CCIO Network leaders urge adoption of Wachter recommendations

Leaders of the CCIO Network have backed the recommendations of a high-profile, independent report on NHS IT that argues digitisation efforts will only succeed if significant new investment is made in the development and support of clinical informatician leaders.

Dr Robert Wachter’s report, published on Wednesday, says £42 million – or around 1% of the total of £4.2 billion Treasury settlement for NHS IT spend over the next five years – should be spent on developing a new cadre of chief clinical information officers, inforatician clinicians, and other IT leaders.

It says there should be higher profile national clinical IT leaders and CCIOs and support colleagues at every trust to achieve NHS digitisation aims. The ideas have been enthusiastically backed by leading NHS CCIOs, who have called for the blueprint to be rapidly adopted as policy and implemented.

A warm welcome for the focus on clinical leadership

Dr Joe McDonald, chair of the CCIO Network, the independent best practice network that has championed and driven the CCIO movement, said: “I am delighted to welcome [the report’s] contents and recommendations, particularly with respect to the importance of developing a cadre of CCIOs to deliver the digital transformation the NHS needs.”

Dr Wai Keong Wong, a member of Wachter’s review team and former chair of the CCIO Network, said: “It is heartening to see the role of clinical leadership in health IT and Informatics given so much prominence and emphasis in Professor Wachter’s review.”

He added: “The findings from the Digital Health CCIO National Survey 2016, which over a 100 members of the CCIO Network contributed to, making it the largest ever of its kind, was directly referenced in the review.

“It played a pivotal role in informing the recommendations – appointment of a national CCIO, a call for more clinically-trained professionalised health IT professionals, and the resources to support this.”

However, he pointed out that Wachter’s report’s recommendations have not yet been accepted and are not yet government or NHS policy.

“It is up to us to turn these recommendations into action,” he argued. “We need to make sure that our boards are aware of the report and get their support in building clinical informatics capabilities within our respective organisations.

“We need to lobby our professional societies to support the professionalisation agenda that the Faculty of Clinical Informatics is pursuing on our behalf. We need to contribute to education and development of one another and future clinical leaders.

Wong concluded: “The door is currently wide open, the centre has shown a willingness to support our vision. As the CCIO Network, we should show leadership and driving the agenda. Our colleagues and patients deserve it.”

Engagement vital to digitisation efforts

Health secretary Jeremy Hunt asked Wachter, the US author of ‘The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age’ and a professor at University of California, San Francisco, to review NHS IT in October 2015.

At the NHS Confederation’s annual conference in June, Wachter, whose report was held up by the ‘purdah’ rules that govern civil service conduct around elections and referendums, said it had set out to learn from the US experience and also from the UK experience with the National Programme for IT in the NHS.

He said both countries had shown that while central money, combined with the right choice of systems, could work, there was a need to focus on interoperability, usability, and clinical engagement; with engagement key to overcoming the ‘productivity paradox’ seen in many industries, where IT investment initially fails to deliver significant efficiency gains.

His report says his advisory group was struck by the lack of clinical input into national IT policy and by “the small number of leaders at most trusts who are trained in both clinical care and informatics, and their limited budgetary authority and organisational clout.”

His recommendations, including a new digital academy, are intended to overcome this. Professor Jonathan Kay, deputy chair of the CCIO Network and former clinical informatics director NHS England, also felt this was the correct approach.

“Buying or developing clinical information systems is expensive, but only delivers benefits if it makes processes safer or more efficient,” he argued. “In healthcare, those processes commonly involve multiple collaborating professionals working under pressure, and are often complex and poorly defined.

“Clinical informaticians can help to bridge that gap between the rapidly expanding technological possibilities and the necessary improvements to processes.

“The CCIO Network has already made great strides in developing the rôle, in sharing experience and in supporting individuals. But it needs to extend its membership, especially in professions other than medicine and in primary care.

“Clinical informatics also needs to become more professional in the production and dissemination of the evidence, especially for new entrants and younger practitioners.

“The Wachter report addresses these important problems with unrelenting good sense that is clearly based on experiences in the messy real world of clinical practice. The ball is back in our court.”

Show us the money

Anne Cooper, deputy chair of the CCIO Network and lead on nursing and AHPs, picked up on the need to include a wide range of clinicians.

“I support the Wachter recommendations, in particular the focus on people and the development of careers that encourage more clinicians, including nurses, midwives and allied health professionals to take up the challenge of integrating technology in practice,” she said.

Some of Wachter’s recommendations have already begun to be acted on. In July, Professor Keith McNeil was appointed as the first NHS CCIO, reporting to Matthew Swindells, NHS England’s director of commissioning, operations and information.

But commenting on what Wachter describes as the ‘strategic’ and ‘symbolic’ need for a national NHS CCIO, on the model of the Office of the National Coordinatory for Health Information, McDonald observed: “Bob’s recommendations will have been implemented when Keith is Matthew’s boss.”

A further critical test will come on funding CCIO development and training. Despite Wachter’s call for a measurable proportion of healthcare IT funding to go on this, the National Information Board is only thought to have committed a fraction of this sum so far.

Much of any new money is also likely to be swallowed up by the new Digital Academy; for which Hunt announced a national competition for universities interested in hosting the new facility yesterday.

However, McDonald, CCIO at Northumbria Tyne and Wear NHS Foundation Trust, a mental health trust, said: “I look forward to leading discussions on behalf of the CCIO Network with the new national CCIO, Professor Keith McNeil, as to how we can best progress the plans outlined in Bob's report.”