Mental health trusts face some specific challenges when it comes to IT. They tend to be spread over a wide area, to use many old buildings, and to work with what can be a mobile and challenging user group.
So the technical IT challenge facing most mental health trusts is to create a network that can link those sites together, and to equip staff with appropriate devices, so they can securely access trust systems whenever and wherever they need to.
Less well recognised are the challenges of managing the clinical engagement and transformation processes involved.
Now Oxleas NHS Foundation Trust, which provides mental health and community health services across South East London, has taken the forward-looking step of appointing a chief clinical information officer.
Two skills and one thing to remember
Dr Hashim Reza is a consultant psychiatrist and has worked in adult inpatient psychiatric services, community and intensive care.
He has also worked at NHS London as clinical lead for IT, supporting the development of the mental health electronic record.
He says there are two, key, skills that CCIOs need to bring together: IT and management experience.
And he says they need to remember one thing to be successful: not to allow IT to support business as usual. Change, Dr Reza impresses, is always required to reap benefits.
From Pakistan to Oxleas
Dr Reza gained his IT insight abroad. He trained in the UK but spent much of the 1990s at the Aga Khan University in Pakistan, which he describes as a “wonderful first class facility in a third world country.”
This is where he took the first steps to becoming a CCIO. “They were using a mainframe computer and for about seven years I was part of a very small academic department managing research databases,” he explains.
“I learned to understand data, to understand databases and how you can use them to understand patterns. That’s where I discovered what a wonderful resource IT could be and how it would be a benefit if the clinicians could talk to the technical boys.”
Dr Reza returned to the UK in 1997 and took on a series of medical management posts, including clinical services director, which he describes as the second training ground for the CCIO.
In 2011, he proposed that his trust should create a ‘clinical director for informatics’ post to help support it through a reconfiguration.
“I proposed – and they accepted – that a job that would be two and a half days in a clinical role, two days as clinical director for informatics, and a half day for other projects.” It is this role that has now morphed into the CCIO appointment.
Building a job from scratch
There were very few precedents for the post in the NHS and no job descriptions. “I think from that point of view I have to give credit to the leadership in this trust in seeing how crucial a role this could be.”
Dr Reza is not alone in this clinical IT space, however. Oxleas has recently completed a major change programme that, among other things, has seen the creation of an informatics directorate.
This brings together about 15 people skilled in transformation and IT specialists. Most of them retain a clinical or operational role as well as their informatics commitment.
“There is a full time executive informatics director, Alison Furzer, and alongside her in the team are nurse managers, finance people, people from IT and so on,” Dr Reza explains.
The biggest item on his agenda now is replacing the current version of RiO, supplied under the National Programme for IT in the NHS, which is now starting to wind down in earnest. “By the end of this year we need to decide what we want to replace it with,” says Dr Reza.
He is also in the midst of configuring Ascribe’s business intelligence suite, which the trust acquired last year. “We are in the process of configuring and rolling out across clinical teams,” he says. He expects this to take about six months.
Rethinking the document
The most exciting piece of work, though, is a technology project designed to take away the keyboard as the interface between the clinician and the record service.
“It’s a big bugbear,” says Dr Reza. “Clinicians are bad typists and the keyboard takes them away from their clinical work and being with patients. To them, the keyboard makes no sense.”
The project is exploring alternative interfaces – digital pens, speech recognition and other mobile platforms. It is also exploring clinical governance issues, such as whether digital pens issued to specific teams can be used to “stamp” documents.
One way and another, though, Dr Reza wants to stop the Word document being an intermediary step between the clinician taking notes and information getting into the patient record. Simpler tasks, such as note taking in meetings, are already using digital pens.
“It’s been going since the autumn and there have been some major technical challenges,” admits he admits. “But we hope it will come together in the next few months.”
Engineering out old processes
Dr Reza has also overseen projects to scan historic notes and introduce videoconferencing. “We have buildings spread 30 miles apart so this is an important technology for reducing the carbon footprint,” he says. “It is not being rolled out as quickly as I would like, but slowly we are getting uptake.”
The trust is not purely a mental health services provider – it took over the provider arms of Bexley and Greenwich primary care trusts under the Transforming Community Services initiative run towards the end of the New Labour era.
So telehealth and telemedicine also fall into his portfolio. This is clearly outside his area of clinical expertise and Dr Reza sees himself as a clinical adviser or facilitator.
“In areas where I do not work personally, such as children’s mental health services or community services, then I need to be providing advice on setting up clinical pathways or a facilitator understanding the transformation process,” he says.
In any IT project, the trust’s approach is first to map current processes, then identify what value IT can add and identify a champion or lead who can identify what needs to change.
The change case with digital pens, for example, is saving time and making notes available near real time for clinicians.
“If you do not engineer out the existing processes then the technology ends up sitting on a shelf or used only by enthusiasts,” Dr Reza reiterates. “Then you have double work processes.”
Finding the words
He enjoys the CCIO role immensely, and toys with the words to explain why, going through being a ‘worrier’ and a ‘nosey parker’ before settling on ‘networking’ to describe where he derives his enjoyment.
“I love going to see other teams,” he says. “People have such clever ideas and many times it is my job just to introduce them to the other people who have already cracked the particular nut they are working on.”