☰ CCIO handbook contents

Chapter 12


Education

To carry out any role professionally requires some continuing education and training. Being a chief clinical information officer is no exception. As we have seen, being a CCIO requires multiple skills and there are multiple ways in which you can build on each of these.

Pick the brains of others

The annual summer school and the regional events are a good source of information, and a chance to talk to your colleagues. The events are invaluable for continuing professional development and can be added to your appraisal documentation.

Reading

This handbook gives a good insight into the work of CCIOs in the UK. There are some American guides which may be of interest, notably ‘The CMIO Survival Guide: A Handbook for Chief Medical Information Officers and Those Who Hire Them’, edited by William Bria and Richard L. Rydell.

Traditional management books are numerous but of varying quality. ‘Redefining Health Care’ by Michael Porter and Elizabeth Teisberg is a seminal work that has influenced health policy in the UK, and is well worth a read to better understand how to improve efficiency through process redesign.

‘The Innovator’s Prescription’ by Clayton Christensen is another highly influential work and gives some fascinating insights into disruptive innovation, many – though not all – enabled by new technology.

The writings of W. Edwards Deming, the father of the “Lean” manufacturing principles, are an enlightening read, particularly when trying to persuade others that change is required. The basic principles of statistical process control are explained, even for the mathematically challenged!

Don’t forget the wide variety of ‘consumer’ IT advances. Most of the major newspapers have a section looking at technology in its wider sense. This can be a useful indicator of what’s on the horizon in terms of mobile devices, IT wearables, and what your patients may be looking at.

Formal training

Many universities now run masters courses in health informatics, as well as postgraduate certificates and diplomas for those unable to complete the full masters programme. Bear in mind, however, that funding for these courses is typically difficult to obtain: most NHS employers will expect you to self-fund.

At least one university is actively considering setting up short courses which will be useful for those of us who would like a limited period of training away from the workplace, backed up by private reading and study.

The larger health IT suppliers often have annual meetings for their users, which can be used for your individual CPD.

Other organisations

If you are a medic, you might consider joining the Faculty of Medical Leadership and Management. Membership gives you access to an online library of management resources, including titles which regularly cover healthcare IT, such as the ‘Harvard Business Review’.

The Royal College of Physicians of London has a health informatics unit, the website of which offers a variety of useful information. The College is currently setting up a Faculty of Health Informatics for all clinicians, which will ensure a large library of resources and continuing development of standards for our field.

My experience of a masters degree in health informatics

Between 2009 and 2012, I studied for University College London’s Masters in Health Informatics. The name is a bit misleading, because the degree is much more than health informatics. It covers almost everything to do with the practice of medicine, except the medicine bit...

University College London

My involvement in healthcare informatics had begun a few years before, when my wife – a fellow consultant at Torbay Hospital – volunteered me to fill a vacancy on the information management and technology board.

This was on the basis of an enthusiasm for building and fixing PCs. If she was going to live with the public embarrassment of marriage to a computer geek, it had better be for a good cause.

At the time the organisation was extracting itself from contracts to deploy an enterprise solution, and the IM&T board was not a happy place to be. The only action the board took at my second meeting was to dissolve the group. By this time I was the only clinical representative anyway. I wasn’t disappointed; I’d been completely out of my depth.

However, the experience had been enough to show me the attraction of having a work interest outside fixing breasts.

With an awareness of my still-developing knowledge, the medical director agreed to support me in a masters degree. I chose UCL partly because it had generated some interesting anti-NPfIT rhetoric; but also because it meant I got to go to London.

Professor Dipak Kalra lead the first, introductory seminar. He began with a slide taken from his on-call notebook from when he was a GP. It read: “Mr Smith called again.”

‘Again’ had been underlined three times, and was followed by three exclamation marks. For me, this captured the tension between the need to establish consistency in meaning and the desire to articulate the hidden subtext in natural language.

The modules had been written with clinicians in mind. I started with research techniques, which introduced me to the world of qualitative research.

I’d always worked to the principle that good research needs words like “randomised”, “power calculation” and “cohort”. However, it became clear that this principle does not work so well when studying the use of complex systems in the real world.

Although a module on ethnographic techniques might seem a bit fluffy to most clinicians, I soon realised that this could be applied in the workplace.

Gary Hotine, my trust’s director of health informatics, and I were looking at what we were left with post-national programme and how we should go about developing a new, clinically-focused IT strategy. I suggested embedding project managers into clinical teams.

They captured basic measurement around how much time junior doctors were spending logging in and out of ward computers and plotted their movement around the ward. We combined this with their narrative of how IT hindered their productivity, and how we should work to improve it.

The message we took was that for IT to support the work, it has to be part of the workflow; mobile and responsive. This message now runs throughout our IT strategy and is a core requirement for procurement.

The module on designing healthcare systems was one that I had anticipated would be most instructive. It was, but not in the way I had expected.

 Essentially, this module covered semantic interoperability, messaging standards such as HL7 and openEHR. Although I grappled with Archetype (a simple programming interface for openEHR) I came to the conclusion that, at least in our organisation, we would struggle to run an open source health record with current resource.

The clinical decision support module started with acute abdominal pain, a computer program from the early 1970s that was better than surgeons at diagnosing appendicitis.

A highlight was the moving story behind Isabel. This is an excellent example of how it is possible to bridge the gap between natural language (medical textbooks) and structured information (hierarchy of diagnoses).

Information law should be part of every CCIO’s portfolio. Given the close relationship with information governance this was the “driest” of the modules but it covers key areas of policy and legislation.

It gave me the confidence to recommend information governance be taken out of the IT board and rebranded as the Information Sharing Group with a mandate to develop its own strategy.

This has probably taken us further than any other move I have recommended, as we now have a group with membership across all areas of health and social care and an information sharing toolkit to support the integrated care IT strategy.

The patient safety module started with the psychology of clinicians facing medical error, the need for accountability, and fair blame versus blame-free. After this excellent module I really wanted to introduce a clinical risk management policy, to support the IT strategy.

However, I struggled to develop a usable framework. It wasn’t until additional guidance was published and clinical safety officer training offered by NHS England that I was able to take this further.

Other areas we studied included the application of research evidence to clinical practice, telehealth, telemedicine and examples of innovation in practice.

Not all of these required electronic systems. Visiting presenters described paper-based systems to improve patient flow and safety based on staffing levels and acuity, and process maps to develop “Lean” systems, where electronic systems had not been available.

For my dissertation I developed an electronic questionnaire for use in long term online follow up of breast cancer survivors. The questionnaire is now used for all follow up patients attending clinic and been adopted by other organisations.

I’m now working on the change management to take patients off face to face follow up and onto a patient held record (Patients Know Best). This has the potential to revolutionise the way we engage with patients, and save a huge number of unnecessary trips to clinic.

However, it is a charge which will involve everyone from the admin team to nurses and consultants. Not to mention how we manage patient expectations...

Has the masters course helped me in my role as CCIO? Absolutely. It gave me a knowledge framework and provided context when I first worked with my IT colleagues.

It’s made the journey to CCIO easier and since completing the degree I’ve rarely found myself in an informatics, quality improvement or patient safety meeting where I’ve been behind the rest of the group.

Areas I had to learn about outside the course are quite NHS specific, for example policies around the National Programme for IT in the NHS and, closer to home, the work to support integrated care systems.

Could I do the job without it? Of course I could, because it's clinical experience which is central to the role. However, I could probably teach anyone interested how to do an operation without any prior knowledge of anatomy, too.

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