The paper handover/team/ward list: folded, kept in your pocket or your clipboard or tucked into the clip of your on-call bleep, but never (no never) lost. You hope.
What’s on that handover list? The patients your team are looking after or who are on your ward, what their diagnosis is, what you are doing for them and need to do for them, what others are doing for them, when they came in and when you think you will be going home.
Perhaps you spent some time “re-designing” the Word template for your list when you started a job, since the last junior’s version didn’t quite fit what you needed. It didn’t quite fit how you wanted your information displayed.
You probably looked at your personal task list on your phone and wondered why you couldn’t do the same for your team list.
If this sounds familiar, then you are not far away from understanding the importance of information/informatics to effective clinical care, organisational management, and – without being glib – to the function of the NHS as a complex whole.
Also, you may be recognising your ability to get involved in IT, to improve informatics in healthcare, and to make it work for us and our patients - rather than making our lives harder.
Within that team/ward list are significant elements of the challenges of a clinical informatics lead:
- Organising and storing information about patients in a way that helps clinicians look after them more effectively (on your list – diagnosis, previous investigations, lead clinicians, admission time)
- Displaying information in a way that clinicians can use readily (the design of the template – it’s a dashboard!)
- Storing the information securely (in your pocket?!)
- Information that can be used to show activity and outcomes (referrals, procedures performed, risk, discharge dates) - this not only make it possible for the organisation to plan how it works, but demonstrates its effectiveness and safety so that it can be paid and monitored
- Keeping systems up to date and making good use of innovation in technology (wondering why you can’t do all of this on your smartphone)
- Understanding the factors that drive change in people’s behaviours around technology (if you developed a phone app handover list, why would people still want to use the paper one?)
Electronic record and ordering systems will be universal within the next few years. To overcome the challenges and make the most of the opportunities that future brings, we need to start developing the necessary skills in junior clinicians.
If you are interested in ditching the paper handover sheet, can see the power of the information it contains, and want to do something to make it work better… then read on.
What skills and expertise may you need to develop?
A future role as an informatics lead may need some specific knowledge or skills. Much of what is required is similar to other clinical leadership roles, however; and as such can be gained from a broad set of experiences.
Below is a list of skills that you may wish to develop over the course of your early career. This development can be through specific experiences, self-directed learning (like reading the CCIO Handbook), attending courses or completing postgraduate degrees.
- Knowledge of leadership styles, and self-awareness about your own
- Communication, including the ability to communicate a narrative to a wide variety of audiences
- Management skills, including project management.
Leadership and management
- Behaviour change in complex systems: implementing change to a IT system challenges the habits that people have developed in using the system, so understanding how to change those habits (and the support that people might need) is important in a successful implementation
- Quality improvement techniques: understanding the process for improving quality will broadly help you see the role for informatics here, but also help you to improve the informatics you use.
Improvement science
- Analytics knowledge and skills: yes, that does include statistics and understanding how data quality can be assessed
- Data visualisation skills and understanding: which means understanding how data becomes information which becomes intelligence
- Knowledge about clinical guidelines and best practice: this should be supported and embedded in the information systems we use.
Information
- IT infrastructure and technical knowledge: for example, an awareness of the software development process
- Software programming: learning to code sounds “techy”, but it is often easier than you think to gain enough knowledge to understand problems that might arise - or at least to learn the language that is used to describe the problems!
Informatics
Whether you need to develop this knowledge through a postgraduate clinical informatics qualification is open to debate at present.
The NHS graduate scheme participants who specialise in informatics complete concurrent postgraduate qualifications in healthcare informatics and healthcare leadership. There are quite a few MScs in healthcare informatics and many more in healthcare leadership.
It is well worth doing some research, talking to people who have completed the courses, and assessing whether the cost (both in time and money) is sustainable perhaps over three years (see the chapter on education for the personal reflections of someone who has completed a Masters in clinical informatics).
Whether you decide to pursue a postgraduate qualification, some of the areas above are really best learned and demonstrated through experience.
Gaining informatics experience, developing your CV and your career
Local projects:
A little research and generating a few ideas – or at least problems to address – is a great way to start gaining some informatics experience.
In your day-to-day practice you will come across “IT problems”. When you do, ask yourself: do you understand the problem and, if so, what are the ideas you have for solving them? What more do you need to know? Find out who in your organisation you need to talk to.
In short, go and ask! A polite, enthusiastic e-mail or conversation - with a few nuggets of thoughtful ideas, a sense of time to commit and a curiosity about how you can help - opens most doors. And those that don’t open are probably worth learning to work around.
Identify the time that you will have to get involved in projects. Sometimes this can be through specific time set aside in your training – referred to as “special interest time” in some specialties. If you time needs to specifically be used for research, then it is about creatively framing the project you want to do in these terms.
Getting involved in audit:
There is still a significant focus on completing audits in many training programmes. You may not realise it, but audit presents two opportunities around clinical information and informatics.
The first is that the topic of the audit could be the use of an informatics system. For instance, it could look for evidence that prescribing in an electronic records system has been documented according to existing trust protocol.
This “audit” project would allow you to go on to explore, using quality improvement methodology, how to change the practice of clinicians; but also the design of the informatics system. Such a project would be a great start in understanding how it all fits together.
The second opportunity is using the informatics systems in the process of the audit. How do you go about getting data out of the “back end”? What processes do you have to follow?
This will take you through many of the safeguards and protocols around information sharing. You may also wish to devise a spreadsheet that allows you to record and analyse the data you are getting.
The process of designing the spreadsheet and using it to record data and generate analysis has many of the key elements that are important in informatics such as user interface design, safely storing and sharing data, and using software to analyse data and generate useful information.
It is better to pick one project and complete it than to try and do many different projects. As a member of staff still in training there will be many demands on your time. Having a clear plan, a realistic sense of how much time you need or have, and also who else can help you, are critical to any project. They are also certainly skills that a clinical informatics lead will need, as his or her informatics role will often be juggled with other duties.
Fellowships/out of programme or training opportunities:
As clinical informatics becomes more central to clinical leadership generally, there are likely to be increasing opportunities for those who wish to develop experience. Fellowships are an obvious example.
At this stage, exploring the idea of taking a year out of training to do a fellowship may rely on developing the right contacts and simply talking to people.
Towards the end of your training, you will have developed significant clinical insight but also insight into how the “frontline” works. That knowledge of the frontline should be highlighted as a key strength when discussing opportunities with other organisations.
First five years as consultant or senior practitioner
It is unlikely you will become a clinical informatics lead in your first post after completing your postgraduate training – and nor should you, perhaps!
Many clinicians entering their first senior role report the first few years being about finding the confidence to perform their clinical duties. However, when you are applying for job, make the clinical informatics work you've done stand out.
Use it as a lever for conversation about getting some time set aside in your job plan to work on a specific project with the chief clinical information officer or informatics team. Consider meeting the CIO/CCIO of the trust or organisation you are hoping to join and getting a sense of what is happening.
The Health CIO Network and the CCIO Leaders Network are both growing. Join them, attend events, and listen out for jobs that are coming up.
Much of the success of being CCIO will lie beyond the technical world of IT infrastructures. Instead it will be about your ability to work with and through all elements of an organisation, and you will need to build these links over time.
Organisations to join:
- The CCIO Leaders Network
- Faculty of Medical Leadership and Management
- BCS Health – part of the Chartered Institute of IT (British Computer Society)
- The informatics committee of your Royal College. If there isn’t one, then set one up!
- The telemedicine and e-health section of the Royal Society of Medicine
About the author:James Woollard is an ST6 specialty registrar in child and adolescent psychiatry, due to finish his training in August 2015.
Between 2014 and 2015 he worked as clinical leadership fellow with the national clinical director for mental health at NHS England, working on the development of the digital maturity model for mental health services. He has previously published and presented on the use of technology in mental healthcare and can be found on Twitter @psycle_doc.