Chapter 10 Contents

Chapters

1

Foreword

Beverley Bryant

2

Introduction

Adrian Byrne

3

So, you’ve been appointed a health CIO

Cairon Hoye, senior information officer, Birmingham CrossCity Clinical Commissioning Group

4

Becoming a successful leader

Owen Powell / Gareth Baxendale

5

Forging relationships with the board

Adrian Byrne

6

Working with clinicians

Rachel Dunscombe / Gareth Baxendale

7

Creating relationships with suppliers

Roger Killen

8

The national and local picture

Paul Rice and Andy Kinnear

9

Running a large scale IT project

Carrie Armitage

10

CIOs in commissioning

Luke Readman

11

The profession of informatics

James Freed

Health CIOs in commissioning

By Luke Readman, chief information officer, Waltham Forest, Newham and Tower Hamlets clinical commissioning groups

The chief information officer role in commissioning organisations is not very prevalent. During the National Programme for IT, there was an increase in the adoption of the precursor to this role at the strategic health authority level.

Since that time, and perhaps since clinical commissioning groups were created, the role has largely diminished. Some CIOs do exist in both CCGs and commissioning support units - but we remain a rarity.

The CIO role in commissioning organisations differs to that in a provider organisations in a number of key respects. I would argue the two most significant are:

1. The need to be a strategic informatics leader across the local health system; it is necessary to seek agreement on a common approach across all the organisations within the purview of the local commissioning arrangements.


2. The need to be fully engaged with the regional and national programmes of work; clearly in this there is an opportunity to help shape and influence the regional and national approaches - indeed, I believe this is a key part of the role if we are to avoid following blind paths locally.

In my role, there is no direct line management of any of the teams providing IT services. The whole of the impact on approaches must be delivered through leadership and persuasion.

In this chapter, I explore the commissioning CIO role in the context of the work we are undertaking in East London with the aim, perhaps naively, of establishing the value in such a role.

I deliberately focus on the delivery of service rather than the contracting requirements; this is only because the CSU model was established with the prime aim of supporting contracting.

Agreeing a common approach

Strategic alignment across a health and care system requires agreement across all the participating organisations to work together and agree a common approach. For informatics, this can be particularly difficult because different people can have very different views about the approach and the detail.

The way we approached this in East London was to agree a set of system themes for informatics in the first instance. These deliberately do not talk about the detail but are very firmly aimed at getting us to the point where we have to do that.

These themes are underpinned by a supporting statement which makes clear “we want people to experience services that are truly seamless” and to “enable better information exchange so that clinicians have access to key patient data to make decisions and reduce the risk of gaps and duplications in care”.

A key part of the role is to build trust among the various parties and in this to appreciate informatics does not exist in isolation from other management systems across the local health economy.

At the heart of building trust is the need to recognise that each of the stakeholders needs to see and agree the collective benefit of the approach. The reality is that in Waltham Forest and East London the vast majority, if not all, of the delivery is through provider organisations.

This requires a good degree of cooperation. It is a great tribute to the people at all levels in this system that they have consistently supported this collective approach.

Delivery programme

Agreeing this approach has by no means been a straightforward task, but it has resulted in commitment from all the local health and care partners to a set of four workstreams:

1. Infrastructure reliability and access - To ensure it can support reliably fast access to systems, a review of the existing infrastructure across the partners was completed.
   
   The review highlighted a number of areas which need to be addressed, including defining a common set of principles for the provision of IT infrastructure and service management.
   
   We will also be running an annual survey of usability across the area. What we have established following the review is the principle that the host organisation bears the primary responsibility for IT infrastructure.


2. Real-time, system-wide, shared electronic health records- Organisations across East London have agreed to progress shared care records.
   
   Without access to shared information, care professionals often need to repeat tests unnecessarily and ask repeated questions to properly diagnose and treat a condition. This is inefficient and leads to a poor patient experience. Access to a shared clinical record also reduces clinical risk as the full patient history (and proposed future appointments) is known; this allows a clinician to provide the most appropriate care.
   
   To provide patients and care professionals with access to the right information, we will ensure interoperability between the IT systems that different health and social care organisations use. Often this can be done through software that identifies and shares crucial data fields from the existing systems, but it may mean organisations need to make decisions about the systems they would like to use in the future.
   
   Organisations will only share information with explicit consent except in an emergency situation (such as if a patient is unconscious). Patients need to have a say in how their data is used and continuing engagement with local residents will be important.
   
   Our approach to interoperability is to implement a local information exchange. Effectively, we subcontract this as a health economy to Barts Health using the exchange provided by Cerner.
   
   In the summer of 2016, this was getting 5,000 views per week across primary and secondary care. We are soon to extend this information exchange to mental health and social care. We are also connecting with the exchange in City and Hackney at Homerton Hospital and will have what we believe is the first federated set of such information exchanges for this purpose.


3. Advanced analytics - By combining data from every responsible organisation, we will be able to inform changes to treatment or to care pathways.
   
   We are already establishing new models of care. For example, primary care patients’ records are analysed using an admission risk tool that uses data from both the primary care EHR and the secondary care EHR. The patients at highest risk of hospital admission are identified and selectively enrolled into the East London Integrated Care programme.
   
   Worries about data sharing, consent arrangements and the overarching governance agreement are uppermost in most people’s minds. To get to a point where partners in health economies take this path, there has to be earned trust among all. Having clinical informatics leaders in each sector who have themselves shaped the programme is key to success.
4. Patients’ involvement with their own EHR - The market for patient-facing applications is large, growing and will be enormous. There is a strong argument patients should hold a full copy of their record from all sources and freely be able to interact with support in the health and care service.
   
   While there may be an appetite to write an app locally, one needs to consider the commercial and development risk involved. It seems to the group in East London we should be using the best of what is available and getting an active connection with the local record.
   
   As a result of our discussions, we are supporting patient choice, allowing people to choose their preferred app, while making sure there is a gateway for them to access basic NHS digital services and their electronic record.

Conclusion

The role of commissioning CIO involves helping to coordinate work on a wider basis across whole regions, and being prepared to engage in debate and discussion to shape the national picture.

Indeed, it is key there is an aligned approach between NHS England, regions and local health economies in the same way local health economies need aligned approaches among providers. We might consider the commissioning CIO is at the pinch point of the demand up from local organisations for support and change and the demand down from policy and other initiatives.

The need for whole system approached to coordination has never been greater. The rapid pace of technological change and expectation must have the right level of senior local informatics support, and that includes in commissioning.