Newcastle University Hospitals NHS Foundation Trust is one of largest healthcare providers in England, with more than 2,000 beds, 14,000 staff and many flagship services. It treats more than a million patients a year.

The trust recently completed one of largest capital investment schemes in the NHS and is in the midst of a massive Cerner electronic patient record implementation, which has already seen it become one of the leading e-prescribing sites in the UK.

The clinical information lead on the project is Dr Daniel Birchall, consultant radiologist, and chair of the information strategy systems board.

Speaking at the recent joint CCIO Leaders Network Clinical Health Informatics Forum event in Darlington on ‘building the business case for CCIOs’, Dr Birchall outlined the importance of the EPR project to the trust and lessons learned.

Putting IT at the heart of change

He said the backdrop is an environment in which there are ever tougher pressures on healthcare organisations to deliver “high quality and financially viable healthcare to patients, in a world where technology capabilities are rapidly increasing.”

However, trusts cannot start with a blank slate. “We also have pre-existing organisational structures, which date from when information systems weren’t so central to what trying to do now,” he told the event.

“The organisational structures we have inherited are not so suited to achieving the improvements in patient care we are looking for now.”

The challenge, said Dr Birchall, “is to place information systems at heart of whole healthcare organisation’s future” so that “information systems underpin future development of healthcare.” To do this, “new organisational structures and processes need to be developed.”

Getting structures right

Dr Birchall said that when Newcastle began planning for its Millennium implementation it had started with a clinical focus.

“The premise is that it is necessary to have a lead clinician as a focal point of information systems strategic organisational structure,” he explained.

But to get its processes and implementation methodology right, the trust has been collaborating with Cerner for the past four years.

“There were structures that had organically evolved, in which there were overlapping groups that didn’t communicate well together – some very enthusiastic and capable individuals often working in isolation, including clinicians who were also IT developers.”

While tackling these problems, the trust also needed to address the lack of a link between its IT and its overall strategy.

“In the past, the trust had a proliferation of unconnected information systems and there was limited central governance or even knowledge of systems existed, with no clear portfolio of what was in use across the trust,” Dr Birchall explained. “There was also inconsistent project management, or prioritisation of projects.”

The trust decided that significant change was needed: “The executive at the trust took the decision to refresh the whole way information systems were organised, strategised and operations put in place in Newcastle.

“And I was asked to see how we could optimise provision of information systems and services, looking at organisational structure, operational delivery, clinical and front-line delivery.”

Putting the right boards and the right people in place

A review was undertaken in 2009 and an information systems strategy board (ISSB), accountable to the chief executive, was created. Half of the ISSB members are clinicians, working with the director of IT, head of programmes, head of development, technical, trust operations and finance.

To take on the new role of head of the ISSB, the trust invested further training and education for Dr Birchall. “I am a consultant radiologist, and was head of the department with experience of managing significant change, but the trust also supported me to get further business qualifications required.”

The ISSB is now responsible for prioritising projects, providing executive review and approval and ensuring a standardised project management methodology is followed.

Beneath the board is a clinical informatics committee, which provides a day to day clinical forum for sorting out operational issues. The trust has also established a clinical advisory group and has a clinical lead on each project.

The additional management qualification has been an essential part of his development to take on the clinical information leadership,” said Dr Birchall.

“I’m bridging clinical and management arenas – and I think providing this link between front line nurses and medics is key to not only information systems but to health service management as a whole.”

Drawing out the lessons learned at Newcastle, he concluded that a huge challenge is to ensure front-line clinical engagement.

“There was a real disconnect between front-line staff and IT at Newcastle. I would see getting clinical engagement would be one of prime roles of any CCIO leader.”

One of the basics, he said, is to involve clinicians right at the outset; not late in the day after the key decisions have already been taken.

Another is to make sure that clinical information leaders have a good infrastructure in place. “You can have best clinical leader, but if you don’t have right people in support you will fail. I’m very fortunate to have excellent people around me.”