Daniel Ray describes his love affair with health informatics as a serendipitous stumble, rather than a date with destiny.
Ray, the director of informatics at the University Hospitals Birmingham NHS Foundation Trust, now works with a team of 180 staff and a budget of millions.
However, his first job with the NHS as a 19-year-old applied sciences graduate involved analysing biological specimens in a microbiology and virology laboratory, before a chance to change paths arose.
“A relatively junior position came up that involved analysing the amount of specimens that the department processed and produced and I thought: ‘That would be quite interesting’.”
Working in the role a couple of days a week, Ray says he was quickly hooked on the chance to work with two of his passions – maths and computers – in a way that could make a difference to patients and the NHS.
“It was just something I sort of fell into, something I understood. When a composer sits down at a piano, it just makes sense to them, and when I saw my first data set it just made sense to me.”
Massive IT expansion
Looking at the limited opportunities for career progression in the biomedical sciences, Ray made the jump into an information officer’s role that came up at Worcestershire Hospital.
The move came with a steep learning curve, as shortly after his arrival most of the hospital’s informatics team left, “all of a sudden and all in one go”.
“At the time I was thinking, ‘Oh my god, what do I do?’, but looking back it was one of the best things that ever happened to me,” he says.
“I was forced to learn a whole bunch of different things – data sets, the patient administration system, various other systems – very, very quickly… and I ended up learning a phenomenal amount.”
From there, he moved into a commissioning information manager position at the University Hospital Coventry and Warwickshire NHS Trust, before becoming head of information at the Dudley Primary Care Trust in 2004.
Then, in 2007, Ray moved into his current position at University Hospitals Birmingham, where he has since overseen a “massive expansion” in the informatics programme. “When I joined, there were a couple of rooms and a couple of analysts, now we’ve got 180 staff and a whole building.”
The IT environment has changed
Ray spent his first few years in the position sorting out the hospital’s infrastructure, preparing for a move to a new hospital, and building or procuring key clinical systems.
Since then, his work has moved towards the national policy arena, using the data his team collects for research and improving patient care, and considering opportunities for commercialisation.
Ray says he has noticed a significant change in the healthcare sector’s attitude towards IT and informatics during his time with the NHS.
“With IT and informatics, if you go back a few years ago it was largely viewed as boxes and wires, something that should just be there and function.
“It wasn’t really engaged with clinicians: it was an important department, but it had a bit of a bean-counter type financial focus.”
That’s no longer the case, and Ray thinks the change in approach is due in large part to the improved variety and depth of data that can now be analysed, as well as the high level of involvement that clinicians now have.
“We’ve now got this really rich clinical data that we can just lay our hands on. The other change is the use of it: we’re using it really directly in close engagement with clinicians and nurses to have a direct impact on patient care, and that’s now viewed as a necessity.
“If a decision has to be made, people always ask, ‘What does the data say?’ The default position in the past was that the data was wrong: you had to prove it was right then you could use it to make a decision. Now, the default position is that the data is right.”
Still, Ray is most proud of the MyHealth patient portal, which provides all patients with long-term conditions the ability to access, share and add to their health records.
“That’s the one that’s closest to my heart. Often, our outputs are rarely directly linked to patients. We make sure the PCs work so the doctors can do their job, or we make sure the PAS works…but we rarely have direct influence into a patient’s life.”
Ray has been able to see that influence first-hand through the experiences of someone very close to him. “My mum’s got breast cancer, and she can log on to the internet and read all of her results. She tells me every day how amazing it is, so I’ve been able to benefit my own family.”
He describes the move towards increased access to records as a “step-change” for patients, some of whom now have a newfound trust for the medical advice they’re receiving.
“One lady said to me that now she actually believed what her doctor was saying. I said, ‘What do you mean?’ She said that she’d never believed him before, but she did now.”
Ray is hoping one of his next projects can have a similar impact on patients: his team is working on a “super-scheduler”, allowing a GP to book appointments for every stage of a procedure like a hip replacement instead of having to book each step in isolation.
“That way, you can walk away with all of the dates listed for each event: outpatients, scans, tests, everything. It’s really complicated, as it involves multi-interfacing with multiple systems.”
Ray does not sit on the trust board: instead, the hospital’s chief clinical information officer represents IT and informatics issues at a board level, while Ray works closely with him and also has a place in the chief executive’s advisory group.
He is happy with this arrangement, and believes the broader issue of board representation for health information leaders is one that each trust needs to deal with in its own way.
“I think it depends on the overall structure of the organisation. Is representation at a board level important? Absolutely, I’d be mad to say ‘no’. But I think there are different mechanisms and ways the informatics sector can be represented.”
Given his own move out of biomedicine, the career advice that Ray gives to new graduates and others considering how to progress a career in healthcare IT is unsurprisingly pragmatic.
“Look at the jobs advertised out there and make a conscious decision about what you want to do, then look at your own CV and see where the gaps and shortcomings are.
“I’m not saying you’ve got to stick with it, but if you pick something you’re interested in, the skill-set will guide you in the right direction.”
And, if they’re lucky, they may fall into a career that fits them as well as informatics fits Ray.
|Job title:||Director of informatics, University Hospitals Birmingham NHS Foundation Trust|
|Time in current role:||Seven years|
|Key project:||MyHealth patient portal providing health record access to patients with long-term conditions.|
|Favourite technology:||The iPhone: “It changed my life basically. I love the simplicity of the use of it: I often say when we develop something, let’s get into the Steve Jobs mindset and make it simple.”|
|Best thing about job:||“I think it’s about knowledge and empowerment, and working with clinicians and operational managers to help them make the best decisions they can.”|
|Worst thing about job: Dealing with bureaucracy:||“Not in this hospital, but sometimes externally, the level of bureaucracy is a problem and getting something done is like walking through treacle.”|
Daniel Ray has been elected chair of the Health CIO Network, the national network for chief information officers and other information leaders that was launched by EHI last November. More details about the network and how to get involved with its programme of events can be found on the Health CIO Network pages.