What does a soap factory, a hotel laundry, a cheese processing plant and a builder’s merchant have in common? They were all places that I learnt my ‘trade’, and somehow I became a CIO in the health service!
Yesterday was a great day for the digital team in Leeds, for the second year running the team interviewed for student placements for the summer. Six bright young things part way through their education in all things digital science came to meet the team and to work with us to decide if the digital team in Leeds is the right place to come and trial the skills they have been learning all year.
So over the next couple of weeks we will welcome; Daniel, Daniel, George, George, Alice and Reece to the team. A gang of Computer Sciences students who have a passion to do something good with their newly developed knowledge, to quench their thirst to try what they know in the ‘real world’! The exceptional thing that made me jump for joy though is that these 25ish year olds all wanted to be in Leeds for one key reason; they wanted to do good with the knowledge they have learned, they wanted to give back, the wanted to deliver return on the reputation that Leeds Teaching Hospitals Trust has built.
So much is written about the lack of faith that our future stars will have in the organisations they choose to work for and yet here I was faced with six stars of the future, all six of them looked ready to burst with enthusiasm. We delivered a presentation to them first, a bit of who we are and what we do, then another super star, Gareth Edwards one of our informatics nurses showed them what working here was going to be like. One of those age defining moments happened though as our amazing Informatics Nurse used a screen image of a computer game form the 80s and a computer game from now to show the difference in expectation that digital consumers have now. One of our candidates exclaimed; ‘My Dad used to play that game’, the sadness with a wry grin that swept over all of us in the room had to be seen to be believed as we realised just how fresh and ready for the challenge these new guys were going to be! But poor Gareth.
Much has been made of the Leeds Way, Davina Mcall has even explained it to Phil and Holly! When you see the Leeds Way ‘infecting’ new people into the organisation though is when you realise how well as a trust we have built this culture. After three hours with the team, in an assessment type scenario these guys were smiling, laughing and most importantly of all making amazing suggestions that we simply had not thought of. The assessment was a paper based affair, ‘think through how you would build the patient consent for surgery form?’ Remove the paper from the equation.
Now, lets just jump back a moment these are six students with no healthcare experience, the ideas they came up with, the references they were able to make to how people use technology, the way they really were appreciating the difference between digital transformation and IT really, truly blew my mind.
Thinking about colours, size of font, language, sensitivity about information recording, data protection, data ownership, access controls, the physicality of kit, the nature of the form; and most importantly the human nature of what was being considered. All came up in a 30 minute paired task!
So, we now have six new inductees into what we are and what we do; my promise is that their ‘summer job’ will not be like mine was; I won’t simply leave them to do the rubbish jobs, I will try to inspire them, I will try to send them back to their next year with a story to tell and if I can help influence a tiny little bit of the next generation of people who do what we do then crikey I am going to love this summer!
The #LeedsDigitalWay just started to create its next generation.
In 2001 AI was ‘just’ a Steven Spielberg film; in May 2018 it is being described by many as a solution too so many ills within the NHS.
On the 21st of May the Prime Minister provided the NHS with her view on the way Artificial Intelligence could revolutionise the delivery of care for patients with Cancer, Dementia, Diabetes and Heart Disease and by 2030 save 50,000 lives. Grand claims and grand plans and a new direction for government. One that focuses on a digital art of the possible although certainly to leap from paper records in vast wire cages and trolleys as an “ok” solution through to AI as an opportunity for the delivery of care is no mean feat, but a goal we can try to play our part in.
The following day Satya Nadella the Chief Executive Officer of Microsoft gathered CEOs and CIOs from digital business from across the UK to discuss what the team at Microsoft described as “Transformative AI”. The CEO used a quote by Mark Wesiser the prominent scientist of Xerox and the father of the term ubiquitous computing to open his presentation,
The most profound technologies are those that disappear. They weave themselves into the fabric of everyday life until they are indistinguishable from it.
This is where we want our EHR to get to!
The conversation continued to try to deliver the fundamentals in AI. Data is what feeds and teaches AI, it provides the fuel to grow to learn the what and the how.
Collecting more data therefore will educate AI more quickly; the next horizon is to make the nine billion micro-processors that are shipped every year become SMART devices. The micro-processor in your toaster, your alarm clock, your motion sensor light can become part of the data collection capability that will be responsible for our education of AI. The sheer growing size of data is something well documented, the creation of data will have reached a new horizon by 2020 and will look something like the figures below:
20 Billion SMART Devices will exist in the world
(8 bits to the byte, 1,024 bytes to the kilobyte, 1,024 kilobytes to the megabyte, 1,024 megabytes to the terabyte and 1,024 terabytes to the petabyte) The average mobile phone now has 128 gigabyte; the first man went to the moon on a computer that had less memory)
So much data to educate the AI of the world, the insights that could be gained are incredible.
The journey from what we know as an IT enabled world to a digital world sees the move from ubiquitous computing to Artificial Intelligence as a pervasive way of life and then on to a world where we live in a multi-sense and multi device experience.
The impact on the relationship between us and technology has evolved in how it is perceived; technology was ‘simply’ a tool, initially as AI evolved it worked for us as a subordinate and as AI evolves still further it will become more of a social peer in how we consider what it can offer us in healthcare. The most common Christmas present in the UK this year was one of the voice activated assistant, people all over the UK are now having chats with Alexa, Siri, Cortana or simply saying Hey Google to find out some fact that just alluded them or to ask for a simple task to be done.
The original concept of distributed computing (or cloud) gives us the ability to create the computer power and data storage that is needed to evolve AI capability. Distributed compute adds IT complexity, it is now our job to find ways to tame the complexity by ensuring consistency and a unification of experiences, this applies more to digital healthcare than any other ‘business’ as we try to utilise digital as a way to standardise the delivery of care as much as we possibly can.
The definition of Artificial Intelligence is said to have been first coined in 1956 in Dartmouth, the journey from this definition now includes the term Machine Learning first applied to algorithms that are trained with data to learn autonomously and more recently since 2010 the term deep learning, where systems are enabled to go off and simply learn beyond a set of specific parameters. The art of clinical practice, the need to have a human touch though is well understood in healthcare. This is why more and more AI in healthcare is referred to as an ability to augment the delivery of care, AI does not deliver a solution to offer less clinicians in the service, what it does is remove the need to have clinical time spent on anything other than patient care, AI offers the opportunity to increase the human touch. A further quote reinforces this in the book The Future Computed;
In a sense, artificial intelligence will be the ultimate tool because it will help us build all possible tools.
Eric Drexler author of Nanosystems: Molecular Machinery Manufacturing and Computation (1992)
The journey to AI in our world is getting quicker. The journey to AI being successful is best measured when the different components of it reach parity with us humans;
The road to an AI augmented world though is about amplifying human ingenuity; AI can help us with reasoning and allow us to learn and form conclusions from imperfect data. It can now help us with understanding; interpret meanings from data including text, voice and images. It can also now interact with us in seemingly natural ways learning how to offer emotionally intelligent responses. A Chat Bot launched in China now has millions of friends on across multiple social media channels, it has learnt to offer help to its ‘friends’ that are demonstrating symptoms of depression, phoning up friends to wish them good night and offering advice and guidance on sleep patterns but in a very human way.
Gartner have reported that the ‘business opportunity’ associated to AI in 2018 is now worth $1.2 trillion! Suddenly AI is the new Big Data which was the new Cloud Computing, which was the new mobile first. All of these terms have had hype but have all in reality brought a new digital pitch to our business strategies and our lives.
Great Ormond Street Hospital in partnership with UCL is leading the way in AI application into healthcare with several projects delivering startlingly real results.
Project Basecode: Transcribing speech in real time and utilising AI capability to add information to spoken word dictation capture.
Project Heartstone: A device for passing messages, verbal and video to patients of GOSH that may be too young to have their own Smart Phone, the device can be expanded to offer services to children who may be deaf or blind.
Project Fizzyo: Puts in place gamification to the delivery of breathing physiotherapy for children with Cystic Fibrosis and captures the information for the clinical record offering analysis as it goes.
Sensor Fusion: Creates perhaps the most immersive AI elements in healthcare today, recording events throughout the hospital, offering machine learning developed advice and data driven descriptions of events as they occur.
At Leeds Teaching Hospitals Trust we have created a platform in the form of our Electronic Health Record (EHR). With this platform we can now begin to consider how this clinical push for AI and the difference it can make to patients lives and the way we work can be achieved in a carful and considered way.
This digital revolution can make a real impact on Leeds; the patients, clinicians and staff enabling us to provide the care we want to provide following the Leeds Way principles with digital as a supportive backbone.
If you want to know more or have an idea as to how you could help in this area get in touch with us via @DITLeeds
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.
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.
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.
First published in CIO Magazine in August 2016. A collaboration with Elaine Naughton in the writing and development of this idea, a huge thanks to Elaine for this.
In the excellent Steve Jobs biography by Walter Isaacson, he describes a discussion between Jobs and Steve Wozniak where Jobs is explaining to Woz that the role he plays in Apple is that of an orchestra’s conductor, here to get the best out of the team, to ensure that they play in harmony and deliver to the listener the most inventive and yet classically rich vision of the original design. This conversation is said to have taken place after a strong ‘debate’ just before the launch of the iMac itself, Woz described by Isaacson had just exclaimed to Jobs that he was neither designer nor engineer and therefore did not really warrant or justify the recognition he was getting as the ‘re-saviour’ of Apple.
Is the creativity of the conductor the real line to success in IT leadership? After all the ‘band plays on’, or at least tries to, whether there is a conductor or not. Even as early as 1998 Jobs was describing, I think, what the modern CIO now needs to be, although maybe we now need an evolved model from conductor to DJ or rock and roll front man.
Why does the analogy and the model need to evolve? Well, in times gone by, the IT leader would have sought out the best in class people he needed. Much like creating an orchestra of around 30 talented artists, the Leader had to be the best that the orchestra could afford and then the conductor had to make them fit into the team, not always an easy job. The ‘prima donna’ persona of the highest calibre technologists is not always easy to integrate into a high-performing team after all. This then, perhaps, is where the evolved model comes in.
The leader of a rock band enables the band to “jam” develops a structure and order to remain in time, and chooses a rift as well as creating a tune as they play. Maybe this roll can be best described as the start-up innovator of the music scene. A band always needs a front man – someone with a vision for the sound they want to achieve and the charisma and charm to wow an audience, the band may play on if the front man leaves, but rarely as successfully; what would U2 be without Bono? or the Rolling Stones without Jagger? Queen without Freddie? Perhaps the best real world example of the rock star digital leader is Larry Ellison of Oracle, truly a front man if ever there was one to be seen in digital leadership. The owner, founder, creator and beating heart of the Oracle empire, whilst no longer leader in name still very much the charismatic front man of the brand and indeed, band!
An orchestra, on the other hand, follows a very strict plan and each of the upwards of 30 members (over 50 for a symphonic orchestra) knows exactly what they need to play and when, whether it is solo or synchronised with their team (by virtue of the score). Only the conductor knows the full score and reads all lines simultaneously, knowing who to call on and who to bring in exactly when they are needed for the orchestra to continue playing in harmony and in time, and for soloists to have their moment to shine. A digital leader in the style of the conductor does just this. The danger here though, is if only they know the full picture, keeping everyone focussed takes a huge amount of energy and enthusiasm. Many public sector digital leaders are of this style (often by necessity) as the full picture is in reality always being altered and reconfigured a small amount by the political leaders and paymasters.
The conductor’s role is an art form and a talent, while being a very technical job. Take the conductor from this and time signatures slip, the musicians become discordant and eventually chaos ensues. Just as with Jobs and his temporary departure from Apple, as conductor of that orchestra he was never truly replaced and therefore for a time the music was not what the audience needed to hear. The creativity, in the sense of innovation of the music, belongs to the composer rather than the orchestra or conductor; with this in mind maybe we need to see the digital leader as composer and conductor more often!
A DJ, unlike the conductor or rock band front man, can take the best work of a much wider variety of stars, mould them together until they find the right mix and then play it for the audience. The DJ doesn’t have to integrate the full character of the artist just that moment of excellence where the beat fits or as the very wonderful NetFlix original puts it, ‘When the Get Down arrives’! A modern successful digital leader then is going to be a DJ! If we consider the ‘gig economy’ to be the future in digital then this kind of character and behaviour is likely to become even more prevalent when building successful teams. The magpie-type ability to bring all the best bits together for one moment of excellence that then can be repeated.
We believe the skills of a DJ are also key traits of a transformational leader: someone who motivates and energises their employees to get behind a transformation strategy, creates something that has been written about many times before, the creation of a fan base if you will!
The styles of these three analogies allow us to consider the nature of digital leadership. There is a mix of two key styles here, one is transactional the other transformational. The conductor is transactional, planning, organising and controlling. The DJ is transformational challenging and changing organisational culture, coaching and developing people, creating a climate of trust, establishing a long-term vision. The front man perhaps mixes both styles dependent on the need of the audience or band members, an ambidextrous style that is agile and responsive as startups require to be.
The analogy can continue in a number of ways beyond just the parts of the mix. A DJ brings with them the theme and the end point they are trying to get to, much like a high performing digital leader needs to, they start with the end in mind. Also, the DJ needs to be aware of the change in trends, evaluate them and consider how to adopt them into their fabric, so much learning of how this is done from both professions; I would love a temporary job swap!
The Jobs autobiography also describes the moment that Woz and Jobs first met from Woz’s point of view, “We first met in 1971 during my college years, while he was in high school. A friend said, ‘you should meet Steve Jobs, because he likes electronics and he also plays pranks,’ so he introduced us”
Jobs and Woz learnt they had so much in common, and yet were so different. The wonderful “Small Data” book by Martin Lindstrom references a Harvard Business Review article by de Swaan Arons, van den Driest and Weed called “The Ultimate Marketing Machine”. The article suggested that there are three types of people needed to make a marketing company successful, they are:
Think people – Who focus on data and analytics
Do people – Who have responsibility for content, design and production development
Feel people – Who are all about consumer engagement and interaction
I wonder if the modern digital organisation can apply this exact same logic as has been done here for the marketing team. The types of people the IT leader needs to bring together are defined less by their technology specialty and more by the person type they act when they are in a delivery focused team. Back to Jobs and the Apple empire, the success of the original swathe of ‘i’ products has always been put down to two elements, one, Jobs own meticulous eye for detail and two, the design standards of the team under Sir Jonathan Ive. If we overlay the commentary from the article in the Harvard Business Review referenced above and the conclusions that Lindstrom himself makes on this article we start to see that the way this team has been successful is by ‘minding the small things’ by being a team that is led by a digital orchestrator but exists as a team that can deliver empathy together, to the benefit that is trying to be attained.
A modern, successful leader needs to be a strategist, a “front-man (or woman)” AND be able to conduct a complex set of teams in a harmonious way – or at least empower capable section leaders (upper strings, lower strings, woodwind, brass, percussion) to do so on his or her behalf.
The theories of Lindstrom in Small Data will blow your mind, you regularly turn a page and laugh at the conclusion he has made and how it applies so completely not just to modern marketing ways of working but to how the right digital function needs to deliver. Whether as leaders we are badged as CIOs, CDOs, Conductors or DJs we don’t care, we just want to be able to make IT work.
…… as a post script we really do care! Two IT leaders were involved in the creation of this article, one of us wishes they had taken the path of enlightenment and become the superstar DJ of their dreams the other is progressing from playing second fiddle in a growing orchestra to becoming a conductor and leader of a great band.
The eHealth Ireland Eco-System was a year old last week, a great achievement for the team to go from the germ of an idea to the formation of a self-supporting Eco-System that has seen the meeting of many ideas and organisations that have been able to be another hand on the tiller, steering the eHealth Ireland agenda.
As part of the birthday celebration meeting we have invited a different keynote speaker from a background outside of health, Niall Harbison, founder of Lovin’ Dublin, inspired the audience with his vision for an integrated Health system. Niall opened his presentation with a slide stating “The world is changing so fast” he brought the audience through a whistle stop tour of what it means to be in Social and Digital Media today in 2016 with a great emphasis on being mobile first.
Niall told us that over 90% of traffic is now via mobile. He spoke strongly on the importance of engaging with our stakeholders through different social media platforms such and commended us on our use of Twitter Hours and our transparency agenda for developing relationships.
Niall spoke about how we all need to be content masters. It’s up to all of us to inform our stakeholders in a way that interests them about what we are doing. It was refreshing to hear Niall speak about what he believed would be the future of health. He spoke about what it was like to not be clinically informed but that he would like to be able to see a future with telemedicine, where he can see a doctor when it suited him, where it suited him and be able to get his prescription sent to him electronically. Niall spoke about how he had great respect for all involved in health and their movement to digital.
He spoke about Apple and how even they, being a multi billion dollar innovation dynasty, have difficulties in mastering this market. The fact that we are trying to digitize something so large and disparate is a challenge and how its often much easier to start with nothing, he likened it to “herding cats”.
This is why he believed that the health innovations would actually emerge from countries where there is nothing currently there. Where they can adopt technologies and build new solutionsquicker. He also pointed to the fact that we can’t believe our stakeholders don’t want or expect this service or will not be able to use it and spoke of the quick adoption by taxi drivers of technologies such as UBER and Hailo and how people would have presumed that taxi drivers would never have adopted that technology
Niall spoke about where health was and asked us to consider what it would be like to pitch Health delivery as it is today in Ireland to Warren Buffet as a business idea, what investment did we think we would secure. If we can’t secure the idea of delivering health as it is done today then just maybe the answer could be a digital revolution was the noise left ringing in many peoples ears.
Niall finished on reiterating his first slide “The world is changing so fast. When will it happen to health?” and an inspirational quote from Michael Jordan;
“I’ve missed more than 9000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed”
When experts from a wider digital field listen and speak to health audiences it always brings a refreshing and different challenge to what we think and do. Imagine being able to reform health at the speed of an organisation like Lovin’ Dublin has been able to form and become a house hold name. All through my own career I have pushed hard to ensure that we can learn as much as possible from other business arenas in health, after all the facts and figures from various studies point to health globally being way behind other businesses so there is clearly going to be something new to learn.
The eHealth Ireland agenda is not unique, but, it is now moving at a rate that requires a different type of support to see it succeed, one straight out of the innovation and new thinking kit back. In the words of Bob Wachter at a recent Kings Fund event,
The purpose of digitisation is not to digitise, but to improve quality, safety, efficiency and the patient experience of healthcare.
With that ringing in our ears we are ready for the next year!
A year ago we were invited to be involved in the Future Health summit for the first time. We built a house as the theme for the event, from blue print to decoration eHealth experts from across the EU used the story of creating a new build as an analogy to describe how eHealth Ireland could build on the foundations it was putting in place to create an eHealth system that could deliver a digital fabric for health in Ireland.
A year later and we have a different theme this year. The eHealth Festival has been pulled together, imagine the process of moving from foundations to a woven digital fabric throughout the country and the complexity of doing this, we have landed on an analogy for this too, putting on the mega festivals across the world, Coachella, Glastonbury and Electric Picnic. Surely a task with a long term view, a success criteria that includes immediate success and bringing joy to millions of people. The team are working hard to put on the festival all day on Thursday.
The eHealth Festival is a truly global affair, taking lessons and experiences of digital health from across the globe and applying them to the plans for Ireland. The first stages will be to consider what it takes to find the right festival site and theme, applied to the delivery of eHealth this section will focus very much on how to set the vision for the future as thoroughly as possible. A number of key speakers with NHS experiences will provide us insight into how engagement was gained at a plethora of sites with very different focuses ranging from a wide ocal geography coming together to adopt a standards based approach to the adoption of an open source model across a major cities record sharing approach and on to a major London hospitals insistence to get it right and not ‘simply’ follow the model brought to bear before.
Every guest speaker has been set a number of music festival themed challenges over the day too, ranging from the slightly different event photograph to a whole series of theme songs being picked; some of the music could get loud! Picking the theme songs has been an important part for each of the presentations as it will reflect the theme of where the presentation goes, so listen out for that.
In keeping with the way eHealth Ireland has evolved over the last year there will be some focus on the way we engage on technology in health as well. One of our partners Think Visual will be able to provide a different insight into how to engage clinicians and patients in a different way, using pictures and visuals to create a journey for them to join us on. This promises to be an exciting look into the art of the possible in this area.
Our focus has been on health care and a somewhat traditional version of health care over the last twelve months, the ability to deliver a new paradigm of research capacity with digital health must not be forgotten, nor must the citizen choice in how this occurs. With this in mind we have a speaker with a huge amount of experience making a health charity digitally capable, the lessons we can take from this I am sure will set the agenda for us in this space.
As with last year we have tried hard with the theme and the brieif to speakers to keep the ‘sales pitch’ presentations away, at the eHealth Festival it would be like the Darkness reforming! But, we need to create relationships with the vendor community over the next year that is a for sure! So in keeping with the festival theme the vendor community will be putting on the record label A&R man guise and trying to encourage us to understand why their label is the one of choice, why they are the Factory Records of the 1990s and not the SAW of the 1980s.
To round off the day we have a speaker by very popular demand, an expert in information governance, information security and getting the handling of data right. Asking a lady from Liverpool to speak on the theme of securing a festival is always going to be a little dangerous so expect some fun to round the day off.
As with any great festival there will be a few secret unannounced shows too by way of a couple of announcements that should set a tone that is exciting for the next twelve months, initiatives with internal and external focuses.
All that really will remain to say is… Put Your Hands Up For Detroit – All will be revealed!
Originally written for and published by Horizon Business Innovation
The role of CIO is more and more about leading a team, and a team of diverse skills and capabilities at that. Healthcare CIOs are used to the term multidisciplinary team, it is intrinsic to integrated care delivery one of the key benefits of technology in healthcare, however the term can equally be applied to a team of IT professionals.
Leading a group of professionals with diverse backgrounds, motivators, knowledge and skill is one of the most important aspects of the CIO role I think. In December 2014 I was lucky to be given the opportunity to lead the digital healthcare function in Ireland. I inherited a team of around 290 directly employed staff and around 300 indirectly employed. As a team it was a group of people who cared passionately about the capacity, capability and function of IT at local levels but had not come together as a single function for many years.
One of the first tasks of the new role then was to bring together these local teams and build ownership of a national vision, a new operating model. By March 2015 the senior management team were able to unveil the route to the new operating model and begin transition, this was marked by the first ever all staff meeting. Bringing together all staff from across the country seemed like a simple but ambitious thing to do, particularly as the team had not done this ever before. The conversations for the day needed to be inspirational and we needed to use the team to make clear not just the new operating model but also the benefits of this. Bringing clinicians to the stage was the best way of doing this at this early stage and certainly the organisations national director for integrated care had the audience really understanding why the new operating model was necessary. The same event was also used to spark an interest in new technology with an Expo type area demoing diverse sets of technology from face recognition to drone tech to wearables.
By September of 2015 the route to a transitioned organisation had been completed, but in reality at this stage the most of what had happened had been a movement of the deck chairs on the deck of the big ship. Everyone now understood their new role but few people had moved to actually doing the new role. This led to the second all staff meeting being put in place, this time not just for staff directly employed but for all people working in healthcare technology across the country. The theme of the second meeting would be transformation and both the Director General and Secretary General of the Department of Health were able to open and close the event. The theme of transformation was illustrated by a number of conversations ranging from the new CIO of a major bank in Ireland talking about technology teams to the futurist view of a technology communicator and broadcaster. The engagement and enthusiasm created in the room was phenomenal and for the first time technology people in health were given ‘permission’ to go forward and innovate, to make mistakes on the way and to be more agile. The transformation process was really given a tremendous kick towards success.
So with transformation now underway it became clear that the engagement of the team throughout the country at a personal level would be of the utmost importance. With this in mind we altered the structure of the Senior Management Team Meetings making them fortnightly and moving them around the country so that as a team we were both visible and available to the organisation. We have a theory that if we can make the senior management team more accessible and more transparent in what it is trying to achieve then we will be able to take the team on the journey with us more easily, transformation to the new operating model was not going to be achieved overnight.
Motivation of a team that has delivered through the adversity of a huge financial downturn and crippling underinvestment in technology and personal development was never going to be straight forward. Meeting staff face to face and delivering open and transparent messages was to be a clear way to try to deliver for the team. Considering Maslow’s hierarchy of needs seemed to be a validation of the effort that needed to be applied. Taking an idea developed and evolved since the 1940’s and then applying this to a team of people in 2016 seemed uncomfortable at first but it has brought rewards and provided a framework for the change we need to make. Certainly we now feel we are trying to deliver on the top three elements of the hierarchy, provide belonging and reason, create an environment where staff can assert their own esteem and finally enable the process of self-actualisation to take place.
The use of social media as an engagement tool is not everyone’s ‘cup of tea’ (maybe that should be pint of Guinness after all I am in Ireland now not Yorkshire). For the very first all staff meeting we created a hashtag to be used internally for all team engagement, #ONEeHI. The SMT and speakers were asked and cajoled to engage on twitter using the hashtag and slowly but surely the identity of all engagement has moved to the hashtag, the latest all staff meeting has even simply become known as the hashtag itself. As we strive for the level of engagement and transparency that we need though we have been able to use social media to make each of the team real to those that want to engage in this way. Social media is not used ‘simply’ for these events but throughout the year as a way to ask questions at any time, as a way to see what thinking is happening where in the team and to simply make real the people that are involved in the changes.
We are a healthcare IT function and one of the next stages of the transformation was to begin the process of real clinical engagement at all levels. As a CIO and CEO of a health technology function I strongly believe that once the transformation has moved us to a platform that we can deliver upon more of what we do needs to be clinically led. So with this in mind as well as creating the single digital function for health we also started to create a clinical engagement function that became known as a Chief Clinical Information Officers council. We also appointed the lead role of this function to SMT to bring us the clinical diversity as part of the leadership team a decision that is bringing huge rewards to how the team functions and delivers.
With this in place and a promise in 2016 of bringing around 50 new resources into the team the next all staff meeting was in early March of this year. Over 300 people descended on Cork to hear conversations about connectivity, the need for us to make connections across the team to ensure that transformation really did become the way in which we worked. The first thing I had to do though was to apologise, we had made promises around new roles back at the September session that we had missed dates on which was a huge shame however being transparent and open around the process to get these roles into the team certainly gained us a level of understanding and engagement that we really needed. Again the Secretary General and Director General opened and closed the event with clear and exciting statements of support for what technology was doing in health and Director General urged the team to celebrate its success but be mindful that success brings more expectation, a powerful statement for a leader of such stature to make to the wider team.
The experience of physically bringing the team together in the days where technology connections are so powerful is still one I strongly believe has been hugely influential in the success of our transition and transformation. We have also used the technology available to make real connections through blogs, web-ex, podcasts, video, social media and animations but nothing has been more powerful than a room full of people who are enjoying the connectivity they are having so much that they are not even aware that lunch is being served and its time to go eat!
If you want to know more about the events have a look at the social media #ONEeHI or consider having a read of the three blogs that have been created ahead of each event at richardcorbridge.com or simply get in touch maybe even see if you can sneak in at the back of the next event in Galway in September!
First published as a blog article on in the Health Management Institute of Ireland Journal.
One of the most critical parts that must be carefully considered when creating an eHealth fabric for any care delivery system is not the latest innovation but actually how will the system react under the worst case scenario. Many systems deployed in the public sector have breached key project management quality criteria (time, cost and quality) due to the need to have a system that meets very very high levels of availability, but in some cases those high levels of availability have not been built against a business back drop but simply a series of assumptions.
In health this is different; if the delivery of health care becomes reliant on technology then technology must meet that need!
Once eHealth is part of the delivery of health care for a country it can’t be stopped. Imagine me in my role explaining to the department or minister’s office that this is not a once off investment; it’s not a project that ends. Investment in technology to support health care delivery is now part of the funding needed to deliver health.
In Ireland we have an accepted and approved strategy (eHealth Ireland from 2014) we have an approved plan to deliver this strategy (Knowledge and Information Plan from 2015) but we don’t have a funding profile beyond 2016 or a clearly articulated delivery vehicle for technology beyond the existence of the Health Service Executive which is said to now be on its final delivery focused journey. However Ireland took a giant leap of faith in 2015 that will begin to reap dividends in 2016. It was a simple leap, that if technology is deployed into the system it needs to be done so against a back drop of reliability and functional requirements; not new technology for the sake of technology.
Chris Hadfield in An Astronaut’s Guide to Life on Earth comments,
“Focus on the journey, not on arriving at a certain destination. Keep looking to the future, not mourning the past.”
This we feel is a great mantra for us to adopt for the delivery of eHealth Ireland. We need to take the permission derived from the strategy and plan and ensure that focus is applied to the benefits that can be released and in incremental steps that provide new benefits to patients and clinicians every step of the way.
For the first time in a decade the technology team of the HSE has permission to add resource to its headcount. This gives the team capacity to move at a relatively agile pace to implement the content of the Knowledge and Information plan. It allows the momentum around clinical engagement to be continued and will see the view of the future coming into reality.
The founder of Turntable Health in the US in early January commented,
“We’re in this sort of weird limbo where the technology is expected to do the heavy lifting, but we haven’t really transitioned the human relationship… it’s gone.”
Zubin Damania is clear in his comment that there is a need so well-articulated through the US experience in the last year to ensure where health care IT is implemented the clinical engagement needs to be kept at the top of the priority list. The eHealth team in Ireland continues to place this at the heart of what it does. The appointment of the Chief Clinical Information Officers council and now the leader of this group sitting on both the senior management team of the HSE Office of the Chief Information Officer and the eHealth Ireland Committee ensures that the voice of the clinician is so prominent in all that is being considered. This type of open and transparent governance will be added to in 2016 to include the patient voice, currently this is well covered with relationships with IPOSSI (Irish Platform for Patients Organisations) and the like, but we know more can and should be done in this space. An initial step into this area is the public consultation pieces, one has already been started in the area of the Electronic Health record and has seen a phenomenal response, a further consultation will be underway in January on the Privacy Impact of the Individual Health Identifier.
As Chief Information Officer I have an ambition I have been criticised for in the last year, that ambition is to not have any IT projects by 2020. This is not because we see IT being ‘finished’ in health in Ireland but because projects should be clinical or business change or continuous improvement projects, within those projects technology and/or information should be a part, not the raison d’être for the project.
Recently the CIO of New Relic Inc. was quoted in a similar vein,
“Successful CIOs will need to be more effective at managing the holistic technology and data environment regardless of who ‘owns’ the resources”
The office of the CIO within the HSE sees Yvonne Wassenaar’s comments here as being crucial to the ultimate position of the new resources within the team, this new capacity will not be seen as simply more technologists, the capacity will be the resource needed to bring benefit from technology and information within health in Ireland.
An exciting start to 2016!
Originally published in Health Management Institute of Ireland
The amazing work of Chip and Dan Heath in the book ‘Switch: How to change things when change is hard’ describes a series of analogies that reference organisational change. One of these is the elephant at the beginning of the path into the jungle with the ‘driver’ and a selection of passengers. This is almost the perfect storyboard for the implementation of an eHealth fabric into the health system of Ireland.
Let me explain, changing the direction of the elephant can only be done by the driver through brute force without the elephant being happy to change its direction. If the elephant is already on the path some way before the driver and passengers get on then it will be more likely to continue than if it is at the very beginning of the path.
You are not convinced still are you? What can this possibly have to do with the implementation of an eHealth fabric into Ireland I hear you yelling!
The formation of eHealth Ireland at the end of 2014 and the publication of the eHealth strategy helped Ireland understand the art of the possible, it didn’t start the elephant journey it simply allowed us to figure out there was a path, a driver and an elephant.
2015 has been the first year for eHealth Ireland, a year that has enabled it to define the direction, make some success of that direction and understand what next. We have started on the path; let us superimpose the Knowledge and Information plan as the path in the elephant analogy. The plan was published in the spring of 2015; it takes the great work of the eHealth Ireland Strategy and the thinking around this and operationalises it. The plan provides the health service of Ireland with a route to implement eHealth solutions that will come together to create the digital fabric that we all agree is so necessary for health to be delivered in a modern world.
The plan also describes the necessary operating model that the Health Service Executive’s office of the CIO would need to adopt to be able to deliver innovation whilst also keeping the lights on a service that is heavily reliant on the ‘human prop up’.
The operating model implemented by the HSE OoCIO is known as a Bi-Modal solution. As an organisational solution it provides the HSE OoCIO with the capability areas to manage operational IT and to develop and indeed deploy some strategic solutions that it needs until such a time as eHealth Ireland can truly come into its own right as an organisational entity.
So, back to our analogy, we have described the path, as the analogy says though to get the elephant to move along this path it will need to feel it has made some headway already. The OoCIO picked a series of projects and priorities to focus upon in 2015. The feeling of embarking on a journey needed to be felt right across the organisation and quickly if faith was going to be created in the delivery of an eHealth fabric.
The key priorities that have set the elephant on its path had to be wide ranging, some needed to be prioritised due to foundation need others were due to clinical or patient engagement, and all were to bring success of some degree in 2015. The four to pick out and reference here particularly are:
Individual Health Identifier (IHI) – At last a key data foundation for the assurance of patient safety through information, an ability to implement information security and a tool to enable efficient audit and management of the health service was implemented in September of 2015.
eReferral – Building on a successful pilot rather than closing it down with lessons learnt was the catalyst for this project. eReferral is the ability to utilise solutions in place already and to create a digital referral process from GP to hospital.
Chief Clinical Information Officers Council (CCIO) – The clinical driving force that keeps the technology enthused OoCIO on the straight and narrow. Ensuring that technology is here to solve a problem not look for one.
Electronic Health Record (EHR) – The signing of national contracts for the delivery of a single lab information system and the final clinical validation of a single Maternity and Newborn EHR as well as the publication of the EHR case for change ensure that eHealth Ireland is taking appropriately paced steps towards an EHR for the countries health system.
So, we now have the path defined and the distance we have travelled on it thus far clear to the elephant. We have the elephant, the health service itself, moving slowly but surely, methodically taking care not to break anything along the way. We have the ‘driver’ defined in the eHealth Ireland function and its structure and the passengers on the elephant as the clinical leadership and senior management team of the health service itself all being able to guide and influence the driver.
This huge elephant has fundamental strengths that need to be made the most of if it is to pass along this path. It has a wealth of knowledge and learning that can be applied to the movement down any new path if brought to bear in the right way. The ‘driver’ is well placed to ensure that the change in direction that sometimes will be required can be influenced rather than demanded, small incremental steps that keep the path illuminated will be a more assured way of getting to the end point of the journey.
However the end point of this journey is not a final drinking spot for the elephant but the continued evolution of a digital fabric to support the capability of the health service of Ireland, a grand ambition for the ‘driver’ and the team to have.
Credit and thanks to Peter Sondergaard of Gartner for the inspiration, advice and guidance.