The importance of IT to deliver efficient healthcare did not hit Dr William Lumb in a “light bulb moment.” Rather, the necessity of good IT has always been “obvious” to the Cumbria GP.
Like many chief clinical information officers, Dr Lumb’s interest in informatics is not in the technology per se, but in how it can be used to improve patient care.
“My interest in informatics, computers, IT, is what it can do for us; that’s my interest, not the box or the wonderful things it does,” he explains.
“I did GP locums for a while and never really reflected on the use of IT; it was just something that I did. There wasn’t a light bulb moment when I suddenly realised ‘this is how we have to do it’; it’s just always been there as an obvious thing.”
As the work of GPs has become more complex and detailed, Dr Lumb argues that patient notes can no longer be kept effectively without an IT system.
“One of those things that’s been very clear in my head for two years is that you cannot deliver modern healthcare without an electronic patient record.
“I struggle to understand why some acutes still have paper notes or have no plans to move away from paper records; maybe I’m missing something?”
Practical experience
Dr Lumb moved to South Cumbria in 2004, where he inherited two single-handed practices in the same building and amalgamated and upgraded their systems.
When the National Programme for IT in the NHS come along he could not help but notice that while all the knowledge and experience of healthcare computing was in primary care, its focus was on the acute sector.
“It was very frustrating. I realised I had to get involved somehow or we would all be going nowhere very quickly,” he says.
Dr Lumb got involved in practice-based commissioning, which allowed groups of practices to get together to plan services, pool funding, and secure any savings made. He persuaded colleagues to invest some of this money in integrated informatics.
In 2008, his PbC group had £400,000 “to play with” and looked to deliver integrated, interoperable systems for GPs and community services and to start moving them into hospitals.
He started with the South Lakes Locality of Cumbria, with a patient population of 110,000. There, he moved community services on to EMIS Web to allow for information sharing with GPs and acute trusts.
The project was seen as a success and in July 2010 he was effectively appointed CCIO of NHS Cumbria to do the same thing across the county.
Dr Lumb explains that the local primary care trust saw IT as essential and wanted someone to drive forward networks and hardware, amongst other things. “I was not delivering it, but part of the process that made sure these things went in the right direction,” he adds.
Internally, he is the clinical lead for informatics, but externally he now refers to himself as a CCIO. “When you look at the role and what I manage, I manage the PCT’s IT budget and the IM&T providers. I have support, but I’m responsible to a clinical executive.
“I don’t want to have to explain the title, the reality is I’m a CCIO. I probably have more role and responsibility than most CCIOs, but it’s the term most other people understand.”
Dr Lumb is also head of IM&T for the Cumbria CCG and lead on networks for the region. His team is in the second phase of implementing the “fibre to the practice” project, putting a community of interest network into every practice in Cumbria.
Retaining credibility
Dr Lumb still works three days a week as a GP and believes that remaining a clinician is critical to the success of a CCIO. “For a jobbing CCIO it’s absolutely critical, as it retains your currency.
“Operationally, it means you win arguments because as a clinician you have been there and you have done it; it’s your experience that can’t be argued with,” he says.
Because clinicians have the welfare of their patients at heart, the decisions CCIOs can influence will be patient-focused.
He also believes the job of a CCIO should be to push boundaries and those that do may become professional CCIOs, if they have 15-20 years clinical experience behind them.
“In my current role I make a big difference in Cumbria; far greater than I can as an individual GP looking after about 1,800 people. I can positively influence the health of 500,000 people; that’s a motivation.”
His CCG role is external to the board, which he reports to every three to four months. This arrangement is possible because the Cumbria board is made up of practicing GPs and they “get” the importance of IT.
“If you had an organisation that didn’t understand IM&T is absolutely essential then the CCIO would need to be on the board, but if they get it that’s a waste of your time,” Dr Lumb adds.
“Clearly provider organisations need a CCIO, they are essential, whether they are a board member or not depends on their maturity of the organisation.”
He believes primary care CCIOs can drive improvements as commissioners of care and that as working GP he can speak the language that means he gets more done than a manager in a suit might.
“We would have got GP record sharing into out-of-hours eventually, but it’s been faster and smoother because of my involvement and that’s a small thing, but you realise you can make positive change,” Dr Lumb explains.
“I realise that, but some colleagues are still suspicious of managers and of becoming a manager and they don’t want to give up the clinical side, but you need to get them to realise that being a manager isn’t such a bad thing.”