered with examples where teams do not equal the sum of their parts and the results simply are not there. Take the difference in commitment from this year’s soccer Euros. The most telling moment of sport TV for me over the summer was a comparison of the Ireland and England team getting off their team bus. The England team exit in ones, big Beats headphones on, no interaction, and no conversation just 12 super stars in perfect isolation. Cut to the Ireland team, talking to each other, gesturing at the stadium, practically hand in hand ready to meet the challenge. The team in white had one of the worst sporting performances ever and the team in green one of the best ever, in my view. Certainly as we head to the qualifiers for the World Cup I am hoping my adopted home allows me to be one of the #BIG rather than a miserable man in white.

The leaders of these two teams had very different sheds. England seemed to have a shed that was strongly built, just a small window and an appointment system to come in for a look with edicts passed under the door every couple of hours about what to do. The analogy for me of the Ireland shed was more of a gazebo, open access, everyone able to see what was happening, to share ideas and move the whole structure easily moved around.

The need to deliver is a pressure the team has to try to handle daily, and that pressure comes from an unwavering pride in what is being attempted. The team has embraced the concepts of the new operating model and is trying hard to make it work often in the face of some adverse conditions, but each small success moves us one notch further towards creating a digital solution that can tangibly make a difference to the way health care is delivered in Ireland. The need to keep delivering, to prove what eHealth Ireland can do, is with us all the time. No matter each success, the media will always find a story that does not play the positive element of digital health. Whether it’s the fact that the wider eHealth Ireland eco-system has sought guidance from an organisation that is globally recognised as a ‘digital-first’ organisation (and for writing about restaurants on that platform) or that eHealth Ireland has pushed hard to be part of the NHS CCIO/CIO councils, these elements do not serve the organisation well in the width of the Irish conscious and perceptions of what is being delivered. And yet they do serve the ability to deliver well!

Camaraderie has to be a big part of how the team works, and that can’t be forced to occur. We are trying lots of different ways to create small eco-systems of support. The amazing initiative from the team around eHealth Moments starts to really put new and exciting opportunities in place. A safe place where the team can share experiences, ask for support, get to know each other or simply understand the many projects and services that are delivered, all on one platform where staff are able to introduce themselves with this now world changing words…

Hello my name is…

I can’t wait to see the way this will bring the team together, and after all, as a digital organisation dispersed across the country, we should absolutely use the tools to hand to achieve improvements to the team culture.

Dare we ever try to emulate the three musketeers’ motto in eHealth Ireland I wonder? It is cheesy but a very good friend used to have it on his email signature, ‘All for one and one for all’. We are trying to get there. I know there will be some of the team who read this who are not sure if they really fit into this, and yet I am committed to get everyone in that shed with me, that’s the style of CIO I want to be!

Times continue to be exciting. An old boss of mine in the National Programme for IT was fond of saying to staff as she passed them in the corridor, she speed walked everywhere,

‘No one said it would be easy, everyone said it would be worth it.’

So rather than just putting the leadership (or worse just me, I need some help) in the shed at the bottom of the garden, who wants to join me, we can break the rules, change the rules and support each other in being committed to delivering, we can strive to keep the positivity and sometimes ignore the negativity.

I’m there!

Grecian 2000 for Grey IT…

First published in the HIMSS British Journal in August 2016.

Turning grey hair to darker hair to protect youthful looks has been a trend for decades, and yet in IT we want maturity to not be grey, kind of odd really! Whether we are calling it shadow IT or grey IT it doesn’t matter. What does matter is that every national health system that has tried to implement a country wide digital answer to connected health first, has to at least understand the different shades of grey that exist in the system.

This has to be done before any success can be made of a national solution.

No matter the pantone of grey that has been implemented it will exist in health perhaps more than in any other business area. Why is health so grey in its IT delivery? I would suggest it’s down to health lagging behind in the ability to innovate and adopt new technology particularly at a national level. Local health technology projects are able to adopt business change and technology at a rate akin to the consumerisation of digital, but ask a national system to do so and it is like asking the plumber how much for the washing machine to be fixed, a whole lot of teeth sucking and estimation ensues. Engagement in grey IT is also a huge factor, a grey IT solution probably is clinically led from the offset, as it is highly likely that a clinician has championed the greyness and because of this a national public engagement is not going to be necessary, because locally it can normally be achieved with less concern due to the smaller implementation scale. This element I worry about the most though, how many grey IT projects meet the data protection requirements applied to health are or indeed the cyber security protection that health needs more and more of? And as a health IT leader how many projects are you going to be asked to take on when the going gets a bit tougher.

But back to that plumber! My suggestion is back to the old business change chestnut! To make national IT solutions works requires national business change solutions to be implemented, and funded. Government and healthcare systems globally want to use technology to standardise the delivery of healthcare and yet we now all realise that the way to success is to enable clinical choice and to build the project on sound business change principles, clinical standardisation may be an outcome of the delivery of national digital solutions but should not be the reason to implement.

In recent months we have seen the NHS launch two ambitious plans to reveal the local digital maturity of the entire service; the answers were startlingly different from locality to locality. Again we find ourselves asking why the dramatic local differences and does it really exist. I would suggest differences do exist, prioritisation at an NHS board level and the starting point even further back will have had a huge impact; however by far the greatest impact on any new understanding of a national maturity is the incentives to reveal all. If the assessment can bring money then the wiley health organisation may well down play their current position to get their hands on much needed funding. However on the other hand if the assessment is going to place the organisation in some kind of league table or ratings created then the opposite will occur.

Here in Ireland we have a digital immaturity in health that is well documented, and yet we have some centres of excellence in disease areas or locations that rival other parts of the world. We need to assess how to build on these centres and we need to work out how to share better. The reform of the Irish healthcare system that is underway has an objective to create larger, sharing focused organisations, doing this for digital is going to be a challenge but is at the heart of the next stages of our five year plan.

A digital maturity understanding across the health sector is being approached by Ireland’s CCIO network, rather than asking IT leadership directly we will ask the clinical network to describe what they think of the maturity of the organisations they work within in the first instance and then go back to validate with the expert technologists, hopefully cutting out the issue of perverse incentives coming into play as much as possible.

The results of this will then drive not just a prioritised work plan for implementations like the whole Ireland maternity and new-born system and national lab system but will also be used as an investment case and readiness starting point for the implementation of the Electronic Health Record.

A clinically led view of the greyness of digital and the need to build the foundations on this could be best summarised by using the famous hair product catch phrase, ‘why take two bottles into the shower when one will do,’ in other words let’s get one digital maturity understanding done once by the right group of people to do it!

And as we started with the Grecian 2000 metaphor lets finish with ‘It lets you decide, day by day’, in other words brings out our natural and real ‘colour’ of IT in health!

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