Another view: how to develop future clinical IT leaders

Taking on a new role has prompted Dr Neil Paul to ask where will the next generation of primary care CCIOs and clinical information specialists come from and the steps needed to develop them. 

I recently took on a new role or should I say added a new role as I don’t appear to have stopped anything else. The local CCG recently recommissioned our local community services. My GP federation as part of a tripartite bid with our local acute provider and our local mental health provider bid and won.

Because I didn’t take a pace backwards fast enough, I’ve ended up on the board with guess what; responsibility for IT. Now the good news for me is I have a brilliant manager to work with and even better, the committee I chair has some good capable people in the room.

They all seem to know their stuff, they all seem committed to improving health care for patients and helping staff do their job, and they all understand the budgetary constraints we are under. I’ve high hopes and we’ve already I think made a load of progress. The only problem is I have little staff and clinician input.

IT knowledge remains thinly spread across NHS

When I got the job – I made a point of touring some of the teams, asking them about their IT, what their problems were, what was going well and what could be done better. I was mildly surprised by the lack of IT knowledge.

There was an almost universal dislike of their current system. Some were using different systems from different agencies, some knew others had access to some software that they didn’t, some had heard of things like the Cheshire shared record, others hadn’t, and neither could really tell you much about it.

At a deeper level, I came across a person who was enthused about her new work iPad, sat in a Wi-Fi connected building using her slow 3G connection to upload her data and was still using a paper diary despite having access to an exchange client on the iPad.

We’ve taken steps to work out who needs access to what has the training they need, but the point I’m trying to get to is you need people to have some level of IT knowledge that allows them to ask the right questions and seek solutions.

Need staff to understand the art of the possible

One answer to the above is to build a standard build, push it out to all devices and create a training list and make sure each member of staff ticks it off. You get people using what they’ve got better but do you get innovation?

Do you get people saying if only we had a piece of software to do X, why can’t Y be automated? The problem is often the IT people will have a solution to a problem, but the real challenge is often to first understand the problem and translate it.

Importance of CCIO as a translator

An example of this is one of our CCG board members turned up to the IT meeting and presented his vision of where out-patients is going. He was keen to make sure the IT infrastructure we are putting in, meets that. That was a good question but he didn’t get the IT and equally the IT people didn’t get him.

Luckily I did and acted as the translator, but if I wasn’t there who would have done the translation? When I was the IT lead of the old PCT, there were a few people dotted around the patch who we tried to get involved.

One is now, the me, in a neighbouring CCG and is doing a great job. But we are few and far between. He also is a techy and almost self-volunteered. It certainly wasn’t a proper job.

Where are the IT literate clinicians?

I worry there aren’t nearly enough IT literate clinicians. When I went to med school there weren’t computers anywhere.  I’d done a computer science A-level in my spare time.

I then worked as an IT support tech for the university in my med school holidays, but it wasn’t until I hit general practice I came across computers again in the world of medicine. However, these days you’d imagine that given the med schools give students iPads and all their course work is on line they would be real IT advocates. But somehow that’s not my experience.

Perhaps it’s that they aren’t senior enough yet to be filling the roles? But I worry that users don’t understand IT well enough. When I met the community staff they weren’t stereotypical 55-year-old technophobes. Most of them were texting, Facebooking, Instagraming, they had smart phones and apps but none of them instinctively knew what to do when the ECG machine lost its Bluetooth connection to the computer or what a VDI is.

No incentive to become an IT specialist

It strikes me that there is no real incentive to become an IT specialist. What does it gain you? As a nurse or HCP or even doctor – you are training in your speciality. There are advanced qualifications you can get to gain seniority. At some point some people decide to go into management, there are training courses academies, coaching, mentoring. What do the people who want to do IT have?

A few years ago, there was a push to get everyone coding. Ok as a coder myself I understand that gives me a better knowledge of how computers work and what they are capable of. I’m not sure it’s the right thing though.

Much more important are questions like, who is creating the courses to improve your IT skills? who is promoting it as a career option?  Who is promoting the much wider informatics agenda: understanding data, understanding information, analysing it, presenting it, using it to make better decisions?

Starting to get the call for CCIOs

I’ve been a little cynical in the past about the call for CCIOs but I’m starting to get it. However, it’s not just about having one person at the top, but building multi-disciplinary teams. And the question remains how do you get there?

Should we rely on people who used to read Acorn User as a boy and learnt to program in 6502 assembly language?

What kind of thinking is required to be a CCIO? What kind of skills? What essential knowledge is there? I remember taking a lesson on the difference between Ethernet and token ring networks and the difference between switches and hubs – its helped me along the way – is that essential knowledge? Do we have a curriculum? Do we have qualifications?

How do we find and train the right people?

I’m a member of the BCS – I haven’t applied for Certified Information Technology Professional – but is that the right qualification? How do we find the right people, nurture them, grow them, promote them? And we need a whole range of IT literate clinicians, not just people at the top.

They need a network of people feeding them info – passing it down to the troops – coming up with new ideas – pushing the person at the top to deliver more. There are still huge productivity savings to be made in the NHS. IT is perhaps the saviour of the NHS, but the IT people can’t do it without partnering with clinicians.

The challenge remains, how do we get the clinicians trained and engaged on health IT and informatics?