Today is the Future Health Summit 2017, last years event felt like the firing gun for a change in the way eHealth Ireland delivered, not just the slightly loud theme we adopted on the day but also the openness we tried to drive, the collaboration we announced we would enable and the key dates and targets we set out to be judged against. I have a team in place who want to be judged by the actions they take, meeting targets we announce seems to be the best way to enable this.
So much has happened in 12 months for what we are trying to achieve, the success of the Epilepsy Lighthouse project, the maternity deployments, the delivery of a national digital function, the move to cloud computing, the delivery of the health identifiers infrastructure, all leaps forward in a single 12 month period.
We do wish we had done more, we wanted the EHR business case to be further along, we wanted the IHI to be live and in as many connecting places as possible, both of which will happen in the next quarter but not in time for a 12 month celebration.
Two amazing digital health CIOs take on the role of running the eHealth Festival today; Rachel Dunscombe and Andy Kinnear; when I think of these two I consider how far we have to go on our journey, I have known both of them for a long time now, the work they have delivered has grown and grown and grown to the point where I think of them as leaders on a global stage, but the right sort of leaders, understated, assured and friends!
I get a quick run on the stage today at their festival. We are going to talk about story-telling and a new paradigm in digital health leadership. We have said for some time, no idea is unique, eHealth Ireland has become good at translating ideas, joining ideas up and making them Irish. (Said the man with the Barnsley accent!) So a big thanks to Social Kinetic who set us off on the journey for todays take away elements.
Our proposal is there are three new types of role in digital health that ensure the function can truly begin to tell stories to engage.
The first new role is the ‘Hacker in Chief’ a merge of the knowledge that the Chief Clinical Information Officer brings and the digital authority that the Chief Information Officer brings. Can we together hack old ideas into a position where they can deliver for digital health in Ireland? Is it really a new idea though, to talk to the customer? I was told a story recently, a story about Heathrow Terminal five when it opened its doors. T5 had a few digital problems in its first few days, one not made in the media too much is the story of the queues in the gents toilets! Bare with me a moment whilst I explain. A week in to T5 opening there were significant reports of concern, there were not enough men’s toilets in the terminal, there were queues! The digital team were on the response for all issues due to the large amount of them being resolved by digital reform, so, the digital team went to investigate. They went to ask the gents queuing why they were queueing. This innovation, talking to the customers, proved to be a huge saving for T5, because the only reason there were queues for the gents was that the tannoy outside in the terminal was not loud enough and gents from all over the UK were heading to the toilet queue to hear the gate of their flight! I guess the morale of the story though is digital people have learnt the hard way that talking to the customer is the only way to really deliver what is needed and the ‘Hacker in Chief’ is here to make sure this is part of what we do in Ireland.
The next new arrival at the digital health top table is the ‘Collaborative Sense Maker’. What we are trying to do is complex, and comes with a real risk of not making the most of the resource we have. Health anywhere is always a big organisation, its why when we ask why digital is so slow to come to health we have an answer, the sheer size and complexity of change. The ‘Collaborative Sense Maker’ has a role to help ensure that business change happens. We have tried to say, ‘No more IT projects,’ but that can’t be true, after all we are leading a team of digital professionals. I think the new meaning to this is let’s not have projects that exist just to deliver technology, lets collaborate to make sense of what is needed to deliver integrated care in health. At the recent EU wide integrated care conference here in Dublin a number of patients and carers in the audience explained that they had become known as the ‘difficult mum’, they were wearing this badge as a badge of honour. They provided care for a loved one with a complex and rare disease, as a mum or a carer they had become the person responsible for creating collaboration around care and indeed for making sense of the care delivered.
This new function can be responsible for working with ‘difficult mum’ to bring about a change supported by digital solutions that will ensure that every step of the way integrated care is the key and maybe not such a reliance on being difficult!
Finally, legitimately borrowed as a term from the Microsoft halls in Seattle is the role of ‘Chief Story Teller’, we all need to become this. The only way to engage on some of these concepts is to tell stories, telling a story is key to building engagement, trust and belief in an outcome. Creating an analogy to describe a complex journey is not new, in digital health I think it could well be essential if we are to get the engagement and buy in we need. Understanding the starting point, the end in mind and the story required to get there, classic story telling, we just need a hero (Andy) and a heroine (Rachel) to lead us there!
None of these roles need the titles in their positions, certainly we have enough chiefs kicking around the system but imagine the functions coming together to make the changes the descriptions promise. David Holzmer talks about,
‘We are witnessing the collapse of expertise and the rise of collaborative sense-making.’
I think this is the answer to so many of our needs is here in these descriptions of new roles, how to make these happen is down to anyone who works in health today, these are not digital roles, they are roles that will see health in any country set up to be patient centred and able to deliver care in a contextualised manner, a manner that citizens deserve.
Seven predictions of trends in eHealth in Ireland in 2017
At the end of 2016 Boston Children’s Hospital in the USA published a blog describing the seven predictions for digital health in 2017. A focus of eHealth in Ireland in 2017 will be digital solutions to support the care of children, be that preparation for an EHR for the National Childrens Hospital or the continued implementation of the Maternity and New-born system. Ireland has, in 2016, delivered on so much of the promise it made, with this in mind we wanted to consider the predictions by one of the world’s leading children’s hospitals and apply them to what we think can be achieved in Ireland in 2017. eHealth Ireland has set its sights on being able to apply these trends to what it delivers in 2017, fully supporting the ‘building a better health service’ agenda of the HSE with digital solutions.
1 – Telehealth adoption by patients
We have seen the adoption of telehealth in other jurisdictions begin to make a difference to how care can be delivered, colleagues in Scotland have been making a success of telehealth in outreach regions for the last five years or more. Whether it is driven by the health system, special interest vehicles or the patient themselves it doesn’t matter in Ireland. The creation and adoption of design principles relating to telehealth and the digital identification of patients and clinicians will aid adoption. Three examples of success in 2016 that can be built on spring to mind. The wonderful work of the Heartbeat Trust in the connectivity of GPs for consultations prior to and after heart surgery has begun to change the model of care on offer and all at a price that is affordable from a technology point of view. The delivery of patient portals is something that will be at the forefront of care in 2017 with the go live of a patient portal for epilepsy and the initial go live of a patient portal for the viewing of a persons own elements of a summary care record will enable Ireland to understand better the impact of this information on the delivery of care away from the more traditional care centres. The final example is an Irish company called Web Doctor, a company that has gone from status as a start-up to truly delivering a platform for primary care that is centred around the patient and is built with the patient in mind.
2 – Increased engagement with patients for telehealth solutions
Boston Children’s describes the second trend for 2017 as increased engagement, in the UK Roy Lilley wrote a blog at the turn of the year asking the NHS to ban the word engagement, suggesting that it is a word that should only be used to describe the meshing of gears or the sound you hear when a phone line is busy! Taking his principles and applying it to this trend though, in Ireland we will see the interest from patients in accessing leap forward through digital solutions. The ‘dawn’ of the wearable and quantified self has occurred already and yet only as we move to 2017 will patients really be able to start to use telehealth that they define themselves, that they are in control of themselves and that the benefit is targeted for them.
3 – Innovative visualisation devices hit the clinic
The adage that health in Ireland has a great deal of data, not so much information and struggles to gain timely insights from the what it collects has been pointed out a great many times over the last two years. At the innovation showcase in November a number of amazing new solutions that enable visualisation were demonstrated, no matter whether it was a holographic anatomy or virtual reality anxiety training this type of technology can and will be adopted where appropriate in 2017. The idea of training clinicians through the use of virtual and augmented reality has become something that the RCSI is pushing ahead with, it is an exciting prospect. The eHealth Ireland team is now in the process of implementing Microsoft Surface Hubs into a number of maternity hospitals, a piece of hardware built to enable visualisation and interaction of data in a whole different way.
4 – Clinical experience software
The piece from Boston’s Childrens describes how the interoperability of information, a move away from data messaging and a move to information integration will change the way in which the clinical experience is delivered. Certainly when Ireland considers the change in the experience now possible in Cork University Maternity Hospital, Ireland’s first digital hospital, I would have to agree. The ability to have information live with the clinical team regarding the care of the patient in front of them, the ability to collect critical information and apply it to the clinical record as it happens clearly makes a difference to the care experience. When lab test results can also be automatically added to the record and algorithms can flag issues to clinical staff that can be linked to information collected in real time then at last digital will be making a difference to the delivery of patient care.
5 – Maturing market for digital health start-ups
The IrishCentral.com site published a review of digital start-ups in Dublin in late December 2016. According to the site there are 775 Irish digital start-ups that have decided to locate in Dublin, funding in 2016 to these start-ups was in the region of 734 million euro! Out of the top ten funded companies six were digital health start-ups, those top six attracted 164.54 million euro of funding in the last year alone. The eHealth Ireland eco-system and the initiatives put in place by the team to support innovation being adopted into the health care system will, in 2017, continue to grow this market, concentrating first and foremost on the health of the nation but allowing eHealth Ireland to meet is secondary challenge, to be a catalyst for the wealth of the nation too.
6 – Expanded offerings from insurers and pharma
The difference in healthcare systems between Boston and Ireland is significant. The relationship between big pharma and public health care systems globally is not always a comfortable one and yet at the same time as the issues of drug costs need to be resolved we are now seeing the role of pharma in digital health changing. For example the work that Pfizer has done with eHealth Ireland in 2016 to create a digital solution to support the medicines reconciliation process from acute to primary care has been extremely successful, so much so that eHealth Ireland will look to implement the solution country wide in 2017. The insurance companies in Ireland have led the way in providing access to telehealth solutions, offering solutions like Web Doctor mentioned above and the ubiquitous Babylon Health solutions to customers, changing the access model for customers to one that is less demanding on the health care system itself.
7 – Personalised care through voice enabled devices
Homes are now asking Siri, Cortana and Alexa for help, search YouTube to the video of all three in a perpetual loop seeking assistance from each other for a feel for how the battle of the virtual assistance is going to take off, one of the funniest things I have seen all year. We really can imagine these services coming to health quickly, voice recognition and dictation is already a key part of any radiologists ways of working for example. When an EHR for Ireland is specified there will need to be an ability not just for the capture of text and images but also voice recordings, a giant leap into new unchartered territory that will need to be managed carefully from a security and governance point of view.
Its great to consider the trends of the future, there is a whole career out there now as a futurist for many commentators on eHealth and where it is going. The difference for eHealth Ireland in 2017 is that because of the foundations created in 2016 each of these seven trends feels that bit more achievable.
Ahead of the Dublin Tech Summit (#DTS) in mid-February where we will be considering the links between what was Sci:Fi and what can now be described as Med Tech.
The leap from Science fiction to a reality gets less and less and less. Amazon Echo, Microsoft Cortana and Apple Siri, are coming so quickly from an odd idea to an accepted part of the daily life. How long before these technologies bring a new information style to healthcare. The digital persona that the Echo and the lovely Alexa are creating for Amazon are said to be worth over $200,000 per person. In some jurisdictions amazon can now value the lifetime revenue from a cohort of customers that have signed up for their Prime service to such a degree that they can actually trade against the expected profits they will make.
Would we want similar technology to come to healthcare, many today wouldn’t but what will the time line and generation gap be before we are happy for this to be the case I wonder? As many people unwrapped the Amazon Echo for Christmas this year the reaction on social media was very mixed, from why would you want the ‘stool pigeon’ in the room to I want one! And by keeping the cost of what in reality is quite an impressive piece of kit low we can see Amazon and others begin to make huge strides in tying up this market place.
Digital personas are starting to exist in many businesses lines; imagine the Amazon digital persona of a Prime user with an Echo and its uses in the consumer arena applied to the delivery of healthcare. The data based prediction of buying patterns and the commercial power this now drives has huge potential. As Amazon step into the pharmaceutical and FCGs market places this is going to grow and grow on its impact on healthcare, the fast followers of this technology are going to be able to make a big splash in healthcare quickly.
The digital twin is a concept now used by Rolls Royce and GE in the management of aircraft engines. Imagine a healthcare system that makes a digital twin and then offers to run ‘you’ in the same way as Rolls Royce run the aircraft engine, spotting the issue before it happens. Genomic sequencing could begin to offer us that opportunity, especially if we linked the data to a service akin to the Echo, where not just the scientific sequences were information the situational analysis of health but also the context of the person, we after all have been talking about the advent of contextualised healthcare for over a decade.
Again many will object and won’t want that information to exist or be willing to take the information risk of the information being misplaced, but some, perhaps a next generation will see the benefit of this. The blur-ing of the lines between next generation digital and Sci-Fi is becoming easier and easier, what is interesting though is the impact of digital on healthcare, the disruptive impact of technology on commerce and wider business verticals has been huge and yet in healthcare its still in its infancy, a bit like Sci-Fi of the 1970s I guess!
The beauty of slow adoption though is that untried and tested technology can be avoided and lessons can be learnt from other business areas more easily. Also, the ability to gain engagement from the user base, the clinical teams wanting to use technology has become much much easier. The consumerisation of technology has reached such a peak that more often than not the new Sci-Fi like advancement has often been tested in the home before it lands in the clinic. Take Microsoft hello, no longer will a clinician need to touch the keyboard to authenticate, hugely powerful in the application of electronic health information at the point of care. Mobile computing more generally opens up the place where care can be delivered. AI allows questions to be asked of learning made more quickly than ever before.
In the last two years Ireland has enjoyed its fair share of global recognition for its involvement in the most important Sci-Fi brand ever, Star Wars and the filming of those crucial scenes in episode seven. In the last two years Ireland has also leapt forward in its application of digital to healthcare, truly looking at how to make use of the next digital disruption enthusiastically.
First published by the NDRC as part of the #HealthTech event in the summer of 2016.
Ireland is the most personally connected country in the world. Or at least I am starting to believe that from the evidence I have seen over the last 18 months. I have been told on so many occasions that what we have in Ireland is the first real example of a global village mentality and in particular for technologists. I have been involved in a number of different forums to support start-ups and big ideas for health technology in the last few months and really I do now believe in the concept of connectivity being one of Ireland’s biggest assets.
The Hollywood concept of “Six degrees of Kevin Bacon” seems to apply even more in the world of the health technology start up in Ireland. If you don’t know someone who knows someone now, you soon will do! The willingness to help, to get the idea off the ground and at least the ability to bring it into the healthcare system is there.
One of the most reinforcing moments of my 20 year career in health technology happened a couple of weekends ago at the launch of the NDRC Health Tech event. Eleven teams were formed on the Friday around some amazing ideas for how technology can improve the delivery of healthcare in Ireland. As well as the idea generators in the room there were a number of volunteers from across many different sectors there to help turn the ideas into a real proposal that can be taken forward to be considered by the health system. The level of knowledge and commitment in the room around a number of great ideas was simply huge. The possibilities for health range, from the ability to provide assistance for Parkinson sufferers to walk with confidence again to an app that allows a mental health patient to step into the centre of the care they are involved in, to a new way of processing lab results nearer the patient and they are just three of eleven amazing ideas. However the magic is as much to do with the people in the room as it is to do with the ideas. Seventy people in a ‘competition’ and yet every one of them rooting for each other, connected in a new way to deliver a support network for new technology based ideas to change the way in which health is delivered. Teams of people working hard to support each other over that first weekend regardless of background, basis of knowledge or years of experience, all these amazing people are now connected to each other in a new way.
Slowly but surely a revolution is happening! The social media response to the RTE programme ‘Keeping Ireland Alive’ has started to open up the concept that the Irish healthcare system is not the issue with the delivery of care to the people of Ireland. The Irish healthcare system is full of heroes and connections to be made to transform the way in which care can be delivered. Truly the system is one going through a digital revolution a change that is having an impact on so much of the way in which care is delivered. The second of the Keeping Ireland Alive programmes had a telling digital moment as a senior clinician opened the paper records of the patient in front of him and exclaimed, as usual I can’t read the notes. Realisation that Ireland is running its healthcare system in the same paper based way that it has for the last 30 years is giving a strong impetus to the digital health agenda within the Future of Health objectives, no bad thing for the great technology organisations of Ireland.
With the type of innovations and connections made by the start-ups at the NDRC Health Tech event the problem the clinician faces can be fixed, removing yet another issue from the delivery of healthcare in Ireland is the desire of so many committed people. The NDRC is just one of many environments now supporting Irish companies movement in the health technology arena; the Health Innovation Hub, Portershed in Galway, ARCH, Insight, Health XL and the HSE’s very own eHealth Connects programme are now all there to support organisations in finding the connection and turning the bright idea into reality.
All this human networked connectivity can really bring about a change to healthcare delivery if we can harness it in the right way. The rallying call for Ireland from here though is simply get involved and help build a better healthcare system.
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.
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.
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.
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.
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.
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!