Do you remember that school report moment, that evaluation and review of the academic year, the fear of what your teachers would say, or not say when your parents went to meet them? A year of hard work distilled to a 45 minute meeting with a bunch of teachers who, in some cases, were probably trying to provide feedback to maybe as many as 100 kids who had various degrees of motivation and ambition. It must have been a hard task for them and it was often a nerve wrecking experience for the pupil!
Key phrases from my school reports: ‘creative writing doesn’t always mean making it up as you go along!’; ‘Please follow the rules of emergency air supply on an aeroplane, secure your own work before turning to help others’; ‘Less communicating and more concentrating will bring more academic rewards, but will make the class a dull class’; ‘Richard’s passion for campanology outweighs any I have ever seen in any teenager’. The last one holds a dear memory for me as a retort from my Dad, who exclaimed he knew I liked camping but thought I wasn’t the only one in school in scouts!
So, a year into the role in sunny Leeds, a year in to concentrating in a new way on what a digital fabric can do for health and care across Leeds and I thought it would be good to try to put together my own school report. A progressive ‘school’ like Leeds would allow the pupils to put together their own review as long as it could be challenged in a fair and productive manner by teachers and peers, so here goes.
First subject to be graded has to be Delivery. I think the #LeedsDigitalWay deserves a B- for delivery in the last 12 months.
Delivery Grade – B-
The first 100 days saw a sea change in the way the team worked. The objectives of what we wanted to do were made clear and the team began to evolve. The ‘simple’ action of getting board approval to invest in the PPM+ solution as the Electronic Health Record (EHR) for Leeds until at least 2022 has seen a new concentration on the process for delivery. Leeds has delivered against an agile methodology for over five years but now delivers on a monthly release schedule; new functionality defined by the clinical team lands into live each month. A new focus on the release function and now the way that test, development and integration work together has brought about some immediately noticeable changes, largely the enthusiasm and engagement that the clinical team has for the solution has improved significantly.
Deliverables such as the A&E dashboard, flu reporting, tasks and jobs inside the EHR, the implementation of Forward, the delivery of the eRespect form, Nursing eObervations, single sign-on for all and even simple changes like the opening of the internet to ‘real’ use has seen a continuation of the acceptance that digital is a hugely important part of what a hospital needs in place every single day.
Scan for Safety and the mobile EHR solution are fast becoming a way of life in Leeds. Not new gizmos but a way to enable the understanding of patient flow and a way of capturing information without fingers being needed on a keyboard. Scan for Safety also is an illustration of LTHT-wide partnership working and what can be achieved when a delivery is led not by IT but by clinicians and key impacted departments.
The delivery of new infrastructure for PACS, Digital Pathology and the new Genomics service all considered to be that unfortunate term, ‘back office’ deliverables, but all crucial to the acceptable running of the digital fabric of the trust are well underway with a limited resource to make them happen.
A slow but steady reform of the way service management is delivered has started to take shape as has a new way of thinking for Information and Intelligence (I&I). The organisational change elements are now in place to enable a function within the I&I capability to focus ‘just’ on data within PPM+, something LTHT has been trying to make happen for some time.
Why the dropped marks in this area? Expectations have been set really very high and whilst the resource to deliver has been changed in its structure it hasn’t changed in its capacity in any dramatic manner. A phrase I think should be avoided has been used too often: ‘do more for less’. Outages have occurred on three occasions, all managed well with no patient impact but in all three cases these outages could have been avoided. On the positive side, key lessons have been learnt and business continuity lessons and disaster recovery plans are now well honed.
When in Ireland I was once challenged by a senior member of the team to spend a few months in the garden shed away from the team and the email. The meaning behind the comment was I was pushing at a speed that the team needed a rest from. I think I drop marks for not learning that lesson as well as I could have. We are going at a pace in LTHT that will tire the team out if I am not super careful in 2019 and therefore I do need to look around and be sure that the delivery ambition we have is met by the resource we can apply.
Culture Grade – B
Building the team I want to work in is always important to me in any leadership role that I have had. Putting in place weekly updates (Can you give me two minutes) and hitting these for 52 weeks in a row has been an important way to show the width of the team how we can act as one. The creation of the #LeedsDigitalWay and the associated goals, vision statement and key strategic plans have not been created in isolation by the senior management team but, following the ethos of the Leeds Way, these have been done through crowd sourcing and via the wonderful ‘Very Clear Ideas’ process.
I feel the team is engaged, not entirely, but better than many would be in the ideals of what we are here to deliver. That is largely because the LTHT culture, the Leeds Way, gives me a jump off point that I can simply add to, but this has to be seen as a great benefit.
The whole team has had the opportunity to come together four times in 2017/18 as a digital team of leaders in the digital health environment. The meeting is not mandated (nor will it ever be) and has seen a steady increase in numbers for each gathering. One of the best moments of the year was the morning after the third All Staff Meeting being stopped by another early riser member of staff to be told they had put the next meeting in the diary already and would be telling all their colleagues how important the meeting was for working in the team – superb, immediate and honest feedback.
It is often joked that only those ‘great places to work’ organisations get IT and Communications right all the time. We have tried to get the level of communications right but in a recent staff survey the team wished for more, so now we move to consider all the different styles of communications we have and how they impact upon the culture.
To me the Leeds Way is our culture and our values with a digital ‘sheen’ applied to it. We have come some way in 12 months but I can see the gaps that we need to improve on.
The reason for some of the ‘dropped marks’? We are going through organisational change and are desperately trying to get that right at every juncture, but we haven’t always been as successfully as I would like us to be. As soon as we create an open culture which we have done then we have to have the capacity to listen and act on opinions that are made clear to us, we are trying to get that right but we are not quite there yet, could do better may be the school report language best used here.
I think we have been able to pick up extra marks though for team development opportunities. In 2018, we were able to be part of content delivered by HIMSS, KLAS, HSJ, CHIME, Digital Health and BCS. We have opened opportunities for staff to apply for the Digital Academy, a hugely important leap for us, and had 10 interns join the team, many of whom have stayed on in some way. Exciting learning prospects for all of us continue to be available across the team and will remain a high priority for us in 2019.
Engagement Grade – B+
The awareness of the LTHT digital journey at a national and international level has doubled in the last 12 months. We have been successful in ensuring that when somebody wants to understand how to deliver an EHR in the NHS then Leeds is one of the top five places they think of. Being able to take part in the Arch Collaborative and achieve the Net Experience score that we did showed the engagement the large proportion of our clinical staff feel for the systems we have deployed.
Leeds’ success has been represented on three continents this year and is synonymous with clinical engagement, an open attitude to delivery, an inclusive ability to resourcing and a willingness to share. If I were to write my own obituary these would be words I would want to see and therefor I think the B+ is justified.
We have been able to bring leaders from across the health and social care system to Leeds to show them how the front line of digital health is really working and I would like to think that has impacted on policy in some small way.
The reason for the dropped marks is, despite the geographic location working for us (Leeds is after all the home of over 20% of the health informatics staff of the NHS), we have yet to truly make the most of Leeds the place. With so many organisations in Leeds that focus on digital health, our own position in that eco-system still needs to be eked out.
Innovation & Technology Grade – C-
Next year I have to focus more on this. We have so many ideas and so many amazing offers of help to make those ideas come to life but time and resource has run away with us too many times. We have been able to get the infrastructure for Single Sign On in place and the migration has largely gone well. Piloting the linking of devices to this infrastructure, not just the software side, is a remarkable feat I think.
I would have loved us to have our first implementation of cloud in place in 2018 but we are still a little way away from that. We have well formed plans for AI access to some specific solutions which I believe will be transformational, but again they will be early next year.
The speed of the systems we have and the reliability of the solutions they are hosted on has improved ten-fold, but user expectation outstrips our current capability to keep up. The work done to make the regional integration capability ‘bomb proof’ is outstanding but took us longer than we thought.
We know how we want to innovate and even who with, but in some cases we have come unstuck as we try to find ways to create relationships. For us, the way we have worked with Forward in 2018 has been a real test of how an NHS organisation can create a true partnership with a new innovative company and really build benefit. Being able to ‘gift’ the content of the Axe the Fax toolkit to Silver Buck for them to industrialise and make available to the wider NHS is another great example of an innovative approach with a new partner.
If ever there was a category with the immortal school report words, ‘must try harder’, it would be this area. I need to consider how to deploy more resource here to give us more chance at being truly ground breaking in this arena in 2019.
Collaboration Grade – C+
Achieving the Local Health and Care record Exemplar (LHCRE) status was clearly done only by collaboration across Yorkshire and Humber and was a big moment in 2018 for all of the team. Collaboration across the city area on the Leeds Care Record remains a highlight of the job and being able to represent Leeds as the platform with my fellow Proclaimer is something that enthuses me every time we get the opportunity to do it.
The dropped marks though here are because I know we have not played the part we should play in the West Yorkshire collaborative to the same degree. Something that next year I will prioritise is ensuring that the blueprinting work we do can be shared first and as a priority with colleagues across West Yorkshire. I know that we have the basis for a great relationship and one that will enable a better platform for patient care if we can find the right projects to collaborate on.
In the school report it was those summary words that always cut to the chase the most, the form teacher comment on the future challenges for the student and the head of year views on focus for the coming year.
I think if these words were being written about me after this year they would go something like this:
A successful start to the new school. Needs to keep a closer eye on the detail and avoid getting distracted by some of the wider picture, even though it is important to still see this and bring it back to the ‘school’ – we need to have all of our own foundations in place before truly looking to help so many others on the journey. The class (the Digital and Informatics Team) needs the focus to be slightly more on them than it has been on some occasions in the year. The key challenge for the next year is to keep moving at the current pace but with the whole class on the same journey. This will be difficult to achieve with the expectations that have been set but is entirely doable with the skills available.
… and if that was the summary I would sleep well at night.
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.
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.
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 HIMSS UK in November 2016.
Answers to questions can change the world, of course they can! When I fly I so rarely check a suit-case in that I had forgotten the words that you are asked before every flight until this year’s summer holiday. Did you pack this case yourself, are any of these (dramatic wave over picture) items in the case, could this case have been tampered with?
Western, male, childish human behaviour always, always makes me want to answer different to how the desk operator expects at this point, but I don’t, I behave and move along the line. But this summer holiday season these questions did get me thinking about the parallels to healthcare. Are the questions the right questions, are they based on enough background information, are they asked at the right time and does anyone really consider what the answer could be?
In Ireland we have three projects known as Light House projects, specific disease areas of focus where we have applied investment that has delivered learning and solutions for the healthcare system. Interesting in the context of question asking in particular is the Bipolar Light House project; one of its early deliverables is a solution that allows the person suffering with the disorder to record their feelings daily. In time and with the patient’s awareness the questions will be prompted by other data, for example has the person been outside today, exercised, and interacted with others. The question and the context of the question is just as important as the answer in these circumstance! And yet current ‘best practice’ is to ask at each consultation, how have you felt over the last month?
And to match the current best practice we also have human nature, where the obvious answer in Ireland in particular is, ‘Grand, thanks’.
Cause no fuss, almost regardless of disease type is the patient ethos when it comes to the sharing of information, and perhaps even more so in complex mental health areas. If a patient wants to share information then it is our role, maybe even our main reason for being in the digital health industry in the future to enable this to happen.
Are the questions the right questions to ask, clinical practice knows because of the wealth of knowledge that clinicians have what the right questions are and how they need to be asked. This is fundamentally why we need clinicians involved in the design, build and test of every system deployed into our healthcare system. Seeking clinical support from the design phase onwards is not a simple task though, design comes with personal perspective and opinion and therefore getting to a point of consensus is always going to be difficult. Maybe then the arbitration vote on the design of an information system that is asking questions should be the patient, to truly deliver contextualised care where the right questions drive a type of care that is infinitely safer, more efficient and makes the care delivery feel like the fast lane for baggage check in and the first class lounge at the airport!
Questions in health need to be based on enough background information to make a difference to the care that the patient is going to receive in a short space of time in the initial consultation. Systems need to inspire the right question.
The airport questions have to be asked at the right time, in health we need to consider are our questions asked at the right time and by the right people. One of the most common perceived benefits to an EHR in an acute hospital is to remove the need to keep asking the patient the same questions over and over again, not just because, lets face it, it doesn’t instil confidence in the patient or the delivery of care but because it is simply inefficient and unsafe. But really an EHR in an acute hospital can do so much more than fix this issue when it comes to asking the right questions.
As Ireland prepares to go live with it’s first EHR in the maternity hospitals of the country we can see a huge enthusiasm amongst clinicians because the system is going to prompt them, based on data, to ask questions against early warning algorithms. The questions will be prompted because the patient is at the centre of a new type of ‘network’ where devices that measure are plugged into data and where the two spheres of influence, the measure and the data, can come together to inform the intelligence of the clinicians so much more than simple observational charts allow us to do today. That’s is why we, the health technologists, got into this business really, the connectivity of technology that allows us to create an Internet of Things that has the patient at the centre, maybe a new name for IoT in health, the Internet of the Patient, IotP!
If you did decide to answer the airport questions differently to the expected answer what would happen? I would hazard a guess a serious double take would be the first thing as the clerk behind the desk has probably never had anyone answer in any way other than to confirm the answers they expected to hear.
But when formulating the questions does anyone really consider what the answer could be? Imagine if a patient answered differently to expected, how much would it throw the care process. In 2006 I was seriously ill in hospital, no one knew why, no matter what questions were asked the team couldn’t get to bottom of it, so they put me in ICU and wired me up to every possible machine, turned down the lights and observed, when the questions fail observation and time are the only keys to unveiling the true nature of disease and illness. Questions answered can come from so many different quarters, in my case the fact I had travelled overseas was the key to unlocking what was wrong, but that took a more casual conversation than how are you feeling and could only be got to once I was stabilised. Somehow the ability to unlock that information needs to be a new focus for health if we are to deliver contextualised care. However the care that needs to be taken in unlocking the data and delivering it to the clinician needs to be significant, as Frank Buytendijk, a Gartner researcher has been describing for several years this could be considered to be ‘crossing the scary line’. The impact on care that data can have is phenomenal, but, two key actions need to be considered, firstly can the clinician handle the volume of data and second what privacy elements is the patient willing to give up to enable the clinician to have this information.
Imagine if we could give an answer that could cause a different question to be formulated! In so many other sectors digital information has already enabled business disruption to occur. If we can get to the point in health care where the question of the patient could actually move from how have you been for the last month to one where the clinician and patient already have the core data shared between them, the conversation can then move away from how to why and then to prevention. A clinician recently told me that the outpatient appoint for him, a psychiatrist, was as much a reminder to review the notes of key patients as it was an actual face to face appointment, with the right systems delivering the right information to all parties then that can become a shared responsibility and the mantra from the UK of no decision about me without me can be taken up even more strongly.
Next time I check a bag in at the airport I think I will have a little more time for the person asking the question, really they have an important job to do in simply asking the most simple of questions.
First published in CIO Magazine in August 2016. A collaboration with Elaine Naughton in the writing and development of this idea, a huge thanks to Elaine for this.
In the excellent Steve Jobs biography by Walter Isaacson, he describes a discussion between Jobs and Steve Wozniak where Jobs is explaining to Woz that the role he plays in Apple is that of an orchestra’s conductor, here to get the best out of the team, to ensure that they play in harmony and deliver to the listener the most inventive and yet classically rich vision of the original design. This conversation is said to have taken place after a strong ‘debate’ just before the launch of the iMac itself, Woz described by Isaacson had just exclaimed to Jobs that he was neither designer nor engineer and therefore did not really warrant or justify the recognition he was getting as the ‘re-saviour’ of Apple.
Is the creativity of the conductor the real line to success in IT leadership? After all the ‘band plays on’, or at least tries to, whether there is a conductor or not. Even as early as 1998 Jobs was describing, I think, what the modern CIO now needs to be, although maybe we now need an evolved model from conductor to DJ or rock and roll front man.
Why does the analogy and the model need to evolve? Well, in times gone by, the IT leader would have sought out the best in class people he needed. Much like creating an orchestra of around 30 talented artists, the Leader had to be the best that the orchestra could afford and then the conductor had to make them fit into the team, not always an easy job. The ‘prima donna’ persona of the highest calibre technologists is not always easy to integrate into a high-performing team after all. This then, perhaps, is where the evolved model comes in.
The leader of a rock band enables the band to “jam” develops a structure and order to remain in time, and chooses a rift as well as creating a tune as they play. Maybe this roll can be best described as the start-up innovator of the music scene. A band always needs a front man – someone with a vision for the sound they want to achieve and the charisma and charm to wow an audience, the band may play on if the front man leaves, but rarely as successfully; what would U2 be without Bono? or the Rolling Stones without Jagger? Queen without Freddie? Perhaps the best real world example of the rock star digital leader is Larry Ellison of Oracle, truly a front man if ever there was one to be seen in digital leadership. The owner, founder, creator and beating heart of the Oracle empire, whilst no longer leader in name still very much the charismatic front man of the brand and indeed, band!
An orchestra, on the other hand, follows a very strict plan and each of the upwards of 30 members (over 50 for a symphonic orchestra) knows exactly what they need to play and when, whether it is solo or synchronised with their team (by virtue of the score). Only the conductor knows the full score and reads all lines simultaneously, knowing who to call on and who to bring in exactly when they are needed for the orchestra to continue playing in harmony and in time, and for soloists to have their moment to shine. A digital leader in the style of the conductor does just this. The danger here though, is if only they know the full picture, keeping everyone focussed takes a huge amount of energy and enthusiasm. Many public sector digital leaders are of this style (often by necessity) as the full picture is in reality always being altered and reconfigured a small amount by the political leaders and paymasters.
The conductor’s role is an art form and a talent, while being a very technical job. Take the conductor from this and time signatures slip, the musicians become discordant and eventually chaos ensues. Just as with Jobs and his temporary departure from Apple, as conductor of that orchestra he was never truly replaced and therefore for a time the music was not what the audience needed to hear. The creativity, in the sense of innovation of the music, belongs to the composer rather than the orchestra or conductor; with this in mind maybe we need to see the digital leader as composer and conductor more often!
A DJ, unlike the conductor or rock band front man, can take the best work of a much wider variety of stars, mould them together until they find the right mix and then play it for the audience. The DJ doesn’t have to integrate the full character of the artist just that moment of excellence where the beat fits or as the very wonderful NetFlix original puts it, ‘When the Get Down arrives’! A modern successful digital leader then is going to be a DJ! If we consider the ‘gig economy’ to be the future in digital then this kind of character and behaviour is likely to become even more prevalent when building successful teams. The magpie-type ability to bring all the best bits together for one moment of excellence that then can be repeated.
We believe the skills of a DJ are also key traits of a transformational leader: someone who motivates and energises their employees to get behind a transformation strategy, creates something that has been written about many times before, the creation of a fan base if you will!
The styles of these three analogies allow us to consider the nature of digital leadership. There is a mix of two key styles here, one is transactional the other transformational. The conductor is transactional, planning, organising and controlling. The DJ is transformational challenging and changing organisational culture, coaching and developing people, creating a climate of trust, establishing a long-term vision. The front man perhaps mixes both styles dependent on the need of the audience or band members, an ambidextrous style that is agile and responsive as startups require to be.
The analogy can continue in a number of ways beyond just the parts of the mix. A DJ brings with them the theme and the end point they are trying to get to, much like a high performing digital leader needs to, they start with the end in mind. Also, the DJ needs to be aware of the change in trends, evaluate them and consider how to adopt them into their fabric, so much learning of how this is done from both professions; I would love a temporary job swap!
The Jobs autobiography also describes the moment that Woz and Jobs first met from Woz’s point of view, “We first met in 1971 during my college years, while he was in high school. A friend said, ‘you should meet Steve Jobs, because he likes electronics and he also plays pranks,’ so he introduced us”
Jobs and Woz learnt they had so much in common, and yet were so different. The wonderful “Small Data” book by Martin Lindstrom references a Harvard Business Review article by de Swaan Arons, van den Driest and Weed called “The Ultimate Marketing Machine”. The article suggested that there are three types of people needed to make a marketing company successful, they are:
Think people – Who focus on data and analytics
Do people – Who have responsibility for content, design and production development
Feel people – Who are all about consumer engagement and interaction
I wonder if the modern digital organisation can apply this exact same logic as has been done here for the marketing team. The types of people the IT leader needs to bring together are defined less by their technology specialty and more by the person type they act when they are in a delivery focused team. Back to Jobs and the Apple empire, the success of the original swathe of ‘i’ products has always been put down to two elements, one, Jobs own meticulous eye for detail and two, the design standards of the team under Sir Jonathan Ive. If we overlay the commentary from the article in the Harvard Business Review referenced above and the conclusions that Lindstrom himself makes on this article we start to see that the way this team has been successful is by ‘minding the small things’ by being a team that is led by a digital orchestrator but exists as a team that can deliver empathy together, to the benefit that is trying to be attained.
A modern, successful leader needs to be a strategist, a “front-man (or woman)” AND be able to conduct a complex set of teams in a harmonious way – or at least empower capable section leaders (upper strings, lower strings, woodwind, brass, percussion) to do so on his or her behalf.
The theories of Lindstrom in Small Data will blow your mind, you regularly turn a page and laugh at the conclusion he has made and how it applies so completely not just to modern marketing ways of working but to how the right digital function needs to deliver. Whether as leaders we are badged as CIOs, CDOs, Conductors or DJs we don’t care, we just want to be able to make IT work.
…… as a post script we really do care! Two IT leaders were involved in the creation of this article, one of us wishes they had taken the path of enlightenment and become the superstar DJ of their dreams the other is progressing from playing second fiddle in a growing orchestra to becoming a conductor and leader of a great band.
When a member of staff offers to put you in a shed at the bottom of the garden for the next 12 months, what does it mean I wonder? So far my time in Ireland has taught me so many new phrases. Most hilarious was learning what being ‘put on the long finger’ meant, however today on the eve of our all staff meeting the concept of asking the leader of an organisation to go and hide in the shed at the bottom of the garden for a little while I thought was uniquely Irish, turns out its not. It’s perhaps a bit unique to the style of CIO I aspire to be.
The all staff meeting occurs twice a year. It has become traditional to try to pull together a blog post for each of these on the eve of the event that sets some of the tone or theme for the day, gives us something to reflect back on and adds a bit to the conversation as the day progresses. The theme for the staff event this time is quite simply ‘Delivery’. We have had ‘Transition’, ‘Transformation’ and ‘Connectivity’ and now we move on to the ‘pointy end’ – delivery as a theme!
Delivery style applies nicely to the concept of the leader of any organisation being put at the bottom of the garden for a little while it would seem. In just under two years the team has moved mountains, to completely re-structure a function and put in place a national focus that organisations like the World Health Organisation are giving Ireland credit for. The credit for making this happen goes to every member of the team though.
But, when the team offer a ‘deluxe shed’ for a few months to the leader it is time to stop and ask why. Strategy and delivery go hand in hand. A CIO needs to be able to do both simultaneously, Grand plans badly executed will not change the way healthcare is delivered in Ireland nor will rushing at a problem head long without a vision in mind. It is well documented and in the public domain the distance Ireland has to travel with digital health. It has become a little too easy to move quickly without always the consideration needed for keeping the whole team on the same path.
One of the key principles as we moved to transition and transformation of the team was ‘don’t break anything’. We haven’t, but maybe on some days it feels like we have come really close. We are currently operating a resourcing style probably best described as robbing Peter to pay Paul. Not ideal and maybe one of the reasons why a proportion of the team wish I was away in the garden shed for a short while. A further principle though when we started this journey was to keep delivering new things, not to go away with a long term plan that had no new early benefits to the delivery of health. That requires a balance of strategy and operational delivery that isn’t always there for technology teams in health but Ireland has been able to make this work better than I have seen anywhere else.
The most successful of teams are really hard to create. They certainly do not come together ready formed and need a plethora of different elements to make them work. Sport is littered with examples where teams do not equal the sum of their parts and the results simply are not there. Take the difference in commitment from this year’s soccer Euros. The most telling moment of sport TV for me over the summer was a comparison of the Ireland and England team getting off their team bus. The England team exit in ones, big Beats headphones on, no interaction, and no conversation just 12 super stars in perfect isolation. Cut to the Ireland team, talking to each other, gesturing at the stadium, practically hand in hand ready to meet the challenge. The team in white had one of the worst sporting performances ever and the team in green one of the best ever, in my view. Certainly as we head to the qualifiers for the World Cup I am hoping my adopted home allows me to be one of the #BIG rather than a miserable man in white.
The leaders of these two teams had very different sheds. England seemed to have a shed that was strongly built, just a small window and an appointment system to come in for a look with edicts passed under the door every couple of hours about what to do. The analogy for me of the Ireland shed was more of a gazebo, open access, everyone able to see what was happening, to share ideas and move the whole structure easily moved around.
The need to deliver is a pressure the team has to try to handle daily, and that pressure comes from an unwavering pride in what is being attempted. The team has embraced the concepts of the new operating model and is trying hard to make it work often in the face of some adverse conditions, but each small success moves us one notch further towards creating a digital solution that can tangibly make a difference to the way health care is delivered in Ireland. The need to keep delivering, to prove what eHealth Ireland can do, is with us all the time. No matter each success, the media will always find a story that does not play the positive element of digital health. Whether it’s the fact that the wider eHealth Ireland eco-system has sought guidance from an organisation that is globally recognised as a ‘digital-first’ organisation (and for writing about restaurants on that platform) or that eHealth Ireland has pushed hard to be part of the NHS CCIO/CIO councils, these elements do not serve the organisation well in the width of the Irish conscious and perceptions of what is being delivered. And yet they do serve the ability to deliver well!
Camaraderie has to be a big part of how the team works, and that can’t be forced to occur. We are trying lots of different ways to create small eco-systems of support. The amazing initiative from the team around eHealth Moments starts to really put new and exciting opportunities in place. A safe place where the team can share experiences, ask for support, get to know each other or simply understand the many projects and services that are delivered, all on one platform where staff are able to introduce themselves with this now world changing words…
Hello my name is…
I can’t wait to see the way this will bring the team together, and after all, as a digital organisation dispersed across the country, we should absolutely use the tools to hand to achieve improvements to the team culture.
Dare we ever try to emulate the three musketeers’ motto in eHealth Ireland I wonder? It is cheesy but a very good friend used to have it on his email signature, ‘All for one and one for all’. We are trying to get there. I know there will be some of the team who read this who are not sure if they really fit into this, and yet I am committed to get everyone in that shed with me, that’s the style of CIO I want to be!
Times continue to be exciting. An old boss of mine in the National Programme for IT was fond of saying to staff as she passed them in the corridor, she speed walked everywhere,
‘No one said it would be easy, everyone said it would be worth it.’
So rather than just putting the leadership (or worse just me, I need some help) in the shed at the bottom of the garden, who wants to join me, we can break the rules, change the rules and support each other in being committed to delivering, we can strive to keep the positivity and sometimes ignore the negativity.
First published in the HIMSS British Journal in August 2016.
Turning grey hair to darker hair to protect youthful looks has been a trend for decades, and yet in IT we want maturity to not be grey, kind of odd really! Whether we are calling it shadow IT or grey IT it doesn’t matter. What does matter is that every national health system that has tried to implement a country wide digital answer to connected health first, has to at least understand the different shades of grey that exist in the system.
This has to be done before any success can be made of a national solution.
No matter the pantone of grey that has been implemented it will exist in health perhaps more than in any other business area. Why is health so grey in its IT delivery? I would suggest it’s down to health lagging behind in the ability to innovate and adopt new technology particularly at a national level. Local health technology projects are able to adopt business change and technology at a rate akin to the consumerisation of digital, but ask a national system to do so and it is like asking the plumber how much for the washing machine to be fixed, a whole lot of teeth sucking and estimation ensues. Engagement in grey IT is also a huge factor, a grey IT solution probably is clinically led from the offset, as it is highly likely that a clinician has championed the greyness and because of this a national public engagement is not going to be necessary, because locally it can normally be achieved with less concern due to the smaller implementation scale. This element I worry about the most though, how many grey IT projects meet the data protection requirements applied to health are or indeed the cyber security protection that health needs more and more of? And as a health IT leader how many projects are you going to be asked to take on when the going gets a bit tougher.
But back to that plumber! My suggestion is back to the old business change chestnut! To make national IT solutions works requires national business change solutions to be implemented, and funded. Government and healthcare systems globally want to use technology to standardise the delivery of healthcare and yet we now all realise that the way to success is to enable clinical choice and to build the project on sound business change principles, clinical standardisation may be an outcome of the delivery of national digital solutions but should not be the reason to implement.
In recent months we have seen the NHS launch two ambitious plans to reveal the local digital maturity of the entire service; the answers were startlingly different from locality to locality. Again we find ourselves asking why the dramatic local differences and does it really exist. I would suggest differences do exist, prioritisation at an NHS board level and the starting point even further back will have had a huge impact; however by far the greatest impact on any new understanding of a national maturity is the incentives to reveal all. If the assessment can bring money then the wiley health organisation may well down play their current position to get their hands on much needed funding. However on the other hand if the assessment is going to place the organisation in some kind of league table or ratings created then the opposite will occur.
Here in Ireland we have a digital immaturity in health that is well documented, and yet we have some centres of excellence in disease areas or locations that rival other parts of the world. We need to assess how to build on these centres and we need to work out how to share better. The reform of the Irish healthcare system that is underway has an objective to create larger, sharing focused organisations, doing this for digital is going to be a challenge but is at the heart of the next stages of our five year plan.
A digital maturity understanding across the health sector is being approached by Ireland’s CCIO network, rather than asking IT leadership directly we will ask the clinical network to describe what they think of the maturity of the organisations they work within in the first instance and then go back to validate with the expert technologists, hopefully cutting out the issue of perverse incentives coming into play as much as possible.
The results of this will then drive not just a prioritised work plan for implementations like the whole Ireland maternity and new-born system and national lab system but will also be used as an investment case and readiness starting point for the implementation of the Electronic Health Record.
A clinically led view of the greyness of digital and the need to build the foundations on this could be best summarised by using the famous hair product catch phrase, ‘why take two bottles into the shower when one will do,’ in other words let’s get one digital maturity understanding done once by the right group of people to do it!
And as we started with the Grecian 2000 metaphor lets finish with ‘It lets you decide, day by day’, in other words brings out our natural and real ‘colour’ of IT in health!
First published in HIMSS engagement and integrated care…
At the 2016 EU eHealth week in Amsterdam a number of commentators made an example of the clinical and patient engagement coming out of Ireland around the digital health landscape. This from a country that until recently had made little impact on the health IT area due to past systemic underinvestment and a lack of agreed direction.
In the last 18 months Ireland has rapidly began a programme that it describes as its Knowledge and Information plan. The programme sees Ireland learning from the success and errors of other jurisdictions with an expressed desire to ‘leap frog’ other countries and put information at the heart of its healthcare reform agenda.
Richard Corbridge is the Chief Information Officer of the health service in Ireland and the Chief Executive of the entity the Irish government has formed to achieve its digital ambition, eHealth Ireland. One of the first appointments made after its formation was to put in place a Chief Clinical Information Officer, this role was awarded to Yvonne Goff a radiographer by clinical background and now Ireland’s technology professional of the year. We asked both of them to comment on the recent success Ireland has had
Yvonne Goff wanted to comment first on clinical engagement,
‘It has been over twelve months since the Council of Clinical Information Officers was established with the aim of bringing together clinicians and practitioners to guide the successful delivery of eHealth solutions across the Irish healthcare system. The council is composed of clinical leaders from diverse backgrounds including, leaders, academics and suppliers, the CCIO has expanded to a network of over 200 members across many regions and disciplines.’
Richard Corbridge added,
‘The number of engaged clinicians in Ireland has been a key to the success of several projects in 2015/16 and continues to be the bedrock that we build engagement upon. It has been commented on that over 200 CCIOs is a large number and we have been asked how can they be so engaged? The reason why is the absolute desire to make the eHealth agenda work and deliver for patients and clinicians. The CCIO in Ireland has been formed to provide not just an advisory group but a clinical leadership workforce.’
The CCIO in Ireland is able to highlight the importance of collaborating with clinicians to ensure projects can be designed, developed, and delivered successfully.
In order to build an understanding of the benefits and implementation capability needed for an Electronic Health Record; eHealth Ireland is investing resources into three clinical project areas – epilepsy, hemophilia, and bipolar disorder. These projects are known collectively as the Lighthouse Projects, each are clinically lead and the CCIO collaborates with a number of other academic and charity organisations in order to advance and deliver these important projects, all in one year.
As well as building the clinical engagement Ireland has had to rebuild its technology function, up until early 2015 it was a function that was able to deliver local excellence but had not been able to work as a single national system. Under the new function of eHealth Ireland and the Office of the CIO the function has evolved to become a truly national set of functions. The CIO has achieved this through a continuous engagement process, adopting digital solutions to engage the staff who are located throughout Ireland. The team has used a wide range of tools to continue to evolve this engagement. Richard Corbridge described these different tools and initiatives,
‘The first thing we had to do in this space was to bring staff together for a face to face, something that in nine years that had not happened, we agreed to facilitate this happening twice a year and so far these have gone extraordinarily well with teams having the opportunity to present their projects and a series of guest speakers ranging from a futurologist through to an academic on the theory of communications. This has galvanized engagement from within, inspiring staff to take control and further drive engagement. New projects have been started by staff such as #eHealthmoments an enterprise facilitating staff to connect on a deeper level using digital technologies and Quality Innovation Corridor (QIC) Programme an initiative to open up innovation pathways through which clinicians, in collaboration with eHealth Ireland expertise, can seek seed-funding for creative digital solutions and assistance in deploying these.
However he does then go on to describe how different solutions have also been required to keep building on the engagement and enthusiasm,
‘We have recorded video interviews, and podcasts some of which have been broadcast live featuring all of the senior management team. We have used animations and story boards extensively to build a level of knowledge of each project and have used these to facilitate a wider understanding for all citizens of what it means to create a digital fabric in health that is needed to achieve a truly integrated healthcare system. One of the health system in Ireland’s core vision statements is to be transparent, social media engagement has enabled an explosion in this area. Project leaders and team members have embraced this vision and really built networks of people willing and ready to engage. It was a real shock to the system to see leadership openly engage through the use of social media; however it has now become a normal solution for communicating, which has truly been inspirational for the health system.
The continued evolution of communications with the CCIO group has been equally important to Yvonne Goff who explained why,
‘To me it is hugely important that the CCIO group continues to grow, expand and diversify to ensure that they are best placed to deliver for Ireland. The building of relationships with other CCIOs, advising appropriate direction for best practices around procurement and adoption of eHealth solutions is our reason for being.’
She went on to say how this engagement has been achieved, ‘the CCIO recognises that one of the most effective ways to engage and collaborate is through social media and digital networking. The twitter handle @CCIO_IRL is used regularly to communicate with clinicians, health informaticians, and other interested stakeholders. The CCIO also regularly take part in discussion and discourse on social media and in the CCIO discussion forum. The CCIO successfully hosted #irishmed Twitter hour resulting in its second busiest hour generating nearly five million impressions. The CCIO come together once a quarter as a group and are embracing digital solutions to ensure that the most can be gained from each meeting.’
Yvonne Goff then summarised with the rallying call, ‘the CCIO is making a positive and lasting difference to Irish Healthcare. And through discourse, collaboration and important projects it is committed to working together in order to implement clinically lead solutions that improve the quality of healthcare and the well-being of Irish citizens.’
The two leaders of the Irish healthcare IT revolution clearly have engagement as a priority, Richard Corbridge went on to round off by saying, ‘we need to take the whole system on a journey, we have managed to create a great environment for clinicians to become part of the team, we need to do the same for citizens and patients, the eHealth Ireland committee recently tasked us with recruiting a patient to the key governance function of Ireland which will be a great starting point for person centered care to truly come to fruition.’
He finished by saying, ‘a friend recently used the phrase ‘legitimate theft’ when describing the sharing of best practice, Ireland has done this to create what it has put in place, the offer is there for any jurisdiction to come forward and reuse what has been developed here, shared learning is a great way to ensure we all have the best engaged staff we possibly can have.’
To contact eHealth Ireland about this, why not do so via social media, @eHealthIreland is their twitter handle and they will definitely come back to anyone wanting to know more.
Thursday 25th of May 2016, The eHealth Festival rocked the stage at the Future Health Summit in City West. No festival would be complete without some audio visual fireworks and with this in mind, we opened with a powerful music video painstakingly produced by Elaine Naughton
The video, which wouldn’t have been out of place at the MTV awards, showcased different countries where music legends such as Bowie and The Beatles and neatly segwayed to all the countries where eHealth Legends came from. These countries included Estonia, Botswana, UK, Denmark, Spain, Australia and I have an honorable mention to my own Northern Ireland. The scene was set for the day: High energy and involvement would be the recipe for a succesfull day. Twitter handles were provided so anyone could tweet the speakers and ask questions using the hashtag: #eHealthFestival. Notably, we were trending in Ireland within the hour.
The speakers for the day embraced the festival theme and played the part of rockstars by choosing their own song to enter onto the stage. Musical references were dotted throughout the presentations some of our Rockstars-for-the-day even dressed up in festival gear to present.
First up to speak was Tony Shannon and Andy Williams from Answer Consulting. They spoke in detail about the critical state of health around the world and how effective sharing of information can mean better care for the patient. Andy spoke about how transformation is needed in digital health and it is his belief that a huge transformation will happen in 5 years or less. He spoke about the importance of open source and the growth in demand witnessed in just the last year alone. Richard Corbridge reiterated their thoughts and argued that health spend is actually an investment for the future rather than just a short term budget item.
The next rock star on the bill was Andy Kinnear. Andy gave great insights from his learning in the digital transformation journey in Bristol. The countless benefits they are reaping now include the amazing research opportunities that become available through a shared network. When I asked Andy about how to create a culture that encourages innovation, he replied that“ You need to create a spirit where loyalty is with the people you serve – the public not the organisation. You should reinforce this mind-set that all you do is for the patients.” It is heartening for me to see that this is exactly what eHealth Ireland are doing by putting their patient: at the centre.
Naomi Fein from Think Visual took to her new found rock star status like a duck to water as she ran up and down the stage interacting with the audience. I have had the pleasure of working with Naomi on a few projects and she is truly inspirational. Naomi spoke to us about leveraging empathy to create clarity. She took everyone through an interactive process ensuring that any plans that we make are truly impactful. The message must be “memorable, actionable, and shareable”. To ensure this we need to start this (planning) process before we communicate by asking –
If we can do this with empathy for our audience it can give us fresh insights, new language and clearer priorities. Naomi’s fiinal piece of advice was: Before communicating, it is imperative to separate between what is true but useless, and what is relevant. This last point was particularly poignant because I feel that often times, we ourselves are overawed with too much information.
Joanna Smith, CIO of Royal Brompton Trust was next up and she set the scene by entering to The David Bowie number “Changes”. She spoke about her experiences within digital transformation in health. She had a lack of engagement at the beginning of her journey as they had no strategy or plan. Joanna used the analogy of growing a garden and how they had to strip everything away, draw up a plan and get the basics right before they could change their system. The now familiar theme of the patient being at the centre was spoken about again and how important it is to have easily accessible and user friendly technology. Joanna also argued that patients should be widely informed as they are interested in these technological advancements. Joanna echoed the importance of building relationships: a common theme from all the speakers and how she felt that one of the biggest challenges is managing change and trust. She gave some great advice on picking your battles, knowing when to give up and knowing when to push a head. In my own experience, this sound advice could apply to many things in life, including raising children.
Julie Bellew and Brian Canavan from the HSE were late additions to the bill after the successful launch of #eHealthMoments. I have had the pleasure of working with this team to develop this idea. It is based on the premise that internal communication is central to how an organisation is run. Up to 70% of Organisational change fails and one of the more commonly cited reasons for this failure is poor communication. This internal communication is truly engagement from within and was developed when both these members of staff were inspired at an All Staff Day in March. The concept is based on “Hello My Name is” created by Kate Grainger. Each member of staff can make a short video clip about who they are and what they do. These clips are uploaded to a private forum created for these staff. Previously there was no real link between the staff as they are traditionally dispersed throughout the country and rarely get to meet. This provides everyone the chance to introduce themselves, put a face to the name and get to know a little bit more about each other. Julie and Brian want to change people’s opinion of the HSE and want to make it fun as they do it. I was sitting beside a few of the speakers at the time of this presentation and they loved it. They took pictures and said it was an initiative they were going to bring back to their own organisations and was so simple but extremely effective.
After lunch Richard Gibson, research director at Gartner spoke about personalisation with healthcare and the importance of patient engagement. He explained how simple technologies like websites can help engage by providing information and portals connecting patients with their information. Richard spoke of many cool technologies that provide great advantages to the user such as fitness trackers, sleep wristbands, devices that keep track of your habits and home diagnostic stations: All technologies that are revolutionising how we live our lives.
We had the lovely Amanda Neylon up next, who danced onto the stage with the song “What a Feeling” from Flash Dance. Amanda was in charge of the digital transformation of Macmillan Cancer Care support. She told an inspirational story about her journey there. The purpose of the organisations was to support people and help them take control of their situation. To do this they took a huge amount of paper information and made 50% of it available through digital services. Social Media put digital at the heart of the organisation. She echoed Naomi by stressing that “you must understand your audience” and through this understanding they segmented their audience through behaviours rather than demographically. Amanda also spoke about the importance of collaboration, iteration and evaluation through all the different stages. Her final word was to be brave and allow people the opportunity to grow through experimenting with what works and what doesn’t. If things don’t work the first time around, simply move forward and try something new.
Clare Sanderson (@IGcom) from IG Solutions was our final presenter and was representing the security and governance side of the festival. She also spoke around the importance of engaging with the public early and informing them on each of the stages you are going through. There is great opportunity to learn from other people’s mistakes by being up front with patients about where their information is going. Research conducted by The Wellcome Trust found that people generally didn’t know where their information is going. Clare spoke about a really interesting concept called Citizen Juries. During this process people hear case studies around the use of data by health care professionals. This process proved that the more information a patient has around the digital transformation, the more positive they are about it. Clare also pointed out an extremely important issue: that there should be explicit consent and the right to object. I asked Clare about the best ways to do this and she gave some interesting ideas such as having the issue as a story plot on popular TV shows. Maybe we could ask Richard’s agent to arrange a cameo on Fair City.
The finale of the show was a panel discussion with the A&R personnel namely vendors – Cerner, CSC, IMS Maxims and HCI. Richard asked the panelists to sell to the audience on why their company should be the one to push forward this transformation in eHealth. Many of them touched on the fact that Ireland could be built as a centre of eHealth excellence and the importance of the integration off different systems. They echoed the importance of being engaged with patients early and ensuring that they go through the decisions with you, putting healthcare back into their hands and also the belief that data sharing is a common sense approach.
Richard rounded up the day with the reiteration that community is an area often forgotten yet it is crucial to the development of eHealth. He spoke about delivering everyone in the HSE a digital identity and how the HSE is opening up to innovation through eHealth Connect and The Quality Innovation Corridor (QIC). This was a very positive end to an extremely positive day. I spoke to a number of people after the event and they were delighted with the festival there was great energy, enthusiasm and optimism around the future of eHealth in Ireland. It really is amazing to have been part of this day and I want to say a big thank to Richard for giving me the opportunity me to co-host the event with him. I look forward to seeing how the ehealth transformation continues to evolve in the near future.
For more information on what is happening in eHealth in Ireland go to www.eHealthIreland.ie
SPEACIL THANKS to Blathnaid Cluskey who is interning at the HSE she is a Communications Student at DCU. She has a strong passion for media and using it to connect with different audiences and helped ensure that it was possible to create this review of the day.