All posts tagged eHealth Ireland

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.

Leaving Ireland…

The 31st of July was a very sad day for me, it was the day I had to sit down with the Director General and say those words, ‘I resign as CIO of the HSE.’ Nearly three years in Ireland has been amazing. In the following week one of the team asked me, ‘was it a hard decision?’ Yes it was, one of the hardest I have ever had to make, over the last three years I have met some of the most committed and talented people I have ever had the pleasure to work with, a team of people who truly, with the right support, can change the face of a country!

Some of you will have heard me tell this story before, so please forgive me; my second day in Ireland, I grabbed a taxi, the Dublin driver turned to me and did the usual, where are you from etc, and then asked what brings you here? I replied without hesitation, somewhat green to Ireland and the culture, that I was working for the health service. The taxi driver stopped in his tracks and said, “You have a lot to learn, you have joined the second most hated organisation in Ireland, after water Irish people hate the health service the second most!”

I assumed he was joking, but no he was kind of right. The health system of Ireland is not a loved system, its not cherished, its described as bloated, regularly someone has a ‘pop’ at it being top heavy, or spending money wrongly, or deploying resources in the wrong places. Yet, here we are with a health system that every day saves hundreds of lives, a system that has a workforce like I have never seen before, a committed one that knows how to deliver care with compassion and often against adversity.

Let me take my own crisis management experience in Ireland, Wannacry, as an illustration. On the Friday evening the team identified the global impacting issue was heading our way, without any consideration for the plans for the weekend the team mobilised, created a defence strategy and set about working all weekend, all hours of the weekend, to protect the systems that delivers care to the Irish citizen. Nobody was paid to do this, no one received any bonus, time off in lieu or really any kind of recognition other than a heartfelt thanks from the system. In fact some ‘friendly’ people on social media suggested that the strategy adopted was even wrong, and that the focus should never have been needed if the HSE had been more prepared. I was so proud when on the following Tuesday we returned all systems back to normal and were able to say we had protected Ireland when others across the world had not been able to achieve the same.    

Leaving this role, not being part of the team in the HSE leaves me with so much trepidation; the personal focus that so many people have put into the changes that we have made over the last three years is significant, I wonder if this ‘perfect storm’ of personalities will ever be created again. One of the first programmes of work I ever owned in healthcare was the delivery of a system called the Data Transfer Service (DTS). The solution was a new way for primary care and acute and administrative functions to share information securely and in a timely fashion and we had to deliver this in thirteen months, this was back in the late 1990s. I thought that was the best team I had ever worked with until I came to Ireland.

The team make-up is a happy accident that has evolved to be one that I will look to emulate elsewhere. The team is a mixture of evangelists, sceptics and pragmatists, after a couple of years in the role that mixture hit the right balance. The team has a group of people who believe in being open and a sub-set who understand the need to be closed. The creativity in some has been astounding and the sheer dogged focus to keep going in others has given us a drive that has seen us get to the finish line on so many projects.

What I have learnt is best described by a Yorkshire phrase; “It takes all sorts!”

Handing the team to a respected, committed and digitally enthused leader has given me a new reflection on what can be achieved. The team are gathering around my interim replacement ready to support her and help her continue the success, not just of the last 3 years but the building success that the team has been trying to achieve for the last decade. There are some new tools now; a ‘brand’ that is synonymous with success and openness is in place in the form of eHealth Ireland. The health identifier is a foundation for information stored digitally, enabling a leap forward in patient safety initiatives with a data flavour. Ireland and its health system has a renewed vigour for what can be achieved in healthcare through the foundations of a digital system. Its first examples of digital hospitals are live and are a success, the programme to sequence the genome of patients with suspected epilepsy is changing the lives of many people this year, people with a disease that is often not considered high enough up the agenda. The readiness to consider innovation, how to work with the new, the fresh, the different ideas is also now part of the way the Irish healthcare system is changing and delivering benefit. In the last 12 months alone there have been over 50 new digital solutions deployed into the health system, each of these implementations requires the unwavering commitment of a team to make the system live and support the system going forward.

Perhaps the biggest ‘thing’ that we have achieved though in the last three years is to place the possibility of digital in health on to the agenda. We have a minister who says that digital is no longer a nice to have, we have a HSE leadership team that has embraced the concepts of digital into the way it works and the way it considers reform. The representation of all of this is the passion of the team that deliver this though, as my goodbye reflection I want to pause here and call out, maybe even embarrass a few of them, “live” on this blog site, to be remembered here and learnt from in the future.

First and foremost, an often unsung hero of the team is Joyce Shaw, the driving force in how we have transformed as a team, a lady with a passion for the team, how It works and perhaps most importantly the reality of people working hard together. Joyce is the conscience of the team!

The most considered, calm and truly gentlemanly Fran Thompson would be next on my list of essential elements to any team of the future. Without Fran being there through thick, thin, muddy and clear so much of what has been achieved in the last three years would have got absolutely nowhere.   

When I consider the team that we were in December 2014 and think about the difference people have personally made I have to call out Michael Redmond as well. Michael is a true example of a leader building through engagement. Working with Michael and seeing him go from sceptic to optimist over a three year period of time has been one of my own personal highlights.  

The eHealth Ireland committee has been a joy to work with, and is a group of people I now call friends, Eibhlin Mulroe, Derick Mitchell, Andrew Griffiths and the ever committed Mark Ferguson have ensured that the path we have walked has been supported. The success of the eHealth brand can be put down to these people and others in the committee who work hard in the background ensuring that we can make a success of what we do.

I have been lucky in that I have worked for two ministers who have wanted to engage with the digital element of health in a different way, they have taken a personal interest in what we do as a team, supported us and been there for us. eHealth Ireland has been able to enjoy an open door to both ministers over the last three years an acceptance and realisation that the team here in health is a high performing team of committed and capable staff is a great by product of that engagement.

A wise old colleague of mine said to me once that those of us that want to evolve and change simply need a good manager, once that person is in place we will be able to achieve anything. It felt a little like a piece of Jedi advice at the time but working for the DG of the health service here in Ireland I now understand. The DG has empowered us to get on with it, insisted we stay calm in the most stressful of situations and supported all that we have tried to do in a way that ensures success, certainly without this support we would still be thinking through how to make some of what we have achieved happen.

There is space for just two more names on this list for fear of it turning into a gushing speech that no one will read.

Niamh Falconer is my conscience, where Joyce ensures the team has a voice in everything Niamh reminds me of my voice in everything, caring for me and reminding me that successful change needs time to happen and time can’t be magically created; although she has had a magic wand in her hand for the last two years doing Tinkerbell like tricks to make sure we can do what we need to do.

Last but not least is Maria O’Loughlin, when grey clouds appear Maria has blown them away for so many parts of the team. She has a unique ability to translate ideas into reality whilst adding a shiny creative style to them, if we adopt Pareto’s rule Maria is the way to achieve the last 20% in all that we do.

Calling out individuals is dangerous, I know that, the reality is that in every single case of every person I have worked with over the last three years they have touched what we have done and indeed who I have become in some way, I would love to simply list everyone here now but no one would find that an interesting final comment from me.

A vision of the future has to be my final comment, I came to Ireland in October 2014 to present at the HISI conference what my vision of the future would be, I think much of that vision is still valid! The purpose of eHealth in Ireland is to create digital as a platform for change, a platform for a health service that has every citizen’s health and wellbeing at the heart of what it does.

If I could have a final wish it would be;

… be nice to the system that is there, help it continue to evolve.

It needs to find a new way to celebrate what it is, the Health Service Executive is the life blood of this country, treat it as that, realise what is limiting its capability and focus on fixing that rather than damaging and attacking the resource that is at its disposal. The HSE is an organisation that is committed, it is an organisation that is caring and it is an organisation that is capable, treat it as that and it will deliver the best healthcare system for the population of this great country.  

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.  

Hospital in a box…

First published as a KLAS blog in June 2017.

Do you remember being a kid at Christmas time, toys came wrapped and in boxes and by Christmas evening so many of us had reverted to playing with the boxes that all the new toys had come in! Imagine your parent’s frustrations…

Imagine if the hospital EHR came in a box ready to deploy, would we be ‘playing’ with the box within the first week I wonder? Once upon a time we used to talk about a hospital without boundaries, in some areas that evolved to a liquid hospital, as we move to the next decade a new idea is starting to emerge, a new parallel, the digital hospital in a box.

No this isn’t a chapter in the SIMS game or an elaborate Minecraft playground, this is where clinicians, patients and managers want to be! The mobile experience has continued to evolve at such a pace that the expectation of what we can do with our devices puts eHealth into a new world, a world we want to go. A world that seems like it could be attainable with just a little different type of effort.

Twice in one week I have been shown patient applications on mobile devices that enable patients to take control of their care wherever and whenever they want to.

The digital Haemophilia support capability deployed in Ireland allows a patient to be in complete control of their care and the treatment plan they have, ‘live’ from their very own smartphone. Ordering new treatment to be delivered and allowing the health system to track this treatment brings a level of patient safety never before seen. The solution also takes the theories of ‘just-in-time’ efficiencies and applies them to healthcare. Just like the fast-moving consumer goods industries where ‘just-in-time’ was invented, this has brought remarkable cost savings and the removal of so much waste in the delivery of drugs to the patient.

The second app is a collaboration between a charity, an academic partner, a technology delivery group and the health system. The epilepsy patient application now delivered in Ireland brings a huge change to the delivery of care to people with this long-term condition. Communication with clinicians is important for any patient with any long-term condition, and the impact on patients with epilepsy has been particularly revolutionary. A patient can now record and communicate the frequency, type and severity of a seizure to their clinician who can use the app to securely communicate suggested changes to the drug and treatment regime.

For patients with a genomic sequence they can now see the geneticist’s opinion of their illness enabling the control of illness to be shared and the nature of the ‘expert patient’ to evolve considerably. In a remarkably short period of time, some patients have been able to come off the drugs they have been on for long periods due to near real-time evaluation of efficacy of the drugs regime they are on and the shared ownership of data about their illness.

When we consider the impact of digital advances on healthcare one of three things can happen; it can continue to evolve at a slow pace but a ‘safe’ pace; digital solutions can optimise what is delivered already, or truly digital could transform the way healthcare is delivered.

The question we are asking ourselves as digital leaders in healthcare is, are we trying to change the way healthcare is considered and delivered or are we ‘simply’ trying to improve it. A supercharged hospital in a box could be the answer we have all been looking for.

On a recent study trip to Barcelona I was lucky enough to meet the team from TicSalut. More than anywhere else I have seen, the Catalonian health system has ‘cracked’ the mobile application and data problem for health, and the way they have done this is by taking the concepts of a mobile engendered Eco-System and making it real in every possible way. Catalonia has built the first box for the hospital to be packaged in! How have they done it?

First and foremost, they have managed to maintain control of the market place by offering a type of accreditation which has significant value to the builders of mobile applications. Their brand is trusted, respected and brings value to patients, by offering a marketplace for accredited apps they have managed to ensure an agility to market without stifling the innovation capability of its growth.

TicSalut have gone a step further than merely a ‘kite mark’ for health apps though. As part of the accreditation process the organisation asks that, with patient consent, the data collected in the app is not only made available to the app supplier but also the healthcare system of Catalonia. A clinician can see the information a patient or carer has and from a clinical point of view decide if the information is a valid addition to the clinical record, accepting it into the EHR of the patient where appropriate. The patient then can see they clinical record and can make use of the information inside the apps they have decided to use themselves. All of this strikes me as a bit like a box with both sides pushed open, truly a system facilitating a new eco-system approach to the delivery of healthcare.

Innovations like these don’t come overnight, of course. TicSalut have been building towards this for 10 years, ensuring that a new paradigm in innovation and openness of data can be achieved for the patients they serve. The concept of the health and wealth of the ‘nation’ really being at the heart of what they are delivering. The links to innovation through universities and academic fellowships are now well established. The apps are always recommendations and not mandatory, also the patient still chooses the app that they want to use. Prescribing an app can take place but it still always comes back to a patient choice.

Throughout Catalonia where clinical apps are used they can also be rated and reviewed by clinician and patient, taking from the travel industry and sites like Trip Advisor the clinical solutions deployed via mobile are crowd source reviewed and the results of this adds weight to the kite mark applied to the app.

If we are to apply the successful digital lessons of other business areas then we need to ‘wow’ the customer. Healthcare has a difficulty in defining its customer which makes this goal complex but, in the case of the hospital in a box this becomes easier. We need the patient that is receiving care to want to be part of the journey and the clinician who is delivering the care to understand the benefits of the information they are receiving, the veracity of that information. Maybe the much used three V definition of Big Data (Volume, Veracity and Variety) can find better application in simple clinical information!

The new concepts of digital allows businesses to become services rather than costly (sometimes wasteful) capital expenditure items. Take for example the work Phillips has done at Schiphol Airport, by applying circular economy principles Schiphol Group and Philips have created a new way of working, a new partnership. Philips now has responsibility for delivering light to the airport, responsibility for the fixtures and fittings and ultimately the recycling of the fittings. By taking this responsibility Philips can offer their most innovative and cost effective lighting solutions as a service to the airport, making a capital free investment for Schiphol in lighting innovation. Now apply this to healthcare, and try to do it without creating perverse incentives.

An EHR service cost model in a public healthcare system, facing the budgetary challenges we all understand, cannot be charged for digital solutions per bed or per patient basis easily. Doing this will instead cause a different consideration; whether to put information into the EHR. Yet, the digital service model can still work. A hospital in a box, a digital solution deployed to the patient first can work in this way, we are seeing this with the consumer driven shift in primary care, Babylon Health, WebDoctor.ie and VideoDoc and others here in Ireland are all facilitating some service model type solutions to the delivery of primary care interaction. The patient becomes the payer for the service in a different way; but in a way that enables innovation to be fostered rather than kept to a decade long cycle of investment.

Service solutions or the new term ‘platform businesses’ are pivoting throughout the globe and becoming new innovations; Tesla becoming an alternative power company, charging home based batteries overnight on off peak electricity or Uber becoming a way of ordering the delivery of vaccinations direct to the citizen in need, and so many more.

The ability to deliver health as a service to patients seems today to be hooked to the mobile capabilities though and particularly to this idea of the healthcare system in a box. In the space of a single piece of writing then we have managed to move from a hospital in a box to the whole healthcare system!

Digital leaders in every jurisdiction of the globe are trying to consider where in the tipping point they are, “are we here to optimise the health system with digital? Or are we here to enable a transformation?” The “healthcare as a service” concept, facilitated by the healthcare system and being delivered in a digital box can transform the health systems of the world! We know that digital is ready but the human factors along with the business change elements, are the more difficult parts to resolve. That’s why I believe the concept of a healthcare system in a box is useful, it simplifies what we are trying to do. Samsung talks about the unboxing of the mobile phone for different reasons at the moment, but if we can deliver, and then unbox the digital healthcare system then maybe we have a route to achieve the business engagement and change that so many healthcare systems need.

The healthcare system in a box provides for our ability to be a multi-channel business, at last the engagement of our hard-to-define customer base can be done comparatively easily as we suddenly have many more digital routes to engage through. Engagement has to be done on the needs of the ‘customer’ rather than the organisation and therefore the idea of multiple channels means we can offer the ability to engage in the same way as so many businesses do who successfully put the customer at the heart of what they do, the box has so many routes into it!

One of the advantages of moving to a concept where the digital hospital is delivered through the proverbial box could well be the ability to lock the hospital in a box and use it to protect the data and the experience of the patient. Recent cyber threats and the escalation of the vulnerability of healthcare to cyber-attack gives us, the digital health professional, a new challenge to overcome. Placing the digital experience of the patient into their own hands provides healthcare with, at the very least, a new level of vigilance. We don’t ask one person to adhere to hygiene standards to enable infection control best practice to become standard, we ask everyone, maybe that is what can be achieved by ‘crowd sourcing’ the customer in the cyber threat battle.

We have had the cardboard box since 1817, and now whether it’s Calvin and Hobbes creating a time machine (or a ‘transmogrifier’) or the gag real on the computer game Metal Gear, the cardboard box is an accepted part of growing up; even the national museum of toys in the USA has a box in it, the only non-branded ‘toy’ it has as an exhibition. So, if the humble cardboard box can become a toy for all our children since the early 1800’s then I am sure as a concept for healthcare it can become the answer to the truly patient focused electronic health record!

The EHR implementation as a relationship…

First published on KLAS research pages, reposting here in celebration of a good friends wedding!

Story telling becomes more and more important as the message becomes more complex. In 2016 I met a Chief Clinical Information Officer (CCIO) from an NHS Foundation Trust; they were to go live with a full Electronic Health Record (EHR) as a big bang in a 400 bed hospital later in that year. He raised a comment from one of his clinicians, ‘the purpose of an out-patient appointment is to persuade the clinician to review the notes!’ He said that without an EHR clinical staff were on a first date with patients too often. And then the story started to grow, how could we create an analogy for an EHR implementation that played into the story of a relationship, if the delivery of care is like a series of first dates without an EHR how would the story evolve with the availability of digital solutions? Indeed, how was the implementation of an EHR like the human relationship?

Asking a person out for that first date is a giant step and making a decision to go for an EHR could be considered to be similar to that giant leap from ‘single-dom’ to dating. Working out how to decide what is the right EHR is no easy task for any health organisation. The tactics for doing this range from huge volumes of output-based specifications to new innovative ways of testing the water, like Ireland is trying to do. Rather than creating a document with every possible permutation of need, Ireland has created a series of personas and scenarios, characters to be used to test how systems deployed in Ireland could be part of the reach for better healthcare. In some ways the approach Ireland is taking puts the people of Ireland at the centre of what is being put in place; a bit like checking with family and friends, before asking a prospective partner out on a first date, what they think of them! Entirely impossible in that scenario, but imagine the relationship success rate if you could do this!

That first date moment for the EHR has to be a comparison to the procurement journey itself. A courtship worthy of comparisons to the best (and worst) first dates. When Ireland carried out market testing of the EHR market back in 2015 the relationship analogy surfaced for the first time. The market testing team felt the range of ‘’relationship choices’ from different vendors and how they wanted to be in a relationship with Ireland spanned everything from ‘A shot gun wedding’ to a ‘free and open relationship’.

The idea of tying the country’s entire health system to a single supplier felt almost a little ‘Fifty Shades of Grey.’ Particularly from a couple of the larger vendors who were keen to see Ireland adopt a single system country-wide: a relationship they certainly would dominate!

The trajectory to deploy a new digital health solution could well be an analogy for proposing and getting engaged, you know where you want to get to but first you have to pluck up that courage and dive in. When an implementation begins we must have an end in mind but knowing the outcome at the beginning still, even in 2017, requires a crystal ball. I would challenge that the world is yet to see an implementation that can foresee the future, planning the benefits that we think will be released through making a healthcare system digital is as challenging as planning the rest of your life together with a new love, and yet just as essential.

The tools we need to plan the benefits of an EHR implementation need to be grown from others’ experience. It is why Ireland is in such a unique position, it can learn from nearly every jurisdiction in the world as it moves towards a digital fabric for health. Let’s all face it, we seek guidance from so many others when it comes to relationships, often so poorly qualified to give advice, simply experienced in the mistakes and lessons.

Digital implementation in healthcare needs to have an element of ‘fun’ with the obvious serious point at the end. Just like the traditional engagement period of time I guess. Taking a health system on a journey to change has to be something that the team are “engaged” in and able to be part of. So much can be done to ensure ownership of implementation remains with the clinicians who will be using the system, avoidance of IT being done to the system keeps the reality check in place. Recently in Ireland the implementation of EHRs has been ‘fun’, because team cultures have been worked on. Real collaborations across a multiplicity of people types, led by clinicians who, because of years of experience running their working lives through things like multi-disciplinary teams, can get the most from so many different types of people.

Keeping the end in sight at all times is an absolute need for digital health implementations. The fact is, scope creep is the project killer. So in keeping with the analogy, the end in sight is perhaps the wedding day, and here scope creep here is just as bad and often caused by not being clear who is the owner of the day (system) really! Clinical validation and decision making in the build of the EHR is crucial to a successful implementation and in particular to ensuring that adoption releases benefits. There are some scary stories in the NHS where systems with 10,000 licences are only being used by 1,000 people because the system does not ‘work’ in the way clinicians need.

The story of several electronic document management (EDM) systems in a few hospitals where black and white EDM was implemented by technologists only to discover that the positioning of the pink piece of paper or the highlight note was crucial to the way the clinician uses the system, are becoming too frequent. Bringing this back to the analogy, maybe this implementation was influenced by this being done in a “shotgun” fashion by the family of the bride? The technologist doing IT to the healthcare system, like a family insisting on the wedding of the couple. The only way to ensure this does not happen is to empower the clinician and their team to be the leader of the project, just like for the wedding day the wife to be has to be in charge to ensure the day is exactly what the couple want it to be!

Knowing that your delivery of care will change, you cannot just do the same as you always did, except now with a digital overview, or even just make it digital now and then go through business change later. Becoming a married couple requires both parties to accept the world is changing and the relationship is now a symbiotic one requiring give and take, pull and push from both parties for it to succeed. The relationship of a health organisation that now has an EHR or other digital solutions needs to bring clinicians closer to the informatics people.

We in Ireland talk about trying harder to remove the terms that separate technology projects from business change projects to try to erase this issue coming up. The CCIO role helps here, a shining example of one of the interested parties’ attempt to get closer to the other. However, as with marriage this fix requires all sides to be active in making it work. Where this analogy falls down I guess is the number of parties now involved in the delivery of digital solutions, they can’t all be married to each other at the same time!

Who owns the wedding? All too often the response I hear is, the wife, the family or the ‘payer’ when I listen to friends planning a wedding, and here the analogy also is strong. The tax payer of a country with a public health system ‘needs’ to own the system, after all they are the payer. And yet my advice to anyone planning the wedding is seize your day, it’s your wedding and you should be in charge, and therefore we should be empowering the clinician and the patient, and dare I say, not the media, the influencers and the trend setters.

Healthcare is not our goal; life is the goal of the system. The parallels to the relationship continue to exist beyond the initial implementation of digital solutions into the health system.

A clinical team will go through the pain point to deliver new life or new capability into the world. Birth of a system or the discovery that you are expecting twins is perhaps a good way to consider what happens next in a relationship or in digital implementation. Once the object of your efforts is ‘live’ in the hospital the world changes dramatically for everyone involved.

One of the key learnings that many jurisdictions have come to after a go-live is that the system being live is not the end of the journey. To maximize benefit from the system needs nurturing; business change is a continuous journey of service improvement and the rate that technology is evolving and growing means that to simply stop the project once the new system is live would be like accepting that nothing more can be achieved. Like with a new baby the role of us, ‘the parent’ of the digital solution is to enable learning to continue and the system to grow and evolve. The health care digital team has to learn to become the parent of each of its digital babies.

“The art of the clinician is to distract the patient whilst nature cures them,” is a quote from Voltaire. The role of technology in healthcare needs to follow a similar path, the art of digital in health is to deliver a seamless solution that catalyses integrated care delivery and can ensure that the goal of contextualised care for every person can be achieved. However, if we are to continue the analogy of relationships then we need to keep an eye out for another danger: the seven-year itch!

Loyalty to the concepts of digital health must be maintained. Once the relationship begins it becomes very difficult to stop and go back, but also the system that has been put in place needs to be continually evaluated. A happy marriage is one where all the partners continue to communicate and work hard to achieve goals and outcomes and a long term digital relationship needs similar consideration. Age old concepts of keeping the supplier hungry really need to be dropped in favour of a harmonious relationship with a shared goal in mind. After all, do we really want to consider keeping our life partners ‘hungry’ for the next 60 years?!

What is the final stage of the relationship? A friend commented that surely its death but that seems a little tragic! Growing old together, being able to act as a one whilst maintaining the individuality is a huge part of this. If we consider the matured relationship of clinicians and digital leaders then this would be a great outcome for us, particularly if we can bring the supplier into the same bed?

All then goes full circle, and continuing to find unique ways to turn on the relationship gene is part of how we continue to learn and grow, and sometimes we really do have to evaluate where the relationship has got us and make changes. As with a digital partnership, there will need to be compromises along the way that lead, ideally, to a happier outcome for all.

As that English ‘expert’ in partnerships, Wayne Rooney, is quoted as saying,

‘Perfect partners don’t exist. Perfect conditions exist for a limited time in which partnerships express themselves best.’

The role of the digital healthcare leader though is to ensure that those conditions exist perpetually…

Talking about delivering all this to Ireland means I can’t in good faith finish my thoughts with a quote from a current and quintessentially English (I really hope he isn’t) footballer. Therefore, let me end with a quote from a wonderful singer songwriter from this wonderful country, Mr. Damien Rice,

“And so it is just like you said it would be, life goes easy on me, most of the time, and so it is the shorter story, no love, no glory, no hero in her sky.”

Maybe a moto for all EHR (or, as autocorrect continues to tell me, HER) implementers now and forever more, we are not heroes in the sky and we know it’s not like we said it would be, but, we are here to make life easy. We are here to make healthcare be about life, not about technology.

 

 

Also posted in honour of my very good friends, congratulations to T&L life begins with Ms Faversham!

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.  

CIO100 – A thank you to a few people

For the last five years I have been part of the CIO100, that is something I am extremely proud of. The role of CIO is something I believe passionately in and to be part of this group, to achieve membership to this rag-tag group of pioneers, leaders, misfits and general try hard, mean well human beings; well it means a huge amount to me…

And on the night you become the top of this pile, well you don’t get that much of a chance to explain why or how, so indulge me for a few short words whilst I do a Gwyneth Paltrow and Natalie Portman all in one on you, I hope it’s not that cringe worthy but some of the next short words may well make you, well, erm, cringe, sorry!

The CIO100 is a unique network of the most influential CIOs from the UK and across Europe. The group consists of digital leaders from a hugely diverse group of business areas, from private and public sector and from experiences that transcend background, gender, age, organisational ambition and ultimately even the concept of what a CIO is. And that is why this CIO100 is so important. Every year the team work tirelessly to create the list, judge the entrants and put on a networking event that brings the majority of the 100 together, that team deserve the first and biggest thank you, the CIO100 is, I think, the most relevant list of its type and this is entirely because of the credibility the team delivers it with.

I am lucky, so very lucky. Over the last decade in particular I have worked with some of the most inspirational leaders you will ever come across; first and foremost, Dr. Jonathan Sheffield of the National Institute of Health Research (NIHR) taught me how to make sure that the way we look from the outside has the biggest influence on how we grow from the inside. At the same time that I was in this role I also had the opportunity to be commissioned by Dr. Peter Knight, the man who, in my opinion, invented making politics work in digital health.

The NIHR was my first role as a CIO and I had an executive assistant known as Jessica Thomas. The reality is she was the original Donna Poulson from US show, Suits. In the show everyone needs a Donna, well in my role, everyone needs a Jessica. A CIO needs support, after all digital is the fastest paced business arena in any vertical and sometimes it’s hard to keep up; folks, go get a good support person, get a Jessica! I have myself a ‘new’ Jessica in Ireland though. I am very lucky to have found a second person who can make me look good on the worst of ‘bad hair’ days, Niamh Falconer, this one is just as much for you, and when you watch Suits you will know why you are also the second Donna!

I learnt my trade from so many ground breaking scallywags. Tom Dean, Dominic Hamilton and Andrew Chadwick first made me number four in their list of capable IT people, they were one, two and three and I managed a lowly number four. As four colleagues in the corner of a very big office they taught me humility and an ability to trust a team with a developed technology skill, and how to inspire them; through chocolate biscuits!

Twenty years ago I met two men who instilled a sense of proper, gentlemanly, leadership behaviours, Mark Hillman; a leader of high virtue who instilled in me a belief in people and their abilities. Even more so though, even now, the person who in the last twenty years of my career is still the most influential is a chap called Phil Randles; Phil is no longer with us, but I would describe what he did as ‘bringing me up’ to understand the way to work with people, perhaps the most important skill for any CIO, certainly one I know I still try to hone every day.

A CIO ‘preaches’ continuous learning to be successful. I learnt how to do this effectively from a formidable manager and expressively talented leader called Carrie Armitage. She gave me a chance to shine, to continue to learn and to be a leader. Even today in Ireland I can apply the things she taught almost daily to how I work and what I consider successful delivery to be. It’s so funny to meet her now, I am still a little afraid and yet still so keen to hear what she has to say to help steer where I go next.

In my role I get to work with the kind of people who are recognised as super intelligent. Professor Batchelor, the master of the beautiful slide as well as the most creative health technology leader to really deliver this stuff and Professor Ferguson, the most entertaining chair of any board I have ever come across, two people who have very kindly helped me shape my own CIO style.

The CIO100 is a reflection of the last 12 months in particular; I don’t want to simply throw out a list of names from the last 12 months, I really don’t, but, in the words of David Grey, please forgive me…

Fran Thompson, for his belief and support in getting us to what we are trying to do. Tony O’Brien for teaching me, again, why I love what I do. Joanne Lonergan for listening, even when it’s just a bit too abstract, and to Hannah Gleave for helping me make it just a bit more Sci-Fi. Managing the intricacies that comes with organisational development of a group of technology professionals is always high on the list of challenges for a CIO, the help I get from Joyce Shaw is the only way this can be achieved by me in Ireland, she truly ensures the team builds and grows in the right direction every single day.

The number of people in the ‘field’ who never cease to amaze me is huge, but a few need a special mention as they make a difference to me and to what we are doing Ireland every day; Dermot Cullinan, Neil O’Hare, Brian McKeon, Dairin Hines, Pat O’Driscoll, David Wall and Mike O’Regan and so many more talented professionals deliver to the health system of Ireland every single day something that every CIO aspires to; a new meaning for the ‘I’ in CIO, inspiration.

Partnerships are key to being successful, it’s even part of the CIO100 questioning. I wouldn’t have been successful over the last year without the help of so many vendors that we have managed to turn into partnerships or just simple inspirational relationships; the team at WebDoctor.ie, TickerFit, Cerner Ireland, the team formerly known as CSC, the Microsoft Health gang, the chaps at ECHA, pTools, JSBDigital, Oracle Health, Clanwilliam, Ergo, Leading Social, Swift Queue and any number of others now working so hard to a common goal, better patient care for the people of Ireland.

So many of the CIO100 make a difference to me and the type of CIO I want to be; it’s a refreshed network that makes a difference. Joanna Smith, Rachel Dunscombe and Rachel Murphy are part of this list and they make sure that what a CIO does in health is above and beyond the norm and needs to be recognised and shouted from the rooftops of every hospital.

I’m getting towards the end I promise, the next thank you is back to the US TV references, in a recent poll US citizens said they would prefer Bartlett as president rather than the current incumbent, showing the West Wing as not a drama but a fairy tale wish that we all want to come true. Bartlett’s team make the show, and I managed, by accident, to find a person who is so many of the team rolled into one person; she is CJ on a Monday and Friday; she is Toby on Thursday; she is Josh on a Tuesday; she is Sam on a Wednesday and somehow she manages to be a Leo all of the time. Maria O’Loughlin is a true and constant inspiration for what we are striving to achieve, she keeps the role creative, she drives clear engagement in all that we are doing; reminding us regularly that we are delivering technology for the good of the patient and the clinician and not for the ‘fun’ of the new digital solution.

What makes a CIO really tick though has to be the diversity of influence; I have worked with some amazing people and continue to do so today, but family is the source of the most important inspiration. My mum will always be the influence that keeps me aware of what we are doing. In my role we are trying to use a phrase; it’s not healthcare its life, and whenever I talk to my mum about what I do this becomes a reality so much more. I am the happiest I can be being a CIO, I have been since that ‘fateful’ first day when I was asked to become the CIO of the National Institute of Health Research, and only one person has been on that journey with me throughout. In many ways this award is shared as much with her as the teams that have helped me be the CIO I want to be. No matter whether its dropping groceries in the supermarket isle at the shock news of becoming a CIO in Ireland or arranging the celebration meal at a restaurant decked out in cow-print to celebrate the first CIO role Alex has been with me the whole way, thank you so much Alex Corbridge.

An award like the CIO100 calls out one hundred people and each one represents a team. It’s not about the person in the list, the CIO, it’s not about the number in the 100, it has to be about the team that the CIO works with, for and around.

This award is for the team, and I’m proud to collect it for them.

Let’s get down to the craic agus ceol…

Slainte

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