When Jo Dickson re-joined Leeds Teaching Hospitals NHS Trust as a nurse specialist in 2001, dealing with systems integration and open source solutions was not on her agenda.
In fact, Dickson says: “I was dragged in kicking and screaming, although that’s possibly the wrong terminology to use…
“I didn’t know what I was getting into, and felt I was definitely taking a risk in moving away from clinical practice.”
However, health IT has since won her heart. Dickson has been the trust’s nursing lead for informatics since August 2013, and recently took on the additional title of chief nursing information officer.
She is also playing a leading role in an EHI CCIO Leaders Network project to support the acceleration and development of chief clinical information officers that is supported by NHS England. Specifically, she wants to see more nurses talking up IT and information leadership roles.
Speaking the same language
As a pain specialist, Dickson says her “eyes were opened on the value of information” while she was working as a nurse prescriber, because this introduced her to the risk and governance aspects of healthcare.
However, her first direct involvement in health IT – implementing an electronic discharge summary – came with some reservations about how it would affect her nursing career. “I didn’t think it would be right for me, because I was worried that I’d lose contact with patients.”
She was also unsure about how her focus on clinical care would gel with the technical requirements of an informatics role.
“Sometimes in the NHS, it seems like a case of ‘The clinicians are here, the IT is here and never the twain shall meet’.”
However, her reservations gradually faded and then evaporated for good in early 2014, during a conversation in an informatics department meeting room.
“I was sitting around the table with a group of IT colleagues, and I was the only non-tech person there. First of all, I realised that I understood 40% of what they were saying, which was amazing because it had only been 10% initially.
“But I also realised that they do speak the same language. Initially, I had felt that I thought differently to them, and that the reason I came to work every day was different to theirs.
“But they also work in the NHS because they want to improve care for people; and I thought that: ‘Yes, I can be a clinical person in this world’.”
A foot in both camps
Dickson became the lead nurse for e-medicines in 2010, before a leadership programme inspired her to aim higher.
“I hadn’t considered that you could be an informatics lead as a nurse… [but] it completely changed my way of thinking. Until then had thought I could only develop in an operational role.”
With some support from Anne Cooper, NHS England’s clinical informatics advisor for nursing, she spoke to the trust’s senior nurse and IT director to suggest that it appoint someone to represent nursing in informatics.
She became Leeds’ nursing lead for informatics in August 2013, before adding the title of CNIO last year.
In her current role, Dickson says she has “a foot in both camps” – a fact she was keen to emphasise in her official title.
“I was keen that they mention the nursing part of it, because I’m very, very clear that first and foremost I’m a nurse.”
She is still out in a nurse’s uniform every week, giving her the ability to maintain her clinical understanding and apply it to her informatics work.
“I don’t want it to go any higher [in informatics knowledge], because I don’t want to become an IT person.
“Lots of people around me can do the IT side of things – I can translate that and see things from both sides, and I’m not afraid to ask questions that need to be asked.”
Strong team, strong work
Dickson is backed up at the trust by chief clinical information officer Dr Tony Shannon, well known in NHS informatics for his work on the Leeds Care Record and the trust’s open source portal.
“A huge amount of the stuff that has happened here is credit to Tony’s tenacity,” Dickson says.
She also has support from “a very strong team of leaders”, including a clinical oncologist who is the lead clinician for the trust’s electronic patient record development.
Other nurses have also been recruited into the informatics team to help ensure that key messages are shared across frontline clinical teams – Dickson says their growing enthusiasm for the subject has been one of her highlights of the past year.
In addition, Dickson says changes to the trust’s executive board 18 months ago have had a significant, positive impact on the organisation’s approach to IT.
“Over the last 18 months, we’ve seen a big change – people now understand that it is an integral part of running the hospital.
“When I first came into the team, it felt like we were on the periphery, with IT coming and doing something to you.
“But now it feels like we’re working as a team of people to understand how technology can help to improve quality of care, as well as achieving required efficiency savings.”
That change of focus is paying dividends with the Leeds Care Record and the trust’s EPR, integrated with other systems where relevant.
Dickson says one of her main projects is the introduction of a nursing observations system, with handheld mobile devices directly linked into the EPR to input National Early Warning Scores.
She is also involved in the trust’s work to implement the MedChart e-prescribing and medicines administration system this summer and integrate it with the EPR.
Clinical documentation is another area of focus: the trust has put a framework model into its EPR over last several months, and is putting all of clinical documents into the framework to be accessed via mobile tablets and computers on wheels.
“There needs to be a more joined-up way of working: the vision is that in two years’ time, there’s a single point of access to a patient’s record so we’re not duplicating when we take information from patients.”
Lonely at the top
Dickson says her new CNIO title is one she rarely uses, due to its rarity and the difficulty in explaining it.
“Honestly, I never use the CNIO title, because if I use it in my day to day job, people have no idea what it means – my husband is a nurse too, and he doesn’t quite understand what I do.”
The paucity of CNIOs across England has sometimes taken its toll, with a lack of colleagues to work with.
“There are times when I’ve thought, this is too lonely for me, because nurses are used to working in teams – that’s how we thrive, we have a group identity.”
Her decision to become involved in the EHI CCIO Leaders Network project was inspired in part by that loneliness, as well as the desire to make more nurses aware of the opportunities available to them.
“Working in informatics, there’s great clinical leadership but not that many nurses… When I started out, it wasn’t seen as a career path, but I’m very keen to make sure people now understand the possibilities for them.”
With some luck, Dickson may be to convince nurses as sceptical as she once was to take up the banner of health informatics.