CCIOs need CIOs as “partners”

The secret to the success of a hospital chief clinical information officer is a strong partnership with a good chief information officer or IT director.

This was a central message from the first joint EHI/BCS Chief Clinical Information Officer event held in London at the beginning of May.

The half-day event, attended by almost 100 delegates, focused on the professional development of CCIOs in the NHS and how to make the new role work

Dr Jack Barker, CCIO at King’s College Hospital NHS Foundation Trust, said that he had  been doing CCIO-like roles under different names for ten years.

Now formally appointed his trust’s CCIO, he spoke of what he believed was needed to make the new role work. “You need a partner or wing man in the IT director, and mine is Colin Sweeney [King’s IT director].”

King’s is working to becoming a paper-free teaching hospital with real time quality reporting, and is nearing the end of a major multi-year e-prescribing roll-out, now moving into ICU, as part of a long-term electronic patient record programme.

Big clinical implementations take time, said Dr Barker, who has been King’s lead on its EPR development since 1999. In that time he says he and his IT director have seen chief executives and governments “come and go”, providing a high degree of continuity.

As well as continuity, a CCIO must be a clinical leader and champion and be willing to sound the retreat where necessary.

In King’s case, this proved necessary after the 2011 introduction of a new e-prescribing initially created howls of protest from clinicians.

“The software kept losing drugs, so we immediately stopped and we took as long as was needed to fix the problem.”

At other times, they must be able to recognise that the problem is with the cultural change and hold the line.

Dr Barker said this was the case when the trust “stopped filing all paper clinical notes in patient notes” as part of its EPR implementation.

“Someone has to tell staff that we won’t file a copy of their clinic notes in the patient notes.” And it comes a lot better from a trusted clinician.

“You’ve just got to be logical and reasonable,” said Dr Barker, who replied to 165 email complaints on the day of the switch.

He added that a CCIO needed to be fairly thick skinned. “Don’t expect to always be popular."

He said the essential skills of a CCIO were around clinical credibility, leadership and communications.

“You have to get on with people, be persistent and be able to convince pretty influential and powerful people, most of them, consultants.”

Having meaningful responsibilities, be it for a project, system or implementation is also crucial, said Dr Barker, who added that, at present, the CCIO role takes him two days a week.

Dr Barker said that in his view CCIOs didn’t have to be technical but it helped if they could “speak the language."

“But I question how many IT skills are needed if you have a good IT director as your partner.”

CCIOs also have to be versatile and able to respond to a variety of challenges. To illustrate his point, he gave a snapshot of two weeks in the life of a CCIO from his calendar.

Meetings ranged from: IT strategy group, performance management, speciality systems, external consultants and implementing IV line control.

He explained why he believed in the potential of clinical information systems. “IT is likely to do more for patients’ health than any drug prescribed.”

Dr Barker added that one of the central arguments for better information systems is to identify and address the huge variability in clinical outcomes and help ensure a much more widespread take-up of best practice and proven research.

“If we applied everything we know right now we wouldn’t have to do any research for a while,” he joked.