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Digital Health Awards 2022 winner profile: Rob Ratcliffe

by Lauren Hoodless
written by Lauren Hoodless

Rob RatcliffeWhat is your current role?  

I am currently a district nursing clinical lead at Midlands Partnership NHS Foundation Trust and have been for the past few years.

How did you get to where you are now? 

I started my NHS career as a clinical support worker some 24 years ago. I didn’t think for one second that I would become a registered nurse at that point due to having dyslexia. I was actively encouraged to apply to undertake my pre-registration course at a local university and that’s when I started to get interested in digital ways to support me through the programme. I started the course in September 2002 and have never looked back since.

How did it feel to win Rising Star in Digital Nursing? 

I still can’t really believe it. I was nominated by IT colleagues at work due to a project that I had been working on. I have previously worked on several IT projects however the roll out of total mobile is by far the largest. I am not sure if winning has really sunk in at all yet. I do keep looking at the award every now and then to remind myself.

At the end of the day, I am a nurse who loves the thought of improving things for patients and staff. Using digital in my work place has really helped me both inform the patients that I work with about their health needs and also has helped staff by speeding up the documentation element of providing care in a patient’s home. The use of a tablet device enables us to use lots of digital in the hope that this will improve the outcomes for our patients.

What is the most challenging part of your role? 

No day is ever the same. I am community based and therefore travel to the majority of my patients. We do run ambulatory clinic services alongside home visits, however it’s the home care that I really love. Some of the main challenges are the huge health inequalities within the areas that I cover.

I also look at all incidents raised for my area and feed back to the reporter (hopefully in a timely manner). Having enough hours in the day is another challenge, and just trying to ensure that we do the best we can as a service, ensuring the patient is truly at the heart of everything that we do.

Within your organisation, what is the most significant digital achievement of the past 12 months? 

I work for a very forward thinking organisation. Midlands Partnership Foundation Trust is relatively new – it has its own digital strategy and really listens to staff to see what the needs of services are. There are currently lots of things going on within the trust. As the trust covers both physical and mental health services there has been lots of work done by IT and ward-based staff on remote monitoring of patients within inpatient settings.

The trust is currently looking at dictation software and has spent the last 12 months engaging with staff to ensure it is getting things right, working hugely on the current connectivity and performance when out and about. All community nursing staff (physical health) now have laptops, tablets and phones to use which makes life much less stressful.

Probably the most significant achievement for the trust is the rollout of total mobile in which I have been heavily involved. It has enabled community nursing to really look at the way it was working and change it for the better using digital.

What is the largest barrier to achieving digital transformation?

I think at the beginning it was connectivity, especially when out in the community. The trust covers the whole of North, South and East Staffordshire and staff like to be involved in new clinical systems, appearing to disengage if they feel that they are not being listened to.

Whenever a new system is being developed it has to be fit for purpose and do the job it is supposed to do, and ideally save clinicians time.

What do you hope to digitally achieve within your role and organisation over the next 12 months?

I have worked for the organisation for the last 14 years and will hopefully continue to engage with the clinical staff and drive forward the trust’s digital agenda to ensure that digital is truly embedded in everyday practice.

My new work stream is to start to look at the way in which we communicate with our GP colleagues and care agencies. It will of course have a digital answer, however it’s just looking to ensure it will work for all.

You can find out who scooped each award here

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Digital Health Awards 2022 winner profile: Peter Thomas

by Lauren Hoodless
written by Lauren Hoodless

What is your current role? Peter Thomas award win

I am CCIO at Moorfields Eye Hospital and director of digital medicine there. My role is to support the development of a digital environment that actively benefits clinical services, as well as to champion a move towards digitally-delivered services. I’m also on secondment part-time to NHS Digital where I act as a clinical lead for digital on the national eyecare programme.

How did you become a CCIO?

I’d been interested in the application of technology to clinical practice for many years before I became a consultant paediatric ophthalmologist at Moorfields in 2017. Earlier in my career I had spent time working in the IT industry and had undertaken a PhD in computational neuroscience.

After I joined Moorfields, I was appointed to a new role working under the CCIO as clinical director of digital innovation where I focused on novel applications of technology to support clinical care. I took over as CCIO last year as a natural career progression from the innovation role.

To get myself ready to be a CCIO, I joined cohort two of the NHS Digital Academy, and took every opportunity to professionalise in clinical informatics, including fellowship of the Faculty of Clinical Informatics.

How did it feel to win CCIO of the Year?

Fantastic. We’ve taken a new approach to delivering clinical informatics at Moorfields, founding the UK’s first department of digital medicine. As with anything new, it’s great when the profession recognises that you’re going in the right direction. Although it’s my name on the award, I’m really only a representative of the brilliant team at Moorfields.

What is the most challenging part of your role?

It’s an interesting time in digital transformation of healthcare because there are so many different areas that you could choose to focus on. At Moorfields we have some of the most capable and innovative clinicians and researchers anywhere in the world and it would be easy to work on innovation projects full time.

However, I have to balance that against a very significant transformation programme to get our core infrastructure ready for a new hospital move in 2026. Getting the balance right is a challenge.

Within your organisation, what is the most significant digital achievement of the past 12 months?

From a clinical informatics perspective, it has been the creation of a department of digital medicine. As part of my Digital Academy research, I gathered feedback from 40 other digital leaders in the NHS to discover how they bring the clinical and technology aspects of digital transformation together.

The new department arose from that work and is supporting us to develop a team of digital clinicians who are professionalising as clinical informaticians and specialising in topics such as digital safety, exclusion, engagement, and innovation. This puts us in a much better place going forwards as we now have an engine to drive clinical informatics that is formalised, well embedded, and sufficiently resourced.

What is the largest barrier to achieving digital transformation?

Looking across the entire healthcare sector, I think it’s the scale and breadth of the change needed. We have hospitals and institutions that, in some cases, have centuries of tradition and process built around traditional models of medicine.

We’re now expecting those same organisations to deliver digital services that we would normally associate with digitally-native organisations that boast large IT departments and have their entire business model built around digital health. At the same time, those hospitals are also struggling with significant pressures and constraints. It’s a process that will take time.

What do you hope to digitally achieve within your role and organisation over the next 12 months?

We have significant improvements to our core systems in the pipeline, and we’ve built the foundations to begin moving exciting technologies like remote monitoring and clinical AI out of research and pilot programmes and into routine clinical care. In the next 12 months, I’d like to implement more of these future-looking technologies into routine care.

What advice would you give to anyone who is thinking of becoming a CCIO?

Take every opportunity to professionalise – there’s a huge chasm between the understanding I had as a clinician-enthusiast, and the understanding I’m developing now through things like the NHS Digital Academy.

Many will still be coming into clinical informatics without knowing that there is a network of professionals across the UK who can support you, and a whole host of conferences and professional development activities that you can use to build a network (such as the excellent Digital Health Summer Schools).

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Digital Health Awards 2022 winner profile: Prof Louise Hicks

by Lauren Hoodless
written by Lauren Hoodless

The Digital Health Awards 2022 took place on the middle night of Summer Schools in York and CNIO of the Year was won by Professor Louise Hicks. The CNIO at Barts Health NHS Trust revealed all to Digital Health, including her role and journey to this point, how she felt when she won the award and her digital ambitions over the next 12 months.Prof Louise Hicks

What is your current role?

CNIO and director of development at Barts Health NHS Trust.

How did you become a CNIO?

Intensely committed to outstanding nursing care, I was in a development role and had an opportunity to use digital transformation to not only enhance quality and reduce variation but also create a strong nursing voice for change. I started out by mapping out a vision and engaging a team of passionate and skilled people, which included patient perspectives.

Building a relationship with informatics leaders locally, nationally and through Cerner really inspired me to want to lead this agenda. I have had fantastic support from my CNO [chief nursing officer], CIO [chief information officer] and CCIO [chief clinical information officer] who really encouraged the development. I also have a great relationship with the whole clinical informatics leadership team that has developed – deputy CCIOs, medical clinical informatics leads, digital midwives and pharmacists, nursing informatics officers and lead nurses.

Importantly though is the leadership and support through the hospital directors of nursing and group directors of midwifery and allied health. You have to have this team ambition and commitment.

One of the big motivations of developing nursing informatics and getting adoption though was that many people said, ‘you’ll never be able to do this’. There was an underlying distrust in informatics and digital solutions and there had been a prior nursing solution in place that wasn’t really used. This was a positive challenge, not only to me but also to the fabulous nursing informatics team that has developed since 2018.

I could see that being the CNIO has a wider opportunity to also impact population health and enhance outcomes for patients and the community. I have had a clinical and academic career that has also included education, research and community engagement alongside coaching, transformation and organisational development. All of these have been incredibly helpful in the CNIO role.

In 2018 we took a team to Kansas City to the Cerner Conference. We used this as an opportunity to galvanise our nursing and multiprofessional clinical informatics vision. From this we developed our Barts Health We Connect vision and my CNIO role formally began.

How did it feel to win CNIO of the Year?

I was overwhelmed! It is such a wonderful achievement and I am truly overjoyed. It’s a great recognition of the nursing contribution to clinical informatics and is so important. I feel that it is a result of masses of support and the commitment and passion of many, not least the nursing informatics team at Barts Health, who are an inspiring and talented group of professionals but also other CNIOs that I’ve networked with and always been so supportive. There is a great camaraderie between CNIOs and we are very happy to share perspectives, solutions and resources. Even though we work with different systems and suppliers, the core is about the patient and NMAHP [nursing, midwifery and allied health professions] as professional excellence.

Since the award I’ve received so many congratulations and good wishes – it’s so kind and positive. It creates a wave of further motivation to do so much more! It’s great for nursing teams to share in this award and recognise that the integration of informatics as part of the caring role is essential.

What is the most challenging part of your role?

Time and resource. At the moment we are growing and need to be strategic and tactical in how we align ongoing resources. We have ambitious plans but these need to be fully supported through robust investment. We are developing strong business cases and have much support so the future is certainly bright.

It’s really important to ensure a robust infrastructure and career framework that enables nurses and clinical teams to see informatics as a great career opportunity. It requires us to have greater national consistency and talent management. We have the talent but we need to enhance the framework.

If we get these two aspects right then the inclusive ambitions to create better population health and remove digital poverty in communities become an easier aspiration.

Within your organisation, what is the most significant digital achievement of the past 12 months?

During our response to Covid, between peaks, we implemented ePMA [electronic prescribing and medicines administration] on 127 of our wards and areas across four hospitals. We established a 90-day assurance and preparation programme followed by 90 days of fantastic go lives across our organisation. It was wonderful to get teams focused on the detail and energy of this and to spread our We Connect method of team development.

It’s been a fabulous achievement that has galvanised the positive power of working with a fantastic clinical informatics team, IT and clinical systems with each of our hospitals.

What is the largest barrier to achieving digital transformation?

The largest barrier would be in thinking it can’t be done!! I never think this – there is always a solution. However, we need the investment to ensure we have the right talent and skills in the right place plus the joined up thinking and strategies to ensure aspirations are systematically achieved and progressed.

We really must ensure that we are truly listening to our communities and not leaving people behind or marginalised. It is really important in our transformation plans to ensure inequalities are tackled and new solutions are in place to prevent exclusion.

What do you hope to digitally achieve within your role and organisation over the next 12 months?

Over the next 12 months we have an exciting agenda and plan to continue to optimise our nursing and clinical records system. Further enhanced implementation that targets women and children, critical and perioperative care and builds on the flow of data and information to impact clinical decision making are just some of the plans.

People are at the heart of informatics development so making sure our core team have the support and development opportunity in place that they need for the next phase of the journey and their career ambitions plus supporting and expanding our fabulous team of 500 superusers is essential.

We are developing impressive education and research opportunities so look forward to working with our Higher Education and Life sciences partners.

The next 12 months has to also include supporting the Shuri Fellowship as an ally and also committing to mentor, coach and support those wanting to develop their careers. We had five fellows on cohort one and they have done so well. Ensuring that this is available alongside other fellowships and digital developments is key to our strategy and also staff satisfaction.

During the next 12 months we will also be continuously improving using data and information. We have achieved much in developing medication safety, improved sepsis screening. enhanced management of deteriorating patients and understanding core nursing criteria and we are targeting more here.

We have had the pleasure of forming closer relationships with Barking, Havering and Redbridge University NHS Trust and over the next 12 months look forward to supporting plans and people as needed.

What advice would you give to anyone who is thinking of becoming a CNIO?

  • Go for it! Think about the skills and talents you would bring to the role and the specific leadership and transformation needed. Not all CNIOs are the same – we bring particular unique talents to the role and can use them to achieve what’s needed.
  • Talk through your career plans with other CNIOs or digital transformation leaders.
  • Talk to the chief nurse or your director of nursing.
  • Get a sponsor who can support you in your career ambitions and will speak out for you.
  • Do a digital fellowship or equivalent – Florence Nightingale, Digital Health.
  • Get a mentor and/or coach – the Digital Health CNIO Advisory Panel is launching a mentor scheme this year for example.
  • Shadow a CNIO and CCIO – look at different models and ideas.
  • Get involved with Digital Health – events, discourse, Summer School, round tables and seminars.
  • Who is your system provider – do they offer development? Access this and understand more.
  • Learn – set yourself a development plan, appreciate your talents and explore opportunities to enhance your skills (working with a coach or mentor will also help here) – integrate this in your annual appraisal and personal development plan.
  • Get involved in your organisation – develop relationships with NMAHP and IT leadership.
  • What do you feel passionate about that digital transformation makes the difference? Get involved in a programme of work in this area – test it out.
  • Enjoy! It’s a brilliant role – it can be called different things in different places so when you are looking for roles be sure to look widely for nursing and clinical informatics lead roles.
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Looking back at my first in person Digital Health Summer Schools

by Lauren Hoodless
written by Lauren Hoodless

In recent years, Digital Health Networks have made an active effort to include more nurses which has helped to drive the digital nursing agenda. I signed up to the CNIO network two years ago and attended my first in person Summer Schools event on July 14 and 15 2022. It was one of the most welcoming environments in health care I have ever experienced.

The BBQ on the first night was a great start to the networking. I was pleased to meet so many nurses face-to-face, having connected on twitter, and they offered their congratulations for being shortlisted for future digital leader of the year. The general buzz for the days to follow was great, with seasoned summer school attendees supporting and guiding us newcomers through the event.

NHS mergers and Integrated Care

The kick off to the event was interesting, we got a real insight from Simon Bolton, and I appreciated that he tackled the mergers of NHS England and NHS Digital head on. He talked about wanting to listen and speak to people to get the purpose of NHS England right.

Then later there was a panel which covered Integrated Care Systems (ICSs) which provided me with such a great insight. The best speaker here was Rushownara Miah (head of business intelligence at Pennine Care NHS Foundation Trust). Hearing her talk about the opportunities that she sees available with the data set my researcher brain going and I gave her an instant followon twitter.

On that note, my standout session from day one was the introduction to Artificial Intelligence (AI). Haris Shuaib (consultant clinical scientist – Guy’s and St Thomas’ NHS Foundation Trust) spoke my language and got me excited about AI, and not in the classic ‘tech will change everything’ way. He gave very real-world examples of the limitations and the options for AI. Plus, when I went to speak to him after for a chat on the bus, he was open to discussing the options for its impact on nursing. This is an area that we are currently looking at as part of the Phillips Ives Review, and I am looking forward to catching up with him again to explore the topic more.

The gala dinner was well co-ordinated, it can be quite daunting to be told that you have to spend the night sat on a table with a group of people you do not yet know. However, I sat next to the wonderful Devesh Sinha (CCIOBarking, Havering and Redbridge University Hospitals NHS Trust ) and Peter Thomas (CCIO of the year from Moorfields), they both made it extremely easy. We discussed research, career journeys, next steps, and NHS culture with such enthusiasm.

Split screens and Phillips Ives

The keynote of day two was by one of my favourite speakers – Matthew Taylor (CEO NHS Confederation), I heard repetition of his split screen analogy throughout the rest of the day. The analogy perfectly depicted the need in the NHS to focus on both the immediate problems and the long-term strategy for resilience in the future. I am always impressed by how well he speaks and how he works the audience, he never professes to have the all the answers, but he is realistic of the state the NHS is currently in.

This was followed by a laughter filled talk from Rhidian Hurle (CCIO NHS Wales Informatics Service), I enjoyed this as I think we need to hear more from the other nations. I am quite jealous of the Welsh infrastructure, and I want to see and understand the impact of their investments.

Then Natasha Phillips (CNIO at NHS England) spread the message of the Phillips Ives Review – this filled me with pride, that I am currently working one of the biggest reviews and shaping of the nursing workforce that we have ever seen. Next up was Sonia Patel (CIO at NHS England) and she acknowledged that we are improving on the diversity in the room, but we still have a long way to go. This is something I whole heartedly agree with, my challenge to digital health networks is to keep increasing a diverse number of future leaders in the room.

The closing session of the day was my opportunity to speak on, ‘Preventing the Brain Drain’. It was with a fantastic panel; Melissa Andison (associate CCIO at Surrey and Borders Partnership NHS Foundation Trust), Darren Mckenna (director of Digital Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust) and Stacey Hatton (CNIO at Barnsley NHS Foundation Trust), chaired by Jon Hoeksma (CEO at Digital Health). When I was first asked to speak on this panel, I was not sure that I had anything to offer the room on the subject. Then I began to think about what has kept me working in the NHS and what has kept me passionate. I have been fortunate and supported in my career to reach for the stars and explore my passions. I am currently doing my MSc in Advanced Clinical Practice and I was supported to apply to the Florence Nightingale Foundation, from which I gained my fellowship with NHS England. I hope the session influenced some digital leaders and gave them something to consider. Staff retention starts with organisational culture.

Summer Schools have once again ignited my passion. I honestly believe that in the digital health space we have some of the best individuals all striving to improve care for the patient and people who use our services. If we maintain this energy, passion, and drive – I know the transformation that we need will happen within the NHS.

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CNIO Handbook Chapter 3

by Michele
written by Michele

Back in 2015, Great Ormond Street Hospital for Children NHS Foundation Trust – a small but mighty specialist paediatrics trust – set a vision for its digital future. We were to introduce an electronic patient record (EPR): “An integrated system to be used by all staff, in all settings that will allow patients access in every interaction and hold the entire patient record.”

I’d worked at the trust since 1997 and, when this announcement was made, I was working operationally but also on a project to introduce electronic observations to the organisation. That led me to being approached to join the procurement team for the EPR, and into months of Excel spreadsheets, understanding system build, system testing, site visits and networking.

When implementation of the system began, it soon became clear a chief nursing information officer was going to be important to success. I was appointed to the role in January 2018, during the groundwork phase of implementation – the go live date was set for just over a year later. I remember feeling excited about the challenge ahead but petrified of how I would lead the nursing workforce through this transformational change in such a short timeframe.

Three core values

In working on the implementation, I always had three core values in mind. The first was patient welfare: we needed to make sure that the introduction of an EPR didn’t interfere with the safety of our care and, indeed, that it helped staff deliver the best possible care to our patients. The second was operational improvement. We needed to make sure that the EPR helped us deliver care more efficiently. The final was staff engagement, which as CNIO was and is a key part of my role.

I knew that clinical engagement was key to a successful implementation. Clinicians would be the ultimate users of the system and so they needed to be part of the journey, helping us build efficient workflows. The design of the system had to be intuitive to staff, to reduce not increase burden.

There are a few key steps I took which made the task of implementation feel more manageable, and which I’d recommend to any nursing colleague supporting a similar project.

  • Create a team: Creating a team of nursing informaticians was the single best thing I did. Members had diverse backgrounds, skills and experience. That meant we were able to build an EPR that was tailored to the range of people in the organisation and the range of work they do: the different pathways and workflows, and also different levels of expertise in digital systems. We appointed a huge number of subject matter experts, who advised us on how the specific workflows in which they and their colleagues were involved should be reflected in the EPR. This has been important in making the most of clinical decision support functionality within the system. We’ve ensured the EPR supports clinicians in applying best practice in specific areas of care, but also that it allows diversion from that when clinical judgement requires. It means we avoid clinicians becoming fatigued by alerts about deviations from best practice that are in fact entirely justified.
  • Learn from others: I spent time making friends with both national and international colleagues who had travelled the journey before. These relationships definitely played a part in the success not only of the EPR implementation but with my development as a CNIO. The CNIO Network was a particularly important part of building these relationships and sources of support.
  • Take the opportunity to review how care is provided: Before we implemented our EPR, we had several different ways of documenting the same information. I saw the implementation as an opportunity to rethink this, and create new ways to care – introducing an EPR shouldn’t just be about digitising existing ways of working. We, for instance, created some functionality we call Essence. This is a means of entering a brief description of what a clinical note is about: it only takes 30 seconds and is up to 156 characters, a bit like a tweet. It means that any clinician looking through a patient’s record can quickly understand which clinical notes are relevant to current care – rather than having to open all of them and read through they can judge the most relevant from the summary.
  • Take every opportunity to communicate with clinical colleagues about the implementation: I invited myself along to every clinical meeting that existed across the trust to talk about the journey, where we were to date, and what we needed from the teams. I wanted the EPR to be at the forefront of everyone’s minds and for everyone to understand that the system was theirs – to use and to shape. We weren’t introducing a system to people, but introducing a system with them.
  • Focus on change management: This project was the single biggest transformation the trust had been through. There are challenges to leading a huge programme of change. The logistics of bringing an entire organisation on this journey, at the same time as staff are facing the normal day-to-day challenges, were far from easy. We appointed change managers to help here. They were trained to support the system design but more importantly the adoption and longer-term optimisation. When working on an EPR project, the go live is of course the main focus but there is so much important work that happens afterwards, once people have actually started using it. Sometimes it’s only then that you see how a workflow or patient pathway can be best represented on the EPR. Having operational teams feel they had ownership of the EPR, and could shape it over time, was a key part of our success.
  • Get training right: We familiarised staff with the system by giving them basic sessions on how it worked and tip sheets. We didn’t train them to use the system fully, because we knew that you only really learn how to use an electronic patient record when you actually start using it in practice.

The system went live over the 2019 Easter weekend. We went with a big bang launch, so the EPR was live everywhere across the trust. It was one of the highlights of my career – seeing months of work come into fruition in front of your eyes was fantastic.

Running the implementation

It was such a big transformation that, as an organisation, we ran the implementation as though we were confronting a major incident. This enabled staff to bring any issues directly to the implementation team to either be actioned or support given.

As a nursing leadership team we created what we called SWAT teams – small groups of experts who were dispatched to help with some of the more complicated process in the new EPR. Blood administration was an example: when we knew that someone had ordered blood, a SWAT team was dispatched to go and help the staff through the process using the EPR.

With all that said, my advice is to make an EPR go live a celebration. It’s one of the few times the whole organisation will come together to support a transformational change. The success of an EPR implementation goes beyond just putting the system in. For some clinical teams, the true value was only seen later, in the form of opportunities to improve services and continually improve the care we deliver. It is at this point that patients, families and staff start to experience the deeper benefits that digital transformation can bring.

“With all that said, my advice is to make an EPR go live a celebration. It’s one of the few times the whole organisation will come together to support a transformational change.”

Benefits

One big area of benefit is the availability of data. With all information being held in the electronic patient record, and the knowledge that it is robust information, we’ve been able to create clinical dashboards. These give staff an understanding of where things are going well and where they are going less well. This in turn means that we can standardise and improve clinical workflows.

I’m always working to engage my clinical colleagues in making best use of the system, helping encourage a curiosity about it can be used to the maximum possible benefit. Once that seed is planted – and nurtured within individual clinical teams – staff can start to use data to drive change themselves.

It’s an example of how EPR-related work doesn’t stop with a go live. It’s a journey but one that it’s a privilege to be on.

About the author: Sarah Newcombe is chief nursing information officer at Great Ormond Street Hospital for Children NHS Foundation Trust. She joined the organisation in 1997 as a staff nurse. In 2012, she became the clinical lead for the implementation of electronic observations at the trust. She has been CNIO since January 2018.

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Digital Health CIOs speak out on EPR convergence and levelling up plans

by Lauren Hoodless
written by Lauren Hoodless

Levelling up piece Back in February, the Secretary of State for Health and Social Care, Sajid Javid, said that he wants 90% of NHS trusts to have an EPR in place by December 2023, with the remaining 10% in the process of implementing them.

Then in March, NHS leaders were reportedly told that they must draw up plans to level-up and converge the electronic patient records (EPRs) in use across Integrated Care System (ICS) boundaries.

This target to level up EPR provision across the NHS is in line with the Long Term Plan commitment for providers to achieve a core level of digitisation by March 2025 and demonstrates a clear change in direction on nationally directed digital transformation.

A new policy direction: But is it the right one?

There is no doubt that many people are firmly behind the plans to level up and converge the EPRs in use across ICS boundaries, as the thoughts of some of the CIO Advisory Panel members demonstrate, however these views are far from unanimous.

Someone who is arguably best placed of all the CIO panel members to give their opinion is Kate Walker, digital programme director at Suffolk and North East Essex ICS, who knows exactly how important levelling up and convergence is for ICSs.

“I feel levelling up and convergence is really important to drive out as it will improve care and to allow us to be able to use that core infrastructure to innovate and be adaptive,” she said.

Her thoughts were echoed by those of the director of health informatics at The Rotherham NHS Foundation Trust, James Rawlinson. He believes that “the principle is sound and it’s a reasonable principle to put into the NHS… it makes a lot of sense”.

The broad idea of convergence and levelling up was celebrated by most, with Dan West, chief digital information officer at the Department of Health in Northern Ireland, saying “the notion of convergence is logically sensible” and Darren McKenna, CIO at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust emphasising that “in principle it’s the right thing to do”.

However, Paul Jones, chief digital information officer at Leeds Teaching Hospitals NHS Trust, raised his concerns about focusing too heavily on EPRs.

“My worry about the focus on EPR levels is that it’s to the detriment of everything else, as if that is the only problem that we’ve got in digital healthcare in England,” he told Digital Health News.

“I think too much focus on it as a national thing just doesn’t feel appropriate from where I’m sat in West Yorkshire.”

Jones’ concerns about the plans are shared by the CIO at University Hospital Southampton NHS Foundation Trust, Adrian Byrne. His view is that “the way our service runs in this country, it’s inevitable that you have more than one system, so a utopian view of running everything from one system seems a far stretch”.

As many have alluded to, the idea and principle of levelling up and convergence is a solid one, but there are doubts about where priorities should lie and whether a single system in an organisation like the NHS could function efficiently.

HIMSS EMRAM: A framework that splits opinion

The idea for levelling up across the country and reducing health inequalities is for all trusts and organisations to achieve a minimum of HIMSS Level 5. The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) incorporates methodology and algorithms to automatically score hospitals around the world relative to their EPR capabilities.

For trusts to achieve Level 5, they must have full physician documentation using structured templates and intrusion/device protection, along with everything required up to and including Level 4.

When asked about this emphasis on HIMSS, Lisa Franklin, CIO at Hampshire and Isle of Wight Integrated Care System, said: “It’s right we should be looking at HIMSS Level 5 and clearly it would be desirable for there to be one single system across an entire ICS.”

Fellow CIO Amy Freeman, who is based at Mid Cheshire Hospitals NHS Foundation Trust, also looks upon the HIMSS framework favourably, emphasising that it is a good that we are “making sure that everybody has a minimum capability that is a standard we would all be willing to accept”.

“I’m quite pleased that it appears that they’re going to be using the HIMSS EMRAM model. In the NHS we quite often think we’re special and we need a special assessment of our own,” she added.

“The fact we’ve picked a benchmarking tool that’s been around for a long time and is well-proven across the globe gives more credence to the standard.”

But Leeds Teaching Hospitals’ Jones views were once again not as rosy as many of the other panel members, stressing that he personally “wouldn’t get hung up about HIMSS Level 5” and that “it shouldn’t be a project plan”.

“The way that the HIMSS judging is done, if you’re not doing one thing in HIMSS Level 0 but you’re doing everything else up to HIMSS Level 5, then you get graded as HIMSS Level 0,” he said.

“I really object to those sorts of frameworks being treated as project plans and as targets because I don’t think a framework developed in abstract should be driving the investments of individual hospitals.”

There is a stark contrast of opinion on the HIMMS EMRAM model, but the general view is that the framework can set a good standard for trusts around the country to aim for, despite it not being a perfect benchmark for some.

EPR targets: Realistic or fanciful?

The question of whether the EPR targets set out by Sajid Javid are realistic and achievable or fanciful and over-ambitious has also succeeded in diving opinion within the CIO Advisory panel.

Franklin (from Mid Cheshire Hospitals) saw both sides of the argument, claiming that it is feasible to have EPRs across all settings in ICSs, but is an unrealistic target without proper support.

“If the question is about whether the aim of achieving EPRs across all settings in ICSs is achievable, of course it is, if we invest in the people who haven’t got EPRs,” she said.

“If the question is about whether the aim of getting one or two EPRs per ICS is realistic, no, not without significant funding which we know isn’t available.”

While Rotherham’s Rawlinson doubted that we will be able to achieve the EPR targets in the timeframe set out.

He said that it is “not necessarily realistic in any short period of time at all” and that “it will be a five, ten-year minimum type of ambition” rather than something that can be done in less than a couple of years.

The panel members were once again very split on whether these targets set out can be achieved and although many agree with the intention and the idea in principle of these ambitions, how they will be accomplished remains the key question.

A healthcare cultural shift on the horizon

There is a cultural shift on the horizon in the way the NHS and UK healthcare system operates and delivers healthcare. The CIO Advisory Panel members were all very enthusiastic and excited about the impact on healthcare that this change in policy direction and the EPR targets set out would have if everything went to plan.

On the potential impact, Walker said: “Don’t get me wrong, it would be staggering. To have a digitised ecosystem for our trusts is massive, but the cultural shift in healthcare delivery will also be huge.

“So, it isn’t just the procurement or mobilisation, it is the complete transformation of the way health and care is done within those organisational boundaries.”

Although the broad concepts of levelling up and convergence were generally looked upon in a positive light by members of the Digital Health Networks CIO Advisory Panel, the way in which the new policy direction will be implemented and achieved, particularly in the time frame set out, left some lacking confidence in the plans.

Part two of our series on levelling up and EPR convergence will be focused on the CCIO and CNIO Advisory Panels.

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FeaturedNews

Looking beyond job titles in the world of data, digital and clinical informatics

by Lauren Hoodless
written by Lauren Hoodless

Job DescriptionIt’s hard not to notice the emergence and flurry of job titles (CCIO, CNIO, CAHPIO, CPIO, CMIO, CXIO, CDIO, CIO, CSIO and CHCIO) under the umbrella of data, digital and clinical informatics in the last few years.

While CIO, CNIO and CCIO job titles have been the front runners for a few years in the data, digital and informatics world, the variety of roles is expanding rapidly, and it is vital that we keep up. More importantly we must ensure job titles are a true reflection of the skills, knowledge, expertise and experience required to meet the demands, provision and delivery of health and care required across systems and for the 21st century.

Informaticians often ask for advice on how to further their careers from others in the industry and the myriad of titles no doubt makes this for an interesting conversation.

With the UK looking to have an additional 32000 jobs in informatics, there could be an argument for the necessity of titles.

Is there a right or wrong path? How many more “C” job titles are envisaged over the next 5-10 years?

Where is the evidence to support the accelerated growth?

Is it time to have a joined-up conversation and review on professionalisation of roles?

Tailored job descriptions

Kaur, who is co-vice chair of the CCIO Digital Health Advisory Panel and the only non CCIO and pharmacy representative, points to the fact that midwives and allied health professionals (AHP) are badged under CNIO job adverts, with the advertisement itself often having a heavy focus on nursing with little or no information related to the other groups.

Also, where do pharmacists, pharmacy technicians, biomedical scientists, ODPs and others who fall into a traditional or non-traditional support services category fit? Job descriptions aren’t always tailored to cater for these groups. Where are the career pathways outlined for different staff to successfully obtain digital roles with clear training pathways to achieve their goals and have the required skillset to flourish in their posts?

Kaur  is an aspiring CCIO who has been involved in the development of the exemplar CCIO JD by the Faculty of Clinical Informatics published in autumn 2021 and has spoken recently at Digital Health Rewired on the Office of the CCIO panel.

Kaur challenges digital health leaders to dispel the myth that only doctors, and nurses can take CCIO and CNIO roles. We need to champion each other and truly recognise that the voice of data, digital and clinical informatics is fundamental, and these roles can be led by a variety of individuals from different healthcare disciplines. Kaur  is an advocate for embedding digital and clinical informatics learning and development from the grass roots at undergraduate level where possible but also not stifling anyone in achieving their dreams to become digital leaders no matter their current career position.

She  firmly believes that teams are richer as a multi-disciplinary network and barriers to current success within the data, digital and clinical informatics field includes the ever-growing number of titles, non-inclusive job descriptions and advertisements and disparity of pay. These need to be addressed and society needs to work collaboratively to bring professionals together from clinical, non-clinical, technical, non-technical and operational fields to enable technology to deliver excellent person-centred care.

Time for a review?

It’s a similar picture for Adejolu, a respected Systems leader and National Associate CNIO, who believes it is time to critically review digital and informatics job titles used across the NHS.

She says, she is often inundated with questions from nurses and midwives interested in digital and informatics asking how many digital courses or programmes they need to undergo before becoming a CCIO, CIO, CIM, CAHPIO or CNIO? How long would it take to get there or for those who already have credible systems experience, they worry if their current career portfolio, work history is extensive or sufficient enough to command such a job title like this now and in the future

“The truth is, there is no straight-forward answer, this is often a mixed bag, you have those who have had structured career pathway, building, and developing diverse system-wide competencies and capabilities along the way, those who have worked their way up, those who may have completed a digital programmes or course, in some cases, this may have proved instrumental in paving a way to becoming a CCIO a CIO, those who  say “my boss thinks I will be good for this” and those who say they just fell into the role etc,” she says.

Adejolu believes it’s time to push the “pause button” on the creation of any more digital and informatics job titles and move away from what now seems like an elite, exclusive and hierarchy of more digital and informatics job titles which only seems to alienate and diminish real opportunities for experienced and skilled professionals across systems. Our focus must be on broader skills development, transforming the workforce, distributed leadership and partnership working so everyone is fully supported to excel, thrive, succeed, bring their best self, work to high standards to deliver the safest digital/informatics transformation and the best possible and safer care for our patients and the population.

Data, digital assisted technologies and informatics is truly an exciting place to be, she adds, but job titles need an urgent review, a structured, unified core competency framework and leadership that truly inspires and encourages innovation, creativity, skills development, without the added burden, pressure or fixation on obtaining job titles as a replacement for skills, knowledge, experience, of real system change.

“As we transition into the world of Integrated Care Systems, working in partnership with Integrated Care Boards, we need to painstakingly stocktake and baseline what we currently have vs what we need across systems, standardise job titles and job descriptions, establish continuous talent and skills development pipelines, encourage diverse talents across systems, increase workplace jobs and opportunities, promote an inclusive and broader learning and development portfolio for ALL clinical professions and champion a culture of innovative geniuses through collaboration, where creativity is the norm and less about job titles,” Adejolu concludes.

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CNIO HandbookFeaturedNews

CNIO Handbook Chapter 2

by Michele
written by Michele

Introducing the CNIO role

The chief nursing information officer role is usually broad but, at its heart, it is about bridging the gap between technology and clinical practice. CNIOs should have a seat at the table when the clinical technology strategy is being set, and then through the procurement, planning and implementation stage of any new system. As CNIOs, we ensure the focus is on using technology to improve outcomes for patients and citizens.

What’s it like starting out in a CNIO role?

If you’re starting out in a CNIO role, you may be replacing an existing postholder or it may be an entirely new post for the organisation. You may also be a lone digital nurse, or you may be part of a team. It may be your first senior nursing role, which you’ve gained through previous digital experience, or you may already be a senior nurse and new to digital. These experiences are all slightly different.

When you’re the first

Being the first CNIO for an organisation can feel like a daunting prospect. It’s important to remember the positive aspects: that you have a fabulous opportunity to develop the role and to bring others along with you.

You will be able to set the agenda and direction, but it’s likely others will try and point you towards meeting existing agendas. Instead, give yourself some time to decide what you want the priorities to be – and agree with your senior colleagues that this is the approach you’ll be taking. You will have a more positive impact in the longer term, as well as getting personal satisfaction and a feeling that you are personally developing too.

If you’re going solo

If you’re the only digital clinical leader in your organisation, then the job can feel like a lonely one and really quite different to what most of us are used to as nurses.

The key thing to do in this situation is to form networks. In your own organisation, it’s helpful to connect to other senior nurses. A good way to do this is by joining existing nursing collaboration groups (these will have different formats in different organisations). Although these colleagues will have different specialisms and interests, they too will have a focus on nursing strategy and workforce development.

If you are not directly reporting to your chief nurse/director of nursing, make sure that you meet with him or her in the early weeks in post and continue updating on progress. The digital nursing agenda should now be a key part of every chief nurse/director of nursing’s portfolio, and he or she will be relying on you to help drive it forward.

Outside your organisation, there are plenty of opportunities to connect with fellow digital nurses. This includes via the Digital Health CNIO Network and via regional and sector-specific groups. There are also the likes of the Faculty of Clinical Informatics’ nursing professional interest group, the BCS (Chartered Institute for IT) nursing specialist group, and the Royal College of Nursing eHealth forum.

If you’re joining a pre-existing team

If you are lucky enough to be joining an existing team, this is likely to be multi-professional. That means it’s important to link with clinical and non-clinical colleagues to determine who will lead on which aspects of the digital strategy. You don’t want to step on each other’s toes, but it’s really important to make sure that all the clinical professions feel that their views are being heard. That means you may also be the identified lead for allied health professionals or other professional groups.

Who leads on what is likely to be based on individual interests and experience, but together the team will need to have input on areas such as research, clinical governance, digital clinical safety and patient/citizen involvement.

An important first step is to understand what has already been done – ask your colleagues to run you through progress over the past couple of years. Focus on what has gone well, but don’t forget to ask about the lessons learned so that you can make improvements in future. Quality improvement is a key aspect of the CNIO role, and it needs to start early and continue always. You will then be able to gain a clear idea of what needs to be done in future, and will increase your understanding around stakeholder relationships (including with system suppliers), transformation and change activity within digital and across the wider organisation, and how involved your nursing colleagues already are in the digital agenda.

Be careful with how much you take on

It’s hard to say no to things when you are new in post, but it’s important not to take on too much – the danger is you won’t be able to deliver, and that’s really demoralising.

Be especially cautious of taking on work which could or should be done by others. Although it’s tempting to ‘fix’ problems (especially for most nurses), you will get overloaded. The digital nursing agenda will be your key one, but it’s important to recognise that you will also want to get involved in things which improve your knowledge and/or pique your interest. It is important to leave time to be able to do those things too, and if you’ve taken on too much work you won’t have time to do so.

Remember there’s no one best way to be a CNIO

As you start out as a CNIO, remember there is not one best way to do the role. It will depend on your own background and how much leadership or digital experience you already have.

Remember too that while some of the digital aspects of what you are doing might be new for you, you have lots of existing and transferable skills from your previous experience – and that’s true whatever previous experience you have.

If you are coming into the role as an existing senior nurse with limited digital knowledge, make friends with colleagues in the IT/digital team. They will be keen to share their knowledge and experience with you, and it’s a really good way to learn the ‘language’ of digital healthcare.

If this is your first post at this level but you have previous digital experience, then the relationships you will likely need to work on are those with other senior nurses and clinicians. This can feel difficult if you haven’t done it before, but also because you are likely to be the one who has most digital knowledge. You’ll need to be prepared to teach, and to encourage others’ understanding and interest in digital, while developing these key peer relationships.

What skills do I need to flourish as a CNIO?

There are a number of key skills that I think you will need to succeed as a CNIO. Some you’ll have already, but all you’ll need to work on and develop.

  • Teamwork. You need to work as part of the team, to collaborate with and motivate others.
  • An authentic, credible style and a passion for improving clinical outcomes by using technology. This will often get you moving forwards even when times are most tough. It’s important to have resilience and tenacity, as well as a pragmatic but can-do attitude.
  • A knowledge of your own limits. You need to know the boundaries of your own abilities, and to be able to ask for help.
  • An ability to make decisions. You’ll need to be able to understand the issues facing colleagues and patients and be able to determine the best actions (sometimes without all the facts you would like).
  • Leadership. You need to be a good leader of others. Supporting and developing your colleagues is such an important part of the job of the CNIO. Some of my proudest moments as a CNIO have been seeing others develop into CNIOs (and other clinical leaders) themselves.

Don’t forget development

The CNIO community is a vibrant and very giving one; in my experience, people will be generous with their time to support you and teach you. The benefit for them is that they will also learn from you.

There are digital nurses in all kinds of roles and across sectors, so make your networks big; include non-nurses and don’t be afraid to link up with digital clinicians working in different sectors, including in industry and outside the NHS.

Know you’re part of a team that is continuing to grow

I was one of the first CNIOs in the UK and am very proud of that fact. What I’m more proud of though is that we have grown in number over the last 10 years and that we will continue to grow as a community of CNIOs and digital nurses. I’m proud too that we are now being recognised as an integral part of any healthcare team which is aiming to transform care through the use of technology. Good luck and keep in touch!

About the author: Jo Dickson is chief nurse at NHS Digital. She had a varied clinical background before moving into technology roles, and was previously chief nursing information officer at Leeds Teaching Hospitals NHS Trust and clinical informatics director at Nuffield Health. Jo is a past chair of the CNIO Network and a founding fellow of the Faculty of Clinical Informatics.

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AHPS and Pharmacists Rewired
FeaturedNews

AHPs and pharmacists: The untapped potential in digital health

by Lauren Hoodless
written by Lauren Hoodless

In a joint piece for the Digital Health Networks, Melissa Andison (occupational therapist and associate chief clinical information officer, Surrey and Borders Partnership NHS Foundation Trust), Euan McComiskie (health informatics lead, Chartered Society of Physiotherapy) and Ramandeep Kaur (lead electronic prescribing and medicines administration pharmacist, Barking, Havering and Redbridge University Hospitals NHS Trust) reflect on a session from Digital Health Rewired 2022 which looked at the untapped potential of allied health professionals (AHPS) and pharmacists. 

Did you know AHPs, make up the third largest clinical workforce group in health and care – we are 14 professions that are an untapped resource to drive digital transformation and innovation.

Did you know pharmacists with a passion for digital usually commence their careers within informatics implementing electronic prescribing and medicines administration (EPMA) systems.

So what’s unique about AHPs and pharmacy staff?  We think about health and wellness differently. The common traits that bind us as a group are often seen in our holistic thinking, collaborative problem solving, health promotion expertise and naturally are adopters of futuristic ways of working.

AHP and pharmacy colleagues are thriving in digital health design, innovation and the cold face of implementation and we feel like it is time to showcase this.

Therefore we joined forces to create events for the Digital Health Rewired programme which captured the fantastic work of AHP and Pharmacy colleagues in digital health. They are the very first pharmacist and AHPs to sit on the chief clinical information officer (CCIO) and chief nursing information officer (CNIO) advisory panels.

With a passion for their professions and digital health, they wanted to give their AHP and pharmacy peers a real opportunity to showcase their work as digital leaders, something which had never been done before at Rewired.

Better representation

One of these sessions was chaired by Great Ormond Street Hospital NHS Foundation Trust’s AHP information officer, Ali Toft. The session included talks from Sarah Thompson (CCIO, Stockport NHS Foundation Trust), Christopher Tack (AHP information officer, Guys and St Thomas’ NHS Foundation Trust), Rafiah Patel (chief data ethics and privacy officer, Surrey and Borders Partnership NHS Foundation Trust) Anna Awoliyi (chief AHO information officer, Epsom and St Helier University Hospitals NHS Trust) and Professor Suzanne Martin (chief AHP officer, Department of Health Northern Ireland).

The multidisciplinary panellists gave a short presentation on their digital journey on the second day of Digital Health Rewired which was then followed by a Q&A.

How better to represent AHPs and Pharmacy than having an operating department practitioner, speech and language therapist physiotherapist, pharmacist and occupational therapist to share their stories and inspire others to follow careers in digital health.

After chairing the session, Toft said: “Our first ever AHP & Pharmacy rewired session was a privilege to chair and be part of.

“It was packed with inspiring stories regarding the diversity of digital career journeys and the importance of putting yourself forward and grasping any opportunities along the way, whilst the array of amazing and collaborative digitally enabled transformation projects we contribute to in our professions was clear to be seen.”

Workshop reflections 

After the panel session, Kaur and McComiskie chaired a workshop which looked at three specific questions; how do we raise the voices of the profession? (Identity), how do we raise the voices of the profession? (Leadership) and how do we bring digital into the portfolio of AHPs and Pharmacy colleagues into undergraduate level? (Learning).

A summary of our findings are as follows:

Identity

  • Need to better market digital within our professions and outside our professions
  • Put ourselves out there more in social media, trust intranet pages, leads meetings etc on a regular basis to keep up momentum
  • Showcase good practice in our trust and to our community and don’t be afraid to ask for advice too
  • Challenge AfC barriers of current roles
  • Build career pathways/routes for digital
  • Myth busting about what it involves
  • Allyship with other less heard professions
  • Collaboration with those mature digital professions
  • Burst existing echo chambers

Leadership

  • Upskill
  • Be enthusiastic and approachable
  • Take initiative and embrace opportunities
  • Networking with staff who have established careers in digital
  • Role modelling with staff newer to the digital career journey
  • Be fearless and confident
  • Be comfortable in challenging and breaking barriers
  • Own our personal development
  • Gain respect from other professions

Learning

  • Early introduction to undergraduate curriculum
  • Easy access to resources
  • Placements, rotations or shadowing with digital organisations and parts of NHS trusts
  • Career talks/ presentations as part of roadshows incorporated in lectures
  • Embed digital as part of practical and theoretical parts of courses
  • Don’t separate digital from rest of education but make it explicit
  • Digital as a pillar of practice
  • Never assume digital competency

AHP and pharmacy troopers, a poem by Ramandeep Kaur

U stand back listen, watch and learn

Never sure whether to speak or just wait in the hope of your turn

Time for change, we hear you say

AHPs and pharmacy teams, let start today

Proudly showcase your work in the digital sphere

Promote yourselves and each other to break down barriers and a perceived hierarchy tier

Empower, excel and educate, to drive great patient care

Digital world needs you, so go forth, seize the moment and share!

Join our journey

So join us on this journey to seek out your AHP and pharmacy colleagues invested in digital at local, ICS and national level. Perhaps digital leaders in each organisation can plan a coffee morning to kickstart a conversation to raise the profile of your colleagues.

At Summer Schools, take the opportunity to meet one AHP or pharmacy colleague you haven’t spoken with before. Inclusivity, diversity and celebrating the success of each other will allow us to all maximise the benefits of digital health for our staff and patients.

#Peoplebeforetechnology

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