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.
It was 2:45am when I was woken to go on deck for the hardest watch of the day: 3am-6am. That brief moment between waking and dressing was important to know what gear to wear. Quiet, easy motion indicated warm clothes and wooly hat. The violent lurches of the boat and a loud rush of water overhead meant I’d be clambering into all the protective gear I could find: drysuit, harness, lifejacket and sea boots.
This was near the Grand Banks, an area of shallow water off Newfoundland that were rich fishing grounds but dangerous in a storm. It was during the last part of a transatlantic sailing race in September 2000. We had crossed the chilly Labrador current and were closing in on Boston having started in Southampton a couple of weeks earlier.
When had been tracking the weather forecasts showing a storm would pass as we planned to cross the Grand Banks. We evaluated the options and decided sailing South to remain in deeper waters was safest. We prepared the boat and ourselves for a difficult 24 hours and raced on. We were all tense, but we were ready.
These days the challenges I face are in the world of health IT. As I work in the Acute Delivery function of the Office of the CIO, I spend my time with managers and leaders in health figuring out how to travel the journey to more effective, efficient and safe services. These decisions are rarely straightforward, involve incomplete information, unforeseen consequences and significant uncertainties; much like the challenges I faced with my crew-mates crossing the Atlantic.
The Project Management Institute publication “Navigating Complexity” describes what constitutes a complex project:
These characteristics are present in many of the projects I’m involved in, day-in, day-out. Introducing technology to support patients and health professionals is usually broadly welcomed. But when the simplicity of pen and paper is replaced by the complications of structured data capture and formal workflows there are many challenges to overcome. Dr. Tony Shannon, a health informatics leader with Ripple, has shared many insights from complexity theory and how they help understand health systems.
As I work with hospitals and hospital groups to plan their IT investments into the future, there are many additional characteristics of complexity in play. Decision-making with imperfect information, ambiguity, and developments in the policy environment is decision-making under pressure. Nonetheless, decisions must be made.
The process we follow uses these approaches:
Nationally, a lot of effort has gone into developing a clear, coherent and costed view of an Irish Health system enabled by the Electronic Health Record. Part of being clear about where a hospital group intends to use IT, is to be clear how the EHR will enable their part of the health system.
Equally important is knowing the current infrastructure, systems and capacity of the hospital group. It’s more than just technology. It’s about understanding how the people involved in health IT can further contribute to health transformation.
The third part of the approach is to chart a course towards the desired future, identifying intermediate waypoints and milestones along the way. This involves making difficult choices about how to apply precious resources and skills to start and complete projects that will bring the organisation towards the vision. Small gains build to big wins for our health professionals, for our service users and for our communities.
The PMI guidance is valuable and describes the competencies required to manage complexity.
There is no one formula that assures success. Choices have to be made with incomplete information, with an uncertain landscape and unknown risks. Establishing the way forward requires collaboration between health IT experts, clinician leaders and service management.
When we skirted the Grand Banks in September 2000 we were making the best decisions possible with imperfect information. There was a storm we couldn’t avoid, but we planned ahead and we were ready for it; we battened down the hatches, we ate early, we shortened sail, we kept each other safe and we adapted to the conditions that came. With a mixture of exhaustion and relief we emerged out of that storm unscathed.
Thankfully there are few days in the office as dramatic as a storm on the Grand Banks. But the challenges we deal with on ordinary days are just as important. They require skill, perseverance, and good judgement. Patience, teamwork and communication are essential. And always with an eye on the forecast and horizon…
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 CIO Magazine in August 2016. A collaboration with Elaine Naughton in the writing and development of this idea, a huge thanks to Elaine for this.
In the excellent Steve Jobs biography by Walter Isaacson, he describes a discussion between Jobs and Steve Wozniak where Jobs is explaining to Woz that the role he plays in Apple is that of an orchestra’s conductor, here to get the best out of the team, to ensure that they play in harmony and deliver to the listener the most inventive and yet classically rich vision of the original design. This conversation is said to have taken place after a strong ‘debate’ just before the launch of the iMac itself, Woz described by Isaacson had just exclaimed to Jobs that he was neither designer nor engineer and therefore did not really warrant or justify the recognition he was getting as the ‘re-saviour’ of Apple.
Is the creativity of the conductor the real line to success in IT leadership? After all the ‘band plays on’, or at least tries to, whether there is a conductor or not. Even as early as 1998 Jobs was describing, I think, what the modern CIO now needs to be, although maybe we now need an evolved model from conductor to DJ or rock and roll front man.
Why does the analogy and the model need to evolve? Well, in times gone by, the IT leader would have sought out the best in class people he needed. Much like creating an orchestra of around 30 talented artists, the Leader had to be the best that the orchestra could afford and then the conductor had to make them fit into the team, not always an easy job. The ‘prima donna’ persona of the highest calibre technologists is not always easy to integrate into a high-performing team after all. This then, perhaps, is where the evolved model comes in.
The leader of a rock band enables the band to “jam” develops a structure and order to remain in time, and chooses a rift as well as creating a tune as they play. Maybe this roll can be best described as the start-up innovator of the music scene. A band always needs a front man – someone with a vision for the sound they want to achieve and the charisma and charm to wow an audience, the band may play on if the front man leaves, but rarely as successfully; what would U2 be without Bono? or the Rolling Stones without Jagger? Queen without Freddie? Perhaps the best real world example of the rock star digital leader is Larry Ellison of Oracle, truly a front man if ever there was one to be seen in digital leadership. The owner, founder, creator and beating heart of the Oracle empire, whilst no longer leader in name still very much the charismatic front man of the brand and indeed, band!
An orchestra, on the other hand, follows a very strict plan and each of the upwards of 30 members (over 50 for a symphonic orchestra) knows exactly what they need to play and when, whether it is solo or synchronised with their team (by virtue of the score). Only the conductor knows the full score and reads all lines simultaneously, knowing who to call on and who to bring in exactly when they are needed for the orchestra to continue playing in harmony and in time, and for soloists to have their moment to shine. A digital leader in the style of the conductor does just this. The danger here though, is if only they know the full picture, keeping everyone focussed takes a huge amount of energy and enthusiasm. Many public sector digital leaders are of this style (often by necessity) as the full picture is in reality always being altered and reconfigured a small amount by the political leaders and paymasters.
The conductor’s role is an art form and a talent, while being a very technical job. Take the conductor from this and time signatures slip, the musicians become discordant and eventually chaos ensues. Just as with Jobs and his temporary departure from Apple, as conductor of that orchestra he was never truly replaced and therefore for a time the music was not what the audience needed to hear. The creativity, in the sense of innovation of the music, belongs to the composer rather than the orchestra or conductor; with this in mind maybe we need to see the digital leader as composer and conductor more often!
A DJ, unlike the conductor or rock band front man, can take the best work of a much wider variety of stars, mould them together until they find the right mix and then play it for the audience. The DJ doesn’t have to integrate the full character of the artist just that moment of excellence where the beat fits or as the very wonderful NetFlix original puts it, ‘When the Get Down arrives’! A modern successful digital leader then is going to be a DJ! If we consider the ‘gig economy’ to be the future in digital then this kind of character and behaviour is likely to become even more prevalent when building successful teams. The magpie-type ability to bring all the best bits together for one moment of excellence that then can be repeated.
We believe the skills of a DJ are also key traits of a transformational leader: someone who motivates and energises their employees to get behind a transformation strategy, creates something that has been written about many times before, the creation of a fan base if you will!
The styles of these three analogies allow us to consider the nature of digital leadership. There is a mix of two key styles here, one is transactional the other transformational. The conductor is transactional, planning, organising and controlling. The DJ is transformational challenging and changing organisational culture, coaching and developing people, creating a climate of trust, establishing a long-term vision. The front man perhaps mixes both styles dependent on the need of the audience or band members, an ambidextrous style that is agile and responsive as startups require to be.
The analogy can continue in a number of ways beyond just the parts of the mix. A DJ brings with them the theme and the end point they are trying to get to, much like a high performing digital leader needs to, they start with the end in mind. Also, the DJ needs to be aware of the change in trends, evaluate them and consider how to adopt them into their fabric, so much learning of how this is done from both professions; I would love a temporary job swap!
The Jobs autobiography also describes the moment that Woz and Jobs first met from Woz’s point of view, “We first met in 1971 during my college years, while he was in high school. A friend said, ‘you should meet Steve Jobs, because he likes electronics and he also plays pranks,’ so he introduced us”
Jobs and Woz learnt they had so much in common, and yet were so different. The wonderful “Small Data” book by Martin Lindstrom references a Harvard Business Review article by de Swaan Arons, van den Driest and Weed called “The Ultimate Marketing Machine”. The article suggested that there are three types of people needed to make a marketing company successful, they are:
Think people – Who focus on data and analytics
Do people – Who have responsibility for content, design and production development
Feel people – Who are all about consumer engagement and interaction
I wonder if the modern digital organisation can apply this exact same logic as has been done here for the marketing team. The types of people the IT leader needs to bring together are defined less by their technology specialty and more by the person type they act when they are in a delivery focused team. Back to Jobs and the Apple empire, the success of the original swathe of ‘i’ products has always been put down to two elements, one, Jobs own meticulous eye for detail and two, the design standards of the team under Sir Jonathan Ive. If we overlay the commentary from the article in the Harvard Business Review referenced above and the conclusions that Lindstrom himself makes on this article we start to see that the way this team has been successful is by ‘minding the small things’ by being a team that is led by a digital orchestrator but exists as a team that can deliver empathy together, to the benefit that is trying to be attained.
A modern, successful leader needs to be a strategist, a “front-man (or woman)” AND be able to conduct a complex set of teams in a harmonious way – or at least empower capable section leaders (upper strings, lower strings, woodwind, brass, percussion) to do so on his or her behalf.
The theories of Lindstrom in Small Data will blow your mind, you regularly turn a page and laugh at the conclusion he has made and how it applies so completely not just to modern marketing ways of working but to how the right digital function needs to deliver. Whether as leaders we are badged as CIOs, CDOs, Conductors or DJs we don’t care, we just want to be able to make IT work.
…… as a post script we really do care! Two IT leaders were involved in the creation of this article, one of us wishes they had taken the path of enlightenment and become the superstar DJ of their dreams the other is progressing from playing second fiddle in a growing orchestra to becoming a conductor and leader of a great band.
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!
First published in HIMSS engagement and integrated care…
At the 2016 EU eHealth week in Amsterdam a number of commentators made an example of the clinical and patient engagement coming out of Ireland around the digital health landscape. This from a country that until recently had made little impact on the health IT area due to past systemic underinvestment and a lack of agreed direction.
In the last 18 months Ireland has rapidly began a programme that it describes as its Knowledge and Information plan. The programme sees Ireland learning from the success and errors of other jurisdictions with an expressed desire to ‘leap frog’ other countries and put information at the heart of its healthcare reform agenda.
Richard Corbridge is the Chief Information Officer of the health service in Ireland and the Chief Executive of the entity the Irish government has formed to achieve its digital ambition, eHealth Ireland. One of the first appointments made after its formation was to put in place a Chief Clinical Information Officer, this role was awarded to Yvonne Goff a radiographer by clinical background and now Ireland’s technology professional of the year. We asked both of them to comment on the recent success Ireland has had
Yvonne Goff wanted to comment first on clinical engagement,
‘It has been over twelve months since the Council of Clinical Information Officers was established with the aim of bringing together clinicians and practitioners to guide the successful delivery of eHealth solutions across the Irish healthcare system. The council is composed of clinical leaders from diverse backgrounds including, leaders, academics and suppliers, the CCIO has expanded to a network of over 200 members across many regions and disciplines.’
Richard Corbridge added,
‘The number of engaged clinicians in Ireland has been a key to the success of several projects in 2015/16 and continues to be the bedrock that we build engagement upon. It has been commented on that over 200 CCIOs is a large number and we have been asked how can they be so engaged? The reason why is the absolute desire to make the eHealth agenda work and deliver for patients and clinicians. The CCIO in Ireland has been formed to provide not just an advisory group but a clinical leadership workforce.’
The CCIO in Ireland is able to highlight the importance of collaborating with clinicians to ensure projects can be designed, developed, and delivered successfully.
In order to build an understanding of the benefits and implementation capability needed for an Electronic Health Record; eHealth Ireland is investing resources into three clinical project areas – epilepsy, hemophilia, and bipolar disorder. These projects are known collectively as the Lighthouse Projects, each are clinically lead and the CCIO collaborates with a number of other academic and charity organisations in order to advance and deliver these important projects, all in one year.
As well as building the clinical engagement Ireland has had to rebuild its technology function, up until early 2015 it was a function that was able to deliver local excellence but had not been able to work as a single national system. Under the new function of eHealth Ireland and the Office of the CIO the function has evolved to become a truly national set of functions. The CIO has achieved this through a continuous engagement process, adopting digital solutions to engage the staff who are located throughout Ireland. The team has used a wide range of tools to continue to evolve this engagement. Richard Corbridge described these different tools and initiatives,
‘The first thing we had to do in this space was to bring staff together for a face to face, something that in nine years that had not happened, we agreed to facilitate this happening twice a year and so far these have gone extraordinarily well with teams having the opportunity to present their projects and a series of guest speakers ranging from a futurologist through to an academic on the theory of communications. This has galvanized engagement from within, inspiring staff to take control and further drive engagement. New projects have been started by staff such as #eHealthmoments an enterprise facilitating staff to connect on a deeper level using digital technologies and Quality Innovation Corridor (QIC) Programme an initiative to open up innovation pathways through which clinicians, in collaboration with eHealth Ireland expertise, can seek seed-funding for creative digital solutions and assistance in deploying these.
However he does then go on to describe how different solutions have also been required to keep building on the engagement and enthusiasm,
‘We have recorded video interviews, and podcasts some of which have been broadcast live featuring all of the senior management team. We have used animations and story boards extensively to build a level of knowledge of each project and have used these to facilitate a wider understanding for all citizens of what it means to create a digital fabric in health that is needed to achieve a truly integrated healthcare system. One of the health system in Ireland’s core vision statements is to be transparent, social media engagement has enabled an explosion in this area. Project leaders and team members have embraced this vision and really built networks of people willing and ready to engage. It was a real shock to the system to see leadership openly engage through the use of social media; however it has now become a normal solution for communicating, which has truly been inspirational for the health system.
The continued evolution of communications with the CCIO group has been equally important to Yvonne Goff who explained why,
‘To me it is hugely important that the CCIO group continues to grow, expand and diversify to ensure that they are best placed to deliver for Ireland. The building of relationships with other CCIOs, advising appropriate direction for best practices around procurement and adoption of eHealth solutions is our reason for being.’
She went on to say how this engagement has been achieved, ‘the CCIO recognises that one of the most effective ways to engage and collaborate is through social media and digital networking. The twitter handle @CCIO_IRL is used regularly to communicate with clinicians, health informaticians, and other interested stakeholders. The CCIO also regularly take part in discussion and discourse on social media and in the CCIO discussion forum. The CCIO successfully hosted #irishmed Twitter hour resulting in its second busiest hour generating nearly five million impressions. The CCIO come together once a quarter as a group and are embracing digital solutions to ensure that the most can be gained from each meeting.’
Yvonne Goff then summarised with the rallying call, ‘the CCIO is making a positive and lasting difference to Irish Healthcare. And through discourse, collaboration and important projects it is committed to working together in order to implement clinically lead solutions that improve the quality of healthcare and the well-being of Irish citizens.’
The two leaders of the Irish healthcare IT revolution clearly have engagement as a priority, Richard Corbridge went on to round off by saying, ‘we need to take the whole system on a journey, we have managed to create a great environment for clinicians to become part of the team, we need to do the same for citizens and patients, the eHealth Ireland committee recently tasked us with recruiting a patient to the key governance function of Ireland which will be a great starting point for person centered care to truly come to fruition.’
He finished by saying, ‘a friend recently used the phrase ‘legitimate theft’ when describing the sharing of best practice, Ireland has done this to create what it has put in place, the offer is there for any jurisdiction to come forward and reuse what has been developed here, shared learning is a great way to ensure we all have the best engaged staff we possibly can have.’
To contact eHealth Ireland about this, why not do so via social media, @eHealthIreland is their twitter handle and they will definitely come back to anyone wanting to know more.
The eHealth Ireland Eco-System was a year old last week, a great achievement for the team to go from the germ of an idea to the formation of a self-supporting Eco-System that has seen the meeting of many ideas and organisations that have been able to be another hand on the tiller, steering the eHealth Ireland agenda.
As part of the birthday celebration meeting we have invited a different keynote speaker from a background outside of health, Niall Harbison, founder of Lovin’ Dublin, inspired the audience with his vision for an integrated Health system. Niall opened his presentation with a slide stating “The world is changing so fast” he brought the audience through a whistle stop tour of what it means to be in Social and Digital Media today in 2016 with a great emphasis on being mobile first.
Niall told us that over 90% of traffic is now via mobile. He spoke strongly on the importance of engaging with our stakeholders through different social media platforms such and commended us on our use of Twitter Hours and our transparency agenda for developing relationships.
Niall spoke about how we all need to be content masters. It’s up to all of us to inform our stakeholders in a way that interests them about what we are doing. It was refreshing to hear Niall speak about what he believed would be the future of health. He spoke about what it was like to not be clinically informed but that he would like to be able to see a future with telemedicine, where he can see a doctor when it suited him, where it suited him and be able to get his prescription sent to him electronically. Niall spoke about how he had great respect for all involved in health and their movement to digital.
He spoke about Apple and how even they, being a multi billion dollar innovation dynasty, have difficulties in mastering this market. The fact that we are trying to digitize something so large and disparate is a challenge and how its often much easier to start with nothing, he likened it to “herding cats”.
This is why he believed that the health innovations would actually emerge from countries where there is nothing currently there. Where they can adopt technologies and build new solutionsquicker. He also pointed to the fact that we can’t believe our stakeholders don’t want or expect this service or will not be able to use it and spoke of the quick adoption by taxi drivers of technologies such as UBER and Hailo and how people would have presumed that taxi drivers would never have adopted that technology
Niall spoke about where health was and asked us to consider what it would be like to pitch Health delivery as it is today in Ireland to Warren Buffet as a business idea, what investment did we think we would secure. If we can’t secure the idea of delivering health as it is done today then just maybe the answer could be a digital revolution was the noise left ringing in many peoples ears.
Niall finished on reiterating his first slide “The world is changing so fast. When will it happen to health?” and an inspirational quote from Michael Jordan;
“I’ve missed more than 9000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed”
When experts from a wider digital field listen and speak to health audiences it always brings a refreshing and different challenge to what we think and do. Imagine being able to reform health at the speed of an organisation like Lovin’ Dublin has been able to form and become a house hold name. All through my own career I have pushed hard to ensure that we can learn as much as possible from other business arenas in health, after all the facts and figures from various studies point to health globally being way behind other businesses so there is clearly going to be something new to learn.
The eHealth Ireland agenda is not unique, but, it is now moving at a rate that requires a different type of support to see it succeed, one straight out of the innovation and new thinking kit back. In the words of Bob Wachter at a recent Kings Fund event,
The purpose of digitisation is not to digitise, but to improve quality, safety, efficiency and the patient experience of healthcare.
With that ringing in our ears we are ready for the next year!