The chief digital and information officer of Leeds Teaching Hospitals NHS Foundation Trust is marking six months in post. Lyn Whitfield asks him what he learned as CIO for Ireland’s health service, what he plans for the trust’s IT, and his ambitions for the Leeds Care Record as it bids for LHCRE status.
Richard Corbridge has been at Leeds Teaching Hospitals NHS Trust for six months. His appointment as chief digital and information officer was something of a coup for the organisation.
Corbridge spent the previous three years in Ireland, developing an ambitious digital strategy for the country from the ground-up, and Leeds chief executive Julian Hartley said his appointment was a “statement of intent by the board”.
Some industry watchers took this to mean that Leeds would go out to tender for an electronic patient record by a major, probably US, vendor. But one of Corbridge’s first big decisions, when he took up post in November, was to stick with the trust’s own system, PPM+.
Adding to strong IT foundations
Cobridge jokes that the origins of the name “are lost in the mists of time” and the initials have been allowed to stand for different things as the system has developed.
In fact, PPM+ started as a replacement cancer system, Patient Pathway Manager. It’s the ‘plus’ that is doing the hard work, standing for a decade of development that has turned it into one of the most advanced portals come electronic patient records in the country.
“PPM+ has been developed on a short term, rolling basis, with money voted to it every year,” Corbridge says. “That left PPM+ with a perpetually uncertain future. But when you see the level of enthusiasm that there is for PPM+, you have to say that retaining it is the right direction for the trust.
“It is designed by clinicians, for clinicians; it contextualises everything around the patient. It could be described as a portal, but it has its own functionality as well.
“Every quarter, clinicians are asked what they would like to see developed, and the team can sit down with them and build it very quickly. With a single solution, the development path tends to be determined by the vendor or, at least, a long lead time to local changes can be expected.”
PPM+ is also the foundation for the Leeds Care Record, a major, open-source, shared care record that covers not just GPs but mental health and social care; and will soon have a patient held record. Corbridge says the LCR is “a really, really amazing piece of work, because all the links are in place, and they are all bi-directional.”
A career observing IT approaches
Although Corbridge’s last role was in Ireland, he has spent most of his career at the heart of English healthcare IT developments. He worked at the NHS Information Authority that was set up to implement the 1998 IT strategy, Information for Health; leading the data transfer programme that determined how information should be sent between organisations.
Then, after the establishment of the National Programme for IT, and via a stint at Solihull Care NHS Trust, he moved to Connecting for Health; where he took over the implementation of the national NHS Summary Care Record.
When he took up his job in Ireland, via three-years as chief information officer at the NHS National Institute for Health Research’s Clinical Research Network, he said wanted to apply what he had learned from the very different approaches taken by IfH, NPfIT and the NIHR.
The strategy that he drew-up started with the basics: the establishment of an individual health identifier to make sure that patients could be accurately and consistently identified across systems; the integration of GP systems to other parts of the health service.
But it also called for a single electronic health record for hospitals (yet to be procured), while recognising the need for partnership working with suppliers and strong clinical leadership. Corbridge set up a Council of Clinical Information Officers for Ireland and, now he is back in Leeds, is seeking to extend the chief clinical information officer idea further.
“I learned a lot about cultural issues that need to be considered in clinical practice in Ireland,” he said. “In Leeds, we have created three CCIO posts, so there is a CCIO for clinicians, for nurses and AHPs [allied health professionals] and research. That is definitely something that we learned in Ireland: you need to include research from the outset.”
Learning the right lessons for Leeds
Corbridge says he learned many other things in Ireland. The need to keep focused on what clinicians really need, and not to be distracted by what England’s chief clinical information officer, Simon Eccles, calls “shiny things”: the latest company launch or tech “big thing”.
Because, as he points out, there was not much money in Ireland (one reason the EHR programme has not progressed) and there is certainly not much money in England. So, any that is available needs to be spent well.
Also, he says his experience reinforced the need to build confidence in the idea that IT will “work”, that it will help with pressing challenges such as staff shortages, and that it’s ok to learn from others. Leeds has been part of a bid for local health and care record exemplar status, and he says: “We have found, putting together the LHCRE bid, that there is some great work going on locally.
“Rotherham has a great shared care record. We need to talk about that kind of technology, and how we can spread it. We need to stop repeating things. We also need to get more savvy with vendors, so they can’t keep charging for developing the same things in different places.”
Tech targets: and the role of AI
Although Leeds has decided to stick with its IT strategy, Corbridge acknowledges that there are issues to address. The trust relies on a patient administration system, CliniCom, that was developed by iSoft, which was bought by CSC, and is now DXC Technology. Even the company has described it as “ancient.”
The trust needs to improve its radiology interfaces. It needs to deploy a maternity system, for which it has chosen an external supplier, K2 Medical. It needs to improve mobile working. However, Corbridge is determined to see Leeds reach at least HIMSS EMRAM Level 5 on all sites by 2019; and to be developing new ideas for digital support for clinical practice.
For example, he says the trust is going to look at how machine learning and artificial intelligence can support clinicians. “We have a plan for a small piece of AI on PPM+ this year, that will let clinicians say: ‘show me Richard’s clinic notes from last Thursday’.
“To do that, it will need to ‘know’ what last Thursday means, and what clinic I am in, and which notes relate to that; if I am in an oncology clinic, it will need to ‘know’ that I want oncology notes. It should also analyse what information clinicians use, so it can put the information they look at most often towards the top.”
Joining up care across Yorkshire and the Humber
There are also plans for the Leeds Care Record. This is already more developed than many other information sharing projects; for example, GPs in Leeds can go into a ‘virtual ward’ view and see which of their patients are in hospital.
Jason Broch, CCIO for the LCR project, told this year’s eHealth Week conference: “On the day after it went live, I saw one of my patients was in hospital with a fractured hip. I knew she was a carer for her husband, and we were able to put in place a care package for him. That avoided another admission – and delivered much better care.”
The virtual ward view is also available to community and mental health; and Dylan Roberts, chief information officer of Leeds City Council, told the conference that “we are developing a blended view, so there is a view of patients anywhere in the system.”
The first element of the PHR will be added later this year. This will allow patients to enter “three things you should know about me” – for example, that they are a carer, or that a neighbour should be contacted in an emergency.
Corbridge is also determined to see Leeds recognised as a LHCRE. The LHCRE programme is the latest extension to the global digital exemplar programme that NHS England set up after Professor Robert Wachter’s review of NHS IT.
It will allocate £7.5 million to five areas of the country with well-established information sharing projects, to show what can be done and lay the ground for a new data collection and analysis service. In May, NHS England chief information officer Will Smart announced that Manchester, London and Wessex would be the first LHCREs.
But Corbridge told digitalhealth.net that Leeds still hoped to be part of one of two, further LHCREs that will be picked later this year. “Our patients receive care in patient pathways that span the region; we need the digital infrastructure to do the same, and we have a good plan to do that,” he told the website. “All we need is to convince the team assessing this that they are the next team to back.”