All posts tagged Connected Health

Twelve month school report…

Do you remember that school report moment, that evaluation and review of the academic year, the fear of what your teachers would say, or not say when your parents went to meet them? A year of hard work distilled to a 45 minute meeting with a bunch of teachers who, in some cases, were probably trying to provide feedback to maybe as many as 100 kids who had various degrees of motivation and ambition. It must have been a hard task for them and it was often a nerve wrecking experience for the pupil!

Key phrases from my school reports: ‘creative writing doesn’t always mean making it up as you go along!’; ‘Please follow the rules of emergency air supply on an aeroplane, secure your own work before turning to help others’; ‘Less communicating and more concentrating will bring more academic rewards, but will make the class a dull class’; ‘Richard’s passion for campanology outweighs any I have ever seen in any teenager’. The last one holds a dear memory for me as a retort from my Dad, who exclaimed he knew I liked camping but thought I wasn’t the only one in school in scouts!

So, a year into the role in sunny Leeds, a year in to concentrating in a new way on what a digital fabric can do for health and care across Leeds and I thought it would be good to try to put together my own school report. A progressive ‘school’ like Leeds would allow the pupils to put together their own review as long as it could be challenged in a fair and productive manner by teachers and peers, so here goes.

First subject to be graded has to be Delivery. I think the #LeedsDigitalWay deserves a B- for delivery in the last 12 months.

Delivery Grade – B-

The first 100 days saw a sea change in the way the team worked. The objectives of what we wanted to do were made clear and the team began to evolve. The ‘simple’ action of getting board approval to invest in the PPM+ solution as the Electronic Health Record (EHR) for Leeds until at least 2022 has seen a new concentration on the process for delivery. Leeds has delivered against an agile methodology for over five years but now delivers on a monthly release schedule; new functionality defined by the clinical team lands into live each month. A new focus on the release function and now the way that test, development and integration work together has brought about some immediately noticeable changes, largely the enthusiasm and engagement that the clinical team has for the solution has improved significantly.

Deliverables such as the A&E dashboard, flu reporting, tasks and jobs inside the EHR, the implementation of Forward, the delivery of the eRespect form, Nursing eObervations, single sign-on for all and even simple changes like the opening of the internet to ‘real’ use has seen a continuation of the acceptance that digital is a hugely important part of what a hospital needs in place every single day.

Scan for Safety and the mobile EHR solution are fast becoming a way of life in Leeds. Not new gizmos but a way to enable the understanding of patient flow and a way of capturing information without fingers being needed on a keyboard. Scan for Safety also is an illustration of LTHT-wide partnership working and what can be achieved when a delivery is led not by IT but by clinicians and key impacted departments.

The delivery of new infrastructure for PACS, Digital Pathology and the new Genomics service all considered to be that unfortunate term, ‘back office’ deliverables, but all crucial to the acceptable running of the digital fabric of the trust are well underway with a limited resource to make them happen.

A slow but steady reform of the way service management is delivered has started to take shape as has a new way of thinking for Information and Intelligence (I&I). The organisational change elements are now in place to enable a function within the I&I capability to focus ‘just’ on data within PPM+, something LTHT has been trying to make happen for some time.

Why the dropped marks in this area? Expectations have been set really very high and whilst the resource to deliver has been changed in its structure it hasn’t changed in its capacity in any dramatic manner. A phrase I think should be avoided has been used too often: ‘do more for less’. Outages have occurred on three occasions, all managed well with no patient impact but in all three cases these outages could have been avoided. On the positive side, key lessons have been learnt and business continuity lessons and disaster recovery plans are now well honed.

When in Ireland I was once challenged by a senior member of the team to spend a few months in the garden shed away from the team and the email. The meaning behind the comment was I was pushing at a speed that the team needed a rest from. I think I drop marks for not learning that lesson as well as I could have. We are going at a pace in LTHT that will tire the team out if I am not super careful in 2019 and therefore I do need to look around and be sure that the delivery ambition we have is met by the resource we can apply.

Culture Grade – B

Building the team I want to work in is always important to me in any leadership role that I have had. Putting in place weekly updates (Can you give me two minutes) and hitting these for 52 weeks in a row has been an important way to show the width of the team how we can act as one. The creation of the #LeedsDigitalWay and the associated goals, vision statement and key strategic plans have not been created in isolation by the senior management team but, following the ethos of the Leeds Way, these have been done through crowd sourcing and via the wonderful ‘Very Clear Ideas’ process.

I feel the team is engaged, not entirely, but better than many would be in the ideals of what we are here to deliver. That is largely because the LTHT culture, the Leeds Way, gives me a jump off point that I can simply add to, but this has to be seen as a great benefit.

The whole team has had the opportunity to come together four times in 2017/18 as a digital team of leaders in the digital health environment. The meeting is not mandated (nor will it ever be) and has seen a steady increase in numbers for each gathering. One of the best moments of the year was the morning after the third All Staff Meeting being stopped by another early riser member of staff to be told they had put the next meeting in the diary already and would be telling all their colleagues how important the meeting was for working in the team – superb, immediate and honest feedback.

It is often joked that only those ‘great places to work’ organisations get IT and Communications right all the time. We have tried to get the level of communications right but in a recent staff survey the team wished for more, so now we move to consider all the different styles of communications we have and how they impact upon the culture.

To me the Leeds Way is our culture and our values with a digital ‘sheen’ applied to it. We have come some way in 12 months but I can see the gaps that we need to improve on.

The reason for some of the ‘dropped marks’? We are going through organisational change and are desperately trying to get that right at every juncture, but we haven’t always been as successfully as I would like us to be. As soon as we create an open culture which we have done then we have to have the capacity to listen and act on opinions that are made clear to us, we are trying to get that right but we are not quite there yet, could do better may be the school report language best used here.

I think we have been able to pick up extra marks though for team development opportunities. In 2018, we were able to be part of content delivered by HIMSS, KLAS, HSJ, CHIME, Digital Health and BCS. We have opened opportunities for staff to apply for the Digital Academy, a hugely important leap for us, and had 10 interns join the team, many of whom have stayed on in some way. Exciting learning prospects for all of us continue to be available across the team and will remain a high priority for us in 2019.

Engagement Grade – B+

The awareness of the LTHT digital journey at a national and international level has doubled in the last 12 months. We have been successful in ensuring that when somebody wants to understand how to deliver an EHR in the NHS then Leeds is one of the top five places they think of. Being able to take part in the Arch Collaborative and achieve the Net Experience score that we did showed the engagement the large proportion of our clinical staff feel for the systems we have deployed.

Leeds’ success has been represented on three continents this year and is synonymous with clinical engagement, an open attitude to delivery, an inclusive ability to resourcing and a willingness to share. If I were to write my own obituary these would be words I would want to see and therefor I think the B+ is justified.

We have been able to bring leaders from across the health and social care system to Leeds to show them how the front line of digital health is really working and I would like to think that has impacted on policy in some small way.

The reason for the dropped marks is, despite the geographic location working for us (Leeds is after all the home of over 20% of the health informatics staff of the NHS), we have yet to truly make the most of Leeds the place. With so many organisations in Leeds that focus on digital health, our own position in that eco-system still needs to be eked out.

Innovation & Technology Grade – C-

Next year I have to focus more on this. We have so many ideas and so many amazing offers of help to make those ideas come to life but time and resource has run away with us too many times. We have been able to get the infrastructure for Single Sign On in place and the migration has largely gone well. Piloting the linking of devices to this infrastructure, not just the software side, is a remarkable feat I think.

I would have loved us to have our first implementation of cloud in place in 2018 but we are still a little way away from that. We have well formed plans for AI access to some specific solutions which I believe will be transformational, but again they will be early next year.

The speed of the systems we have and the reliability of the solutions they are hosted on has improved ten-fold, but user expectation outstrips our current capability to keep up. The work done to make the regional integration capability ‘bomb proof’ is outstanding but took us longer than we thought.

We know how we want to innovate and even who with, but in some cases we have come unstuck as we try to find ways to create relationships. For us, the way we have worked with Forward in 2018 has been a real test of how an NHS organisation can create a true partnership with a new innovative company and really build benefit. Being able to ‘gift’ the content of the Axe the Fax toolkit to Silver Buck for them to industrialise and make available to the wider NHS is another great example of an innovative approach with a new partner.

If ever there was a category with the immortal school report words, ‘must try harder’, it would be this area. I need to consider how to deploy more resource here to give us more chance at being truly ground breaking in this arena in 2019.

Collaboration Grade – C+

Achieving the Local Health and Care record Exemplar (LHCRE) status was clearly done only by collaboration across Yorkshire and Humber and was a big moment in 2018 for all of the team. Collaboration across the city area on the Leeds Care Record remains a highlight of the job and being able to represent Leeds as the platform with my fellow Proclaimer is something that enthuses me every time we get the opportunity to do it.

The dropped marks though here are because I know we have not played the part we should play in the West Yorkshire collaborative to the same degree. Something that next year I will prioritise is ensuring that the blueprinting work we do can be shared first and as a priority with colleagues across West Yorkshire. I know that we have the basis for a great relationship and one that will enable a better platform for patient care if we can find the right projects to collaborate on.

Summary Comments

In the school report it was those summary words that always cut to the chase the most, the form teacher comment on the future challenges for the student and the head of year views on focus for the coming year.

I think if these words were being written about me after this year they would go something like this:

A successful start to the new school. Needs to keep a closer eye on the detail and avoid getting distracted by some of the wider picture, even though it is important to still see this and bring it back to the ‘school’ – we need to have all of our own foundations in place before truly looking to help so many others on the journey. The class (the Digital and Informatics Team) needs the focus to be slightly more on them than it has been on some occasions in the year. The key challenge for the next year is to keep moving at the current pace but with the whole class on the same journey. This will be difficult to achieve with the expectations that have been set but is entirely doable with the skills available.

 

… and if that was the summary I would sleep well at night.

Arch Collaborative

First published as a KLAS blog after Leeds teaching Hospitals NHS Trust received the analysis of the Arch Collaborative. If anyone wants access to the full Arch Collaborative results from Leeds then feel free to get in touch, happy to share.

The Arch Collaborative exists to ensure that we understand what the users of our systems really think of them!

The technology industry is one of only two industries[1] that describe their customers as users. Launching the Arch Collaborative locally ensures that each healthcare system that takes part can move further and further away from that ill-gotten term, user to a new paradigm where we have valued customers with opinions that matter, perceptions we should act upon, and innovations that we would be foolish not to consider.

The first time that my organisation, NHS Leeds Teaching Hospitals Trust (LTHT), considered the Arch Collaborative was in early 2018. We regularly share ideas and concepts with two NHS Trusts: The University Hospital Southampton and the Salford Royal Foundation. Those Trusts had taken part in the survey and were clear that it was a great way to really understand the clinical views of the Electronic Health Record (EHR) and the way it is implemented.

My organisation has risen to the EHR challenge in a different way than many. 15 years ago, our organisation decided to begin building its own EHR. We released new functionality in subsequent years until it became clear in 2017 that the organization had evolved the solution to the point where it was a clinically developed EHR.

Taking on the Arch Collaborative survey felt like the next step in understanding the direction we should head. It could be the basis for a strategic road map.

Standing up on such a public stage was a big decision for an organisation that has invested so personally in the creation of an EHR. For us, this wouldn’t be a comment on the vendor implementation or the partner development of the training materials; this would be a comment on what we had built, what we had prioritised and what we had invested our time in.

There were no gimmicks, backing tracks, or staged production; the Arch Collaborative just asked for an evaluation of our raw digital ability.

By the time we agreed to get involved in the Arch Collaborative, there had been a number of departmental changes in our organisation. We brought together individual teams and elements in the hope that we could form a super group.

We were so nervous about what would happen next that a colleague compared this process to an audition for the a cappella singing team at university, but we were resolute to know how our voice fit into the digital health mix.

The Arch Collaborative involves getting the broadest clinical input possible to a series of questions about the functionality and implementation of the EHR solution within the organisation. The survey is quite in-depth and requires time and energy to work through. We asked one of our Chief Clinical Information Officers (CCIO) to take on the project. The CCIO worked with our digital engagement team to ensure that the survey terminology was anglicized and then to widely promote the survey. In the first week, over 400 members of the hospital team had completed the survey; by the time we closed the survey, over 980 members of the workforce[2] had completed it.

We were so proud that so many clinicians had come to our gig. We were not playing to an empty stadium—they had come to join in and sing about the EHR they used every day.

Our organisation uses the EHR for point-of-care delivery; over 19,000 unique users accessed the system in September of 2018. In the same month, there were over 74 million interactions with the system. An average nurse is now collecting over 100,000 data items a year!

When we consider the size of the audience that the Arch Collaborative response will reach, the throughput of the system feels huge. That comparison to the a cappella sing-off is more like the national sing-offs at the Kennedy Centre in the film Pitch Perfect.

When organisations and senior staff members look at the success of EHR implementations in the NHS, it is easy to focus on the traditional project management triumvirate of cost, time, and quality. That is understandable—these are important aspects of a large-scale procurement project.

But a lesson hard learned and seemingly relearned many times over in digital healthcare is that an EHR project is not just a procurement project. The Arch Collaborative was the perfect way for us to test the pitch and tone of our EHR.

We believe we have an approach worthy of blueprinting for reuse but not a specific system, although that is possible. We are more keen to consider the approach we have taken—an approach that includes the following: open standards; the concept of the geography as a platform for care rather than separate healthcare systems trying to interact and integrate; and the clinical focus we have placed in the prioritization of developments.

Each of these methods has been a major part of how we developed the #LeedsDigitalWay, and we believe it is worthy of blueprinting and digital implementation in healthcare across the world.

Ultimately the Arch Collaborative at LTHT would be a comment on the concept of the #LeedsDigitalWay as much as it would be about the actual EHR.

In discussions with KLAS about the decision to take part in the Arch Collaborative, they stressed that our taking part showed humility, a strong word that meant a great deal to us. Around the same time, a tweet from Damian Hughes (@LiquidThinker) resonated particularly with our reaction to the Arch Collaborative results:

Ego is often a roadblock to your development. Humility is a key to a new pathway.

Taking the ego out of delivery means that we can adapt and learn more quickly and ensure that the silos that so easily spring up between clinicians and digital leaders can be avoided.

The results from the Arch Collaborative are not for the faint of heart. They deliver a complex, true, and statistically sound message that will shine a very powerful light on the weaknesses of the work that you have done and specifically highlight the areas that you can change to improve your “Net EMR Experience score” with minimal effort. Unlike a HIMSS score, the Arch Collaborative is based not on what is in the “box” but how the box is used and the success of its functionality.

The headline score for Leeds Teaching Hospitals Trust was a 41% Net EMR Experience score. This is the macro score that sits front and centre on the report. The score ranges from -100% to +100% and is built up from the entire survey. We were pleased with our score.

60% of our staff members described themselves as “pleased with the experience” that the EHR offers, while 19% are frustrated daily. The detail of the Arch Collaborative report allows you to investigate how to improve each evaluated area as well as the headline figures.

By offering just four hours of training every year to every staff member that uses the EHR (that’s over 19,000 people, remember), we could improve our Net EMR Experience score by a further 10%.

That final statistic makes a digital leader in the NHS pause for thought; the cost-to-impact revenue on that 10% Net EMR Experience change is not insignificant, and the debate about where the cost sits would be a long one to resolve. Is it the digital team’s job to continue to deliver business changes? If the digital solution has been embedded in everyday life, should it be a cost of ownership?

35% of our team members that use the EHR daily would describe themselves as proficient in the use of the solution. That seemed immediately positive. However, 8% of our staff members indicated that they struggle every day.

The Arch Collaborative shines a light on what you need to do and the evolution that you need to inspire. Being on the receiving end of a complex statistical readout of your digital agenda enables you as a digital leader to take a breath, look around you, and consider how you move to the next stage.

Computer Weekly refers to the CIO role and its responsibility for the transformation of a system for driving business outcomes. It suggests that the CIO role is the “third leg of the stool” of modern “business” evolution, the other legs being marketing and sales. In healthcare, we are also in a modern evolution, made clear in the following quadruple aims:

  • Purpose
  • Productivity
  • Efficiency
  • Better health and better care

The Arch Collaborative provides an opportunity to focus on the aims of the quadruple claims, but it doesn’t provide the means.

The Collaborative is grounded in the quadruple aims by accident rather than by design, but it does expose how necessary EHR capabilities needs to be implemented with the aims in mind. The Collaborative does not pass judgement on the EHR, though—it offers the statistical vision of how to improve.

If we consider the Virginia Mason Institute improvement method that was based on the Toyota Production System management methodology, we can understand how to innovate and improve using the Arch Collaborative as a baseline measure and the evolutionary plans as the rapid-improvement plans.

To ensure that what we deliver is received better, we need to find a way to offer 19,000 extremely busy people a way to not do what they do for four hours of the year! (I picked those words carefully.)

We can offer the opportunity to do the training and learning relatively easily. It is a great deal more challenging to find four spare hours for each professional who needs to use the EHR to devote to the digital agenda. It feels like a budget issue at first; who is going to pay for this? However, it soon becomes clear that it is an organisational culture issue.

The statistics from the Arch Collaborative allow you to dive into perceptions from different parts of the clinical team. The definitions need a little work to map with NHS language, but they work well at a rough-order view. For LTHT, the Collaborative highlighted a difference that we already knew, but the existence of the analysis reinforces where to focus. Clinical roles placed the LTHT EHR in different percentiles of approval, and they map as follows:

  • All clinicians – 72nd percentile
  • Physicians – 41st percentile
  • Nurses – 63rd percentile
  • Allied Health Professionals – 59th percentile

The results also include sophisticated symptom analysis to distil some key phrases for us to work with:

  • Enhance initial EHR training and follow-up education to focus on supporting efficient clinician/speciality-specific workflows using personalization tools.
  • EHR personalisation tools for shortcuts, filters, and report views have the highest impact on satisfaction. The use of these tools should be a focus in initial training and follow-up education.
  • Timely, helpful support for clinicians’ EHR requests will improve the clinicians’ trust in leadership and the wider digital agenda. Trust will be further built as clinicians are solicited for their input into workflow designs and personalisation tools and as those enhancements are delivered as communicated.
  • Engaging clinicians in ongoing enhancement of the EHR will support a culture of teamwork at Leeds that will ensure that the group coalesces around the digital agenda.

This kind of commentary was very powerful for LTHT for two key reasons: first, it wasn’t particular commentary on missing functionality—it concentrated on additional ways for system use; second, it refocused on the engagement piece as an area for improvement. We took these statements as suggestions for how we can do better.

The distance we have to travel on the journey of improvement is not to be underestimated. KLAS and the Arch Collaborative may have hit on something important. If the rest of the NHS spent the time to consider their suggestions, the wealth of comparison data that would become available could bring about the change in attitude and aptitude that digital healthcare needs so badly. Southampton has completed their Arch Collaborative research, too.

The CIO in Southampton, Adrian Byrne, commented, “I think it’s hard to come up with a set of measures to get a good evaluation report. We want to have some things we change and refine and some things we keep the same, so we can measure improvement. I like the Arch Collaborative’s ability to measure across peers. That is its main benefit. We can measure improvement ourselves, but it’s all arbitrary. KLAS has a great record in research and tends to provide real insight.”

That is the key. The Arch Collaborative today, in its full glory, enables LTHT to build its strategic direction for the continued evolution of the EHR. As more NHS organisations take part in the survey, more souls are bared, and more agreement is reached for sharing the report’s details, then we will build a platform that can inspire the next phase in the NHS digital revolution where the stars align. We will ensure that digital healthcare is about collaboration between CIOs and digital leaders who lean into the challenge together.

My last comment is from many years ago:

Forgetfulness is in the learners’ souls because they will not use their memories… they will be hearers of many things and will have learned nothing; they will appear to be omniscient and will generally know nothing; they will be tiresome company, having the show of wisdom without the reality.

Socrates (5th Century BC)

Let us prove the genius wrong. Let us learn from each other by remembering the past and noting the opportunities of the future with a humility that allows us to continuously learn and collaborate. As David Amerland says;

Collaboration is the new competition!

 

 

[1] The illegal drug trade has used the term since the 1960s and yet the technology industry has remained the only other business to maintain this reference.

[2] 530 clinicians, 147 Advance practice clinicians, 153 nurses, 154 allied health professionals

Digital & Mental Health

I love technology and how it has transformed the way we live today; so sitting in a Matt Haig event last week in sunny Leeds I began to feel like an interloper, an enemy of the ‘people’, like at any moment I would be found out and the audience would rise up against me and swing me from ‘the wall’ very much Handmaid’s Tale-esque.

Matt’s opening comments were very much about the speed of life today and the impact it has on us all. There is no denying what the speed that not just digital brings but the speed of change more generally. We now witness fast paced change in the political scene, the way in which social media impacts upon us all, even the instant gratification of things like Uber, Amazon Prime and Deliveroo, the effect these have on our lives is unrealised day to day.

We spend very little time simply waiting for something without distraction. A friend, an avid Twitter poster, recently commented that he was on the family summer holiday and camping. There were queues everywhere and little mobile signal, so people were actually talking to each other, although the irony wasn’t lost on others, that he was still posting this on Twitter!

Mental health (or rather a lack of it) is the biggest killer of men under 50 years of age! We call the collective for illnesses in this pandemic ‘health’ even though this is a misnomer that we hide behind. People die through a lack of understanding, a lack of support, a lack of diagnosis; they don’t die because they have ‘mental health’, that’s what we need to strive for, we want people to be mentally healthy!

No one would think you should only get treatment for a physical illness if you’re on the point of death

The political mighty have taken it upon themselves to remove sugary drinks from most of the market place to attempt to remove the obesity issue threatening the kids of today. Yet what has the same intelligencer done about the support for the mental health of the same children? Very little yet! Anti-depressants are the fastest growing prescription drug in boys aged 11 to 14 in 2018, this figure floored me!

The pressure on the young of today outweighs anything anyone my age would have ever felt. Matt pointed out in his talk that when we were kids the need to fit in, the need to hide from the bully or even the annoying friendly chap, ceased to be there at four o’clock because we could go home and close our bedroom doors with only our parents and siblings to handle. Now the school and the peer groups’, friendly and unfriendly, follow children home. Social media brings us ever closer, so close that time away, time alone, is becoming the most treasured position. That unique opportunity we chased used to be connectivity and sharing, now it’s time unplugged and chance to breathe without so much connectivity a chance to just be.

When you interact with the next generation now how does it make you feel? What is the generation gap when it comes to mental health I wonder? A member of Matt’s audience asked about the definition and difference between nervousness and anxiety. He quickly compared the difference being the equivalent to hungry and starvation! For me nearing 45 years old, I thought that was quite an amazing way of considering the difference in how the younger generation will define the impacts on mental health – worlds apart. How many people under the age of 30 will exclaim that they are stressed, and how often will the ‘elderly statesman’ retort that they have nothing to be stressed about.

The way we consider mental health of people in the UK needs a fresh pair of eyes. We need to get to impacts and causes somehow.

My boss in Ireland used to talk eloquently about the health care system being a system of the sick not a health care system because it doesn’t do (isn’t able to do) prevention. The ‘shift left’ change to health care much talked up all over Europe now needs to be applied to the mental health of the people of the UK more than ever before. Matt gave a great example of Fiji in the mid-1990s, when they started to air US TV shows, ahead of doing this there were no eating disorders in Fiji. Anxiety was almost unheard of, but within five years, eating disorders grew to the ‘norms’ of the US and anxiety was at one point described as a pandemic. There are no official studies linking the two events, and as I have said already the world is changing at a high speed, but, it does make you pause for thought.

But there has to be hope, doesn’t there? When do we become aware of what makes us better? When do we apply that to the next generation of young people, harmed by the pressure the system applies to them to such a degree that society becomes malformed and somehow changes in how it treats the disease are never quite impactful. We have now accepted the term mental health as a phrase that is ok to use as an everyday description for a reason for school exclusion.

Matt asked the audience to ‘hear their own advice’, ‘it’s ok to be well one bit at a time’, ‘you can be a bit better’. We need a new acceptance, it’s ok to be at work with a cold, just don’t give it to me, and therefore it needs to be ok and supported to be at work or involved in activities with some mental health issues. How do we accept, understand and support mental health illness in the work place, in the school system, in the street in the same way as the common cold I wonder?

We have to do something, the speed of life isn’t going to slow down, I don’t want the speed of digital innovation to slow, which means it will continue to have an impact on our lives. I took another great little anecdote from Matt: digital and social is like ice cream! We can have a bit of what we love, and I love dearly chocolate and vanilla in the same bowl, but staying in bed on Saturday morning for four hours with a bath of chocolate and vanilla would not do any of us any good, the same goes for digital and social media I guess.

If we move our world forward just five years we need to be able to give ourselves some assurance that the digital world we create does good without causing harm. In my professional area we talk of patient centred design and portable data owned by the citizen but we also need to consider inclusivity and the bias associated to what digital brings. I am still excited for the future, our awareness is improving and I hope that this means we can get it right, evolve in a direction that is safe but also considerate of the wider impacts. Just maybe digital can be part of the cure not the problem.

Handover CIO

First published in CIO Magazine, November 2017.

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

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

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

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

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

1 – Delivery of Person Centred Care

2 – Trust and the Protection of the health systems assets

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

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

5 – Connect the Care Delivery Network

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

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

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

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

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

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

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

What is Pink Socks?

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

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

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

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

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

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

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

   So for me Pinks Socks is…

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

I want to be seen because I want to help.

Digital health and the Hollywood re-boot!

What can digital health learn from the biggest trend in Hollywood block busters, the Re-Boot.

In the last 15 years Spiderman has been through three ‘re-boots’, Tobey Maguire, Andrew Garfield and now Tom Holland. Batman has managed even more changes that have brought various degrees of success (personally I thought Michael Keaton did a great job!). Digital health can learn from this trend, a re-boot or two of how digital health is ‘sold’ to the public, the tax payer and the media is perhaps a little overdue.

The cynic amongst us though would be worried of the PR agency spin at this point, but I would disagree. Earlier this week I was being taken on a high-speed car chase through the streets of Leeds, otherwise known as a taxi ride from the train station to St. James. The usual conversation, what do you do and where do you come from ensued (does anyone else feel they are on a game show sometimes when they are in a taxi?) What was surprising was how much the taxi driver knew about the digital reform of the UK health system, but here is the issue; “Was that the disastrous IT project that failed”, says the taxi driver. No matter where you go the National Programme for IT (NPfIT) is almost universally hailed as a failure, and yet the programme put in place foundations for digital health to rival any country in the world, it put in the ground work to engage the customer whether that’s the clinician or the patient. I guess much as Michael Keaton put in the ground work for the plethora of super hero movies that have become de ’rigour as the summer hit movies!

Ireland still has its own NPfIT. PPARS is still described by the Irish media as a ‘comedy of errors’, and just as NPfIT it has its failings, PPARS today is a success that can be built on! To go back to the superhero movie analogy, PPARS and NPfIT are best linked to the Daredevil and Elektra movies, Ben Affleck and Jennifer Garner vehicles of 2003, fans know these were ‘great’ films, the critics were convinced they were rotten tomatoes, but, they now have influenced some of the best Netflix superhero fodder ever to be made!

The culture and leadership of the digital team is significant in a judgement of success.

Building a team is a trick that every digital leader should accept as their number one priority. Without the team the priorities, the governance, the customer at the centre, any of the benefits of digital will not be delivered! Across the world the delivery of healthcare is under financial pressure and this in turn means that the immortal words, ‘do more for less’ are likely to be uttered to you as a digital leader.

When you then look at what you can do less of there is a risk that the things that ‘could’ be seen as not digital’s responsibility are the first to go. If your mind lands on this as a decision please, please think again!

All over the world organisations are being told digital fails without business change resource, and yet as fast as this is becoming a key message for many business areas health systems are trying to cut the business change element from the budget of digital. In Ireland, we have spent the last three years trying to reinforce the message that the projects we have set as priority projects will fail without proper business change elements. The success Ireland made of the first digital maternity hospitals was a success of the business change functions and the clinical leadership. The need to have 9,500 hours training in one of the hospitals is described in some of the Irish media as a failure, what a shame that is. Business change perhaps shouldn’t be labelled as training, I guess that’s where we went wrong in Ireland, the ‘brand’ of business change resources within the team needs to be clearer, they are the engineers of success!

In my move to Leeds I was recently asked what sort of a CIO I am? One that focuses on technology or one that focuses on information? I think I confused the person asking the question when I said I am a CIO that focuses on the people. The need to create a team that cares most about the business change we are trying to achieve; I hope is part of the legacy I leave in Ireland as I begin the handover of what I do to the next digital leader for healthcare, a team that has moved from one that delivers digital to one that helps create business change through digital innovation.

Resourcing any organisation to be able to achieve a business change is difficult, trying to ‘re-boot’ the view of the team at the same time really does require an engaged and enthused leadership team.

How will we find the right people for the right job at the right time is a tricky question for any digital leader trying to create a cultural change. It’s a challenge that we have worked hard on in Ireland. In November 2015 the department of health gave us permission to recruit 49 new members of staff to the team. An exciting time being able to consider how we could now truly begin to move the ‘dial’ on the ratio of staff available to the business and how we really could begin to focus on the delivery of business change. The trick though was what sort of staff did we need. We were pleased with permission to recruit 49, we had asked for 150 new staff which meant a prioritisation exercise and a structural alignment that matched the resource we were now allocated, a re-boot with a limited budget. Not all of the re-boots require the superstar actors and huge budgets though, think of the collection of superhero TV series now gracing the screens of Netflix, nowhere near the super budgets of Batman Vs Superman, nor do they have the big name actors and yet they are probably making a bigger dent in the film buff psyche than the most recent Batman film ever will, sorry Ben Affleck!

How do we professionalise the digital health function though, how do we become recognised as the go to function to achieve change in healthcare. First and foremost, the logic of success building on success is key. Pick the projects that can be successful, not the easy projects or the quick wins, but the projects that will make a difference and that you know can be achieved. Professionalising the digital role in health is influenced from the outside in to some degree, the clinical engagement in the success of digital will build an organisational ally to help in the consideration of what a professional digital workforce can bring.

The re-boot of digital health needs some tools as well as the new actors. The SAMR ladder has worked well for us in understanding where our focus needs to be. Are we Substituting, Augmenting, Modifying or Redefining the delivery of healthcare. Are the terms mutually exclusive or are they an innovation journey that digital healthcare is on?

Dr. Ruben Puentedura’s model gives any digital leader an opportunity not to just re boot the organisation but a model to re boot projects as well.

Lets look at PPARS in Ireland, its original premise using SAMR was to simply Substitute what was currently in use with a digital platform, what went wrong according to the general consensus is that a simple substitution wasn’t enough. The human process was exactly that, not a logical process that digital could be a substitute for but an emotional and geographically different process that actually needed a redefining re boot. The success of eReferral in the last 18 months is because the process has been augmented, and the project team set about the re boot of the process knowing that was the case.

As we move to the EHR programme here in Ireland we know that the whole programme of work has to be about redefining, that is why the business change resource is so important and its why Ireland’s EHR business case insists on the budget and resource allocation for the business change elements,

Einstein’s definition of insanity is perhaps over used, but it fits so neatly here; ‘doing the same things over and over but expecting different results’ is his tried and tested definition. Without a re boot digital health is not going to succeed and we need it to be the next Avengers re boot not the best forgotten Nicholas Cage classic, Ghost Rider.

Consider the re boot theme, build the business change resource and lets get this movie started!

Whose data is it…

Biden Vs Faulkner, whose data is it any way.

 

Having a common enemy, a common ‘bad guy’ will always help a cause. A figurehead to rally against is one of the best motivators for the creation of a movement. Maybe in the last few weeks the Biden vs Faulkner showdown will be the catalyst for a new lease of life for the patient data movement. If the reports are true the Chief Executive of Epic; the Digital Health multinational may have ignited a new enthusiasm for patient data openness, by challenging Joe Bidden as to why on earth a patient would want access to their own data.

The conversation is said to have gone like this; Faulkner was amongst a group of healthcare executives gathered together to discuss with Biden the Cancer Moon-shot. The internet based magazine Politico reported that Faulkner raised questions about the utility of patients being given access to their own health records in a digital format.

“Why do you want your medical records? They’re a thousand pages of which you will understand 10,” she allegedly told Biden.

“None of your business why, I, the patient want access to my information,” Biden is said to have responded. “If I need to, I’ll find someone to explain them to me and, by the way, I will understand a whole lot more than you think I do!”

The culture of digital health organisations in the UK and Ireland has changed over the last decade so substantially that Faulkner’s comments sent many of us into shock. I distinctly remember arriving in Ireland and in 2014 and being asked to take part in a patient advocacy roundtable. At this event the gentleman who represented the Parkinson’s patients of Ireland towered over me and demanded that I, “… stop pussy footing around and get my data shared if it means that a cure can be found for this god-awful disease!” His premise was that if I didn’t he would and he wanted his information now, on a memory stick so that he could give it to an academic.

In the US we are told that the way the patient portal payment structure was created for meaningful use means that vendors were paid on a ‘log in attempt’ basis, this meant it was in the vendors interest to lodge a member of staff in waiting rooms and ‘help’ patients log in to their records, just the once. Pretty much taking the meaning of the phrase meaningful use and throwing it away.

We can also think back to the National Programme for IT in the UK and its version of patient access, HealthSpace, I can place a clear reason why that didn’t take off too, it was so very very hard to authenticate yourself before you could use the service. It required to visit a library with three forms of ID, to receive a letter with a PIN and then set up a significant password structure, the drop off rate before people got to view their records was huge, and understandably so. And yet here we are in 2017 with a new start up bank, N26, who have the technology to allow you to authenticate who you are with a camera on a mobile phone, from the safety of your own bedroom you can have a bank account up and running in eight minutes! Technology moves quickly and really does allow us to implement the digital health dreams we have.    

So there are a few technology examples of Faulkner being right, well at least the technology not facilitating her being wrong! But, now glance over to Finland and Catalonia two regions that have proven the ideals that Biden has described for patient access to information to not just be the art of the possible but be actually here now, information in the hands of the patient and making a difference to the care being delivered.

The first time I heard the solution that Finland has created to this issue I was in awe; the work is a partnership with Microsoft and shows the innovation and ingenuity of the possible through partnership, clever thinking and a will to put the patient at the centre of what can be done. In Finland the national electronic health record is effectively a set of data that is mirrored to two windows. The first is the clinical EHR, the first place the clinician sees information about their patient, the second window is the patient version of the same, the key difference is the patient can add information to the record via their ‘window’. The patient can add free text or wearable gathered data or home held diagnostic information, the clinician can see this information and decide to add it to the clinical side of the record. The clinical governance of the information is still held with the clinician but the ability is now presented to the clinician for them to value the patient input to the record and move it over to their ‘window’ on the information, thus giving it the clinical validity it deserves.

Suddenly the comment made by Faulkner become even more ludicrous; the patient information is not only about them and owned by them but now has real clinically valid input into the care being prescribed and practiced, let’s not forget that this is the person Faulkner is worried won’t understand the information, they are now an author of some of the information.

The next success story here must be the amazing work that Tic-Salut have done across Catalonia in this area. They have created an eco-system throughout the region that has driven a new type of credibility to the delivery of patient access to information. The proliferation of health apps is huge; in Catalonia the market place for these apps to be released into has been created by the health system itself. An accredited app store for the healthcare system built to allow patients and clinicians to use health apps with confidence. Unique though to Catalonia is the arrangements put in place around the data that these apps can use. If you have an accredited health app one of the conditions is where the data is made available, not just within the app but in a secure, audited and protected way the data can be used within the health care systems own information systems. What Tic-Salut have done here is ensure that the lines between clinical data created by clinicians can be blurred with the data created or collected by the citizen and patient without overloading the clinical team with data, after all data is only useful when it becomes information.  

Then we come to our own projects; in Ireland we have a decade long history of under investment in digital health to first get over to allow patients digital access to information, but, in Epilepsy we are seeing an almost immediate patient impact by having access to information. The patient portal trialled in the delivery of care for patients with Epilepsy has been a huge success for many reasons. First and foremost the portal and its functions have been co-designed by the patients and families themselves, the elements you can do with the portal are exactly what the patient wanted to be able to do. So viewing the clinical note is there as a function that has been seen as being useful but also the new ability to record a seizure, its severity and frequency and type has enabled a new paradigm in the delivery of care.

The ability for a patient to be significantly involved in reviews of medication efficacy through the capture of data has seen around 100 patients come off anti-epilepsy drugs since the portal has been introduced. I have championed digital solutions for the care of epilepsy since coming to Ireland in 2014, largely because of the passion that clinicians and patients, the careers and the special interest groups have shown for what can be done here. I hope that this light house on the art of the possible in Ireland can continue in to 2018.

In Ireland we have a plethora of digital health start-ups and new organisations. The Jinga Life team for me are delivering a solution that is a ‘light at the end of the tunnel’ for what can be done in Ireland. A design unlike any I have seen in healthcare, truly a delight to use and see. The concepts of Jinga Life is to concentrate on the key member of the family who is ‘tasked’ with the care organisation of the family. In their research over 90% of care is managed and organised by the female in the family. The Jinga Life portal allows the family member a tool to organise that care and to provide new data that can become clinical information to the clinician. Part of the success on the build of Jinga Life is its clinical and patient focus, definitely one to watch and one that I hope will show Faulkner yet again how wrong she is.

In the same week that Ireland launches its Open Data portal this data debate rages on, whose data is it anyway? Much can be discussed here but one thing we do know, its not the data of the digital vendors that are out there, and we need to seize back the ability to get at that data. A patient engaged, involved and aware of the information that is used for their care is a patient that can be part of the clinical delivery process, a patient empowered to help themselves.  

The Liquid Hospital…

First published for KLAS research, republished here for completeness…

Liquid healthcare systems.

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

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

Simple ideas

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

A year on, the Festival of eHealth

 

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 trends prediction…

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.

 

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