CCIO profile: Dr Brendan O’Brien

Dr Brendan O’Brien is keen to see more chief clinical information officer roles in Northern Ireland; an ambition that comes out of his long-standing interest in informatics and determination to apply it to medicine.

In 1986, as a 17 year-old boy, he worked at the head post office in Belfast as a data entry clerk, and soon became hooked on how data could be used to improve the way things worked.

He left the post office two years later to study medicine, qualifying in 1994. He then completed his house officer years in Northern Ireland before joining a public health training scheme in England.

As part of the scheme, he gained a Masters in Public Health, which he says comes in handy in his current job at the Health and Social Care Board.

However, Dr O’Brien also wanted more formal IT qualifications. In 2000, he went back to university to study for a Masters in Computer Science and Applications; after which he did an MSc in Healthcare Informatics at University College Dublin.

“When I came back to Northern Ireland I set up my own business, a health informatics consultancy,” he says. “If a position like the one I have now existed when I qualified, that would have been the perfect role.”

Delivering a new IT strategy

Dr O’Brien now regards himself as a chief clinical information officer, although his official title is consultant clinical informatics specialist. This is a brand-new role, one he only took up in 2012, and he admits it has taken time for people to get used to it.  

“I’m involved in a lot of projects. Now that people have begun to understand what my role is, I get a lot of calls out of the blue and have become somewhat of a focal point for people,” he says.

Northern Ireland faces many of the same pressures as the rest of the UK when it comes to having to deal with an ageing population, and an awful lot of chronic disease, on an increasingly tight budget.

Two years ago, it drew up a new model for health and social care services that focused on putting individuals ‘at the centre’ of their care, and shifting services out of hospitals.

Technology was seen as a key enabler for the plans, and the country is now refreshing and rebuilding its health and social care IT strategy.

The country’s e-Health and Social Care improvement programme is led by Sean Donaghy, the director of e-health, and Dr O’Brien is part of his team.

This means he is both involved in contributing to the development of the strategy, and in many of the projects that come out of it.

“There is a lot happening in Northern Ireland,” he says. “In primary care, we are implementing electronic referrals and upgrading the GP network so GPs can do more; for example, we are giving them video conferencing capabilities.”

In the secondary care world, Northern Ireland began the roll out of a Northern Ireland Electronic Care Record last spring. This aims to give 20,000 clinicians access to a range of health and social care systems through a portal from Orion.

“The NIECR is done with the first phase, which is a common view of legacy systems. Now we need to continue to work on more functionality” says O’Brien. Meantime, he adds, a lot of trusts are working on clinical noting.

Many hats to wear

Dr O’Brien is also the programme director for the Health and Social Care Web Portal project, which he wants to have similar functions to the NHS Choices treatment advice and provider information site in England.

“[The web portal] needs to be improved.  The project is endorsed by the Department of Health and we’re working through the process of redesigning it and going out to procurement. At the moment we’re getting stakeholders together,” he says.

Northern Ireland is also looking at ways to extract more information about its services from providers, and will start extracting primary care data under a new, Northern Ireland Enhanced Service for GPs later this month.

This means Dr O’Brien has been following the debate over care.data with considerable interest. Care.data is the NHS England / Health and Social Care Information Centre project to extract hospital and GP data for a wide range of uses that has run into a firestorm of controversy over patient consent and confidentiality.

However, the controversy is something that Dr O’Brien does not expect to see replicated when it comes to care.data’s counterpart across the North Sea. “We are going to do extractions of data, much like care.data in England.

“But we believe that it’s possible to pseudonymise [replace patient identifiers with placeholders] at source. We’re taking a different view on that to England,” he says.  

Finally, he is involved in a project to run ‘teleECHO clinics’, which he is very excited about. ECHO clinics – or Extension for Community Healthcare Outcomes clinics – are an idea developed by the University of New Mexico to help medical services improve their capacity to safely treat chronic and common deceases, and monitor the outcome of treatment.

Northern Ireland wants to use telemedicine technology for educational purposes so, for example, GPs can get advice on how to treat patients in a safer and more effective way.

“It is about getting GPs to deliver better primary care services. We will have a specialised team at the hub and the GP will use telemedicine technology to present the case to the hub and get more advice on how to treat the patient,” he says.  

Over time, he points out, GPs should become more confident of dealing with cases themselves. The plan is to start with clinics in diabetes and palliative care, and Dr O’Brien says: “We hope to be in a position to run our first teleECHO clinics in late March / early April 2014.”

A different kind of CCIO

Among the many other hats that he wears, Dr O’Brien is also the country’s representative for the Professional Records Standards Body and a member of UK Council for Health Informatics Professions.

Overall, he admits that his CCIO role is probably rather different to that of most CCIOs in England; not only because he does not work for a trust, but because he tends to take a very technical approach to problems.

“I probably have a much more technical background and focus than most CCIOs,” he says. “In terms of the nature of the role, it’s also much more about informatics use in the commissioning world.”

In addition, although Dr O’Brien has a nursing informatics colleague, CCIOs are almost non-existent in Northern Ireland, while they are becoming increasingly common in trusts in England.

This is something Dr O’Brien is determined to change. “In the regional organisations, there are obvious candidates for CCIO roles but we don’t have any CCIOs. That’s something I will be pushing for,” he says.

“We hope it will be a much stronger clinical voice in the strategy. We want more clinical buy-in; it’s essential.”