Designing services around the needs of the individual runs in Ian Bailey’s blood; the chief clinical informatics officer of Liverpool Community Health NHS Trust has almost 15 years’ experience in district and community nursing roles.
So it is no surprise that he advocates health technology that works for clinicians when speaking to Highland Marketing’s senior communications manager, Rob Benson.
“One of the most important requirements for any technology implementation is that it has to be clinically-led. If it is led as a technology or IT programme, it will fail – clinicians will not engage with it as easily.
“If you can demonstrate that technology can improve patient outcomes, that’s what clinicians want. But as well, it needs to improve their working life, and their ability to provide efficient services.”
Putting informatics in front of clinicians has been a key success during his 11 months in the role. “Whilst it was recognised that informatics was available, it wasn’t at the forefront of our strategic planning, and it was IT-led. Now we have an increased focus and understanding of clinical informatics amongst our frontline staff and in our strategic plans.
“One of the biggest challenges has been to get busy clinicians to engage with the potential of technology. We have produced videos to show staff this, in terms of how technology can feature seamlessly within the day of a healthcare professional. We have given people mobile devices and apps to support them, for example to work with patients with dementia and support safer prescribing.
Promoting the potential for clinically-led health technology
Anything that can help clinicians and others deliver care is high on Bailey’s agenda. “We need to remember that clinicians are busy people. They do not always have the time to see the potential of what technology can do for them. We need to create that vision – the ‘art of the possible’ – to show what opportunities technology can bring to their services.”
Having the right leadership is important to making this happen, and this extends to widening the scope for informatics leads across the care system. Chief nursing informatics leads are emerging, and one trust local to Bailey is employing additional CCIOs from different professional disciplines on a regular, sessional basis to engage with frontline staff and strengthen a collaborative approach.
“CCIOs are traditionally from medical backgrounds and whilst I am not saying that medics cannot lead other professions, from an engagement perspective, it adds a lot of weight to discussions with frontline staff when they know that they are talking to like-minded professionals, who have walked in their shoes.
“It’s key that organisations consider what their strategic plans are, who their strategic stakeholder groups are, and reflect those requirements throughout their senior informatics structure.”
Clinical input into health technology requirements is one of several positive impacts of CCIOs across the country. Bringing the patient into the frame is also something that is possible.
Bailey would absolutely advocate clinicians using technology as part of the therapeutic relationship. This could be as simple as showing information such as blood pressure graphically, or getting people more involved in their care planning. “There’s a world of information available to patients, a lot of whom either do not know about or know how to gain access to.”
This can extend to the information held within their record, and Bailey is very supportive of patient access to records. As a district nurse, Bailey has much experience of working with patient-held records; paper records are held in the patient’s home. Patient access is commonplace; information sharing the norm.
“It’s not as new to me as to some other professions,” he says. “This is information we collect about them, so they absolutely should have access to it.”
Collaboration and information sharing is key
Opening up access to records is just one of the many plans for the future outlined under the Five Year Forward View from Simon Stevens, and Tim Kelsey’s supporting health technology framework, Personalised Health and Care 2020.
Bailey sees collaboration, underpinned by information sharing, as crucial to supporting the vision for the NHS of the future. And using the right tools for the job is also important.
“It would be too costly and unwieldy to the point of being unrealistic to attempt to instigate one informatics solution across a health economy,” he says. “We have to look to exploit interoperability to share appropriate information, whatever the model of delivery chosen. And this must be underpinned by a robust patient consent model.”
The clinical informatics lead sees mobile technology as one the chief enablers for clinical care – but importantly, information has to be available offline.
“The ability to have a full suite of information wherever you are providing care is key. And the information needs to be available even when the healthcare professional does not have a connection, so the standard of care does not drop.”
Bailey is helping the region explore how information can be made available without such connectivity – part of a wider range of initiatives that puts Liverpool at the forefront of clinically-driven technological development.
“There are some real model examples of communities using mobile devices and electronic health records, including within Liverpool community health NHS trust. A number of our services are using electronic patient records, or planning to move on to them. We are at the forefront in some areas, but there are others we are not exploiting fully.”
But the CCIO does not see these as gaps; the challenge is often from clinicians who push health technology suppliers to deliver even more. “As technology advances, you get forward thinking clinicians who see that they can exploit this even further. You will always get that tension between what is required and what is deliverable.
“But we should never wait to get a perfect system. If you wait for that to happen, you will never implement anything. I am an advocate of incremental implementation, where services exploit technology and others learn from them, whilst we work on the culture change that also needs to happen.
“Nurses such as myself, and other health professionals, are not always the easiest people to convert to technology use. But I want technology to be part of the clinician’s toolkit.”
Key to all this is designing technology that meets the needs of the end user. “Clinicians should be able to collect clinical information, with commercial information such as activity being collected without additional work from the clinician. This can get in the way of care.”
District nurses especially have always been at the frontline of capturing patient data. But, Bailey argues, technology could now help us collect vital information whilst still being part of time-pressured care. “Just because we can capture more data, does not mean we should put that burden on to clinicians.”
Exploiting social media
Another way in which clinicians can use technology to help their professional practice is through social media. The CCIO is an active community member of @WeNurses and @WeDistrictNurses, where regular tweetchats see nursing staff and like-minded people connect, and share ideas and experiences.
Each chat is around an hour long, and usually based around five or six questions. There are around 75,000 active followers across a number of health-related communities, and Bailey is experiencing first-hand the benefits it can bring.
“It’s very challenging in the current environment for clinicians to understand what else is going on in their professional community. The use of social media and @WeNurses gives that potential.
“Even at a national level, there are a lot of people experiencing the same issues and you can see how they are trying to resolve them, creating the opportunity for people not to re-invent the wheel. I’m a huge advocate of sharing experiences both positive and negative, as well as best practice.”
Bailey acknowledges the risks – social media is a public forum with a long memory. Professional standards should remain. But the benefits are clear, and these include clinical attitudes towards technology.
“One of the big issues is to get clinicians feeling comfortable and accustomed to technology. A lot of them already are through social media and personal networks.”
Sharing and learning are clear drivers for the CCIO; but overall, it is his drive for clinical input into this new world of technological opportunity that leaves a lasting impression.
Always engage clinicians in health technology development
Bailey’s final message to suppliers looking to work with the NHS is to involve clinicians in product development. “Engage clinicians throughout the development of the product. Suppliers will fail without this, or spend a lot of time on redevelopments.”
And the former district nurse recognises that care is not delivered in a fixed environment. “Please do not develop things that will not work in a mobile or agile way – it will not meet the needs of a lot of the market that needs to be engaged with. A lot of the functionality that is available on a desktop needs to be available on a mobile device.”
Technology should be driven by the needs of end users; something of which the NHS and its suppliers should take note.
About Ian Bailey
Ian has been chief clinical informatics officer at Liverpool Community Health NHS Trust since May 2014. Previous to that, he was area manager and strategic lead for district nursing at the trust, after being the clinical lead for planned care. He has worked in nursing in the region for over 15 years, and is also a clinical design consultant for EMIS.