HTN caught up with Matt Connor, group chief digital information officer for University Hospitals of Liverpool Group, consisting of Liverpool University Hospitals Trust and Liverpool Women’s and spanning multiple hospital sites. Matt shared insight into the importance of having a cohesive strategy for digital and his views on cyber security – the current threat landscape, priorities for the group, considerations to take around finances for cyber, and more.

Officially, the group was formed at the start of November, but in reality Matt has been working in the joint role since the start of February 2024, and took on the expanded role following five years as chief information officer for Liverpool Women’s.

The group way of working “offers a real opportunity to deliver digital at scale”, Matt reflected, whilst not losing sight of the collaboration taking place on a wider scale with local Liverpool trusts and beyond across Cheshire and Merseyside.

Digital priorities, and balancing innovation with operational needs

Matt highlighted the need to address ‘why’ digital innovations are needed and put in place, summarising: “We need to make life easier for our clinicians, regardless of what system they are using, and we need to remember that patients are always at the core of everything we do. We need to make it easier for them to engage with our services; and the complexity of the different systems across our different sites can make that really difficult. It can result in overly complex processes affecting patient care pathways, with patients having to tell their story more than once.”

“We cannot forget about getting the basics right, if we are to deliver effective digital innovation,” Matt continued. “If we can do things once and at scale, and get to a place where we reach a level of systems convergence and integration, then that will benefit both how we are able to deliver services to a high standard; but also provide a simplified digital and IT offer for our staff and patients alike.”

The “power of collaboration” is also a priority for the group; Matt shared the ambition to develop a single electronic patient record throughout Liverpool, with Liverpool University Hospitals Trust to be the first to implement that EPR in the group’s planned roadmap. Work is underway with NHS England to help this become reality, with the trust working closely with the national team.

In order to support staff in their roles and improve their experiences, the group will prioritise streamlining and simplifying where possible, with Matt acknowledging that whilst group working opens up plenty of benefits, it also brings challenges such as the use of multiple systems and duplicated governance procedures and policies.

“We need to optimise our time and resources so that we can make the most of what we have and make things more efficient for staff across both organisations,” he said. “This is particularly important when it comes to clinicians having a need to access different clinical systems – historically this has been extremely challenging, so we are working on a number of projects designed to improve IT access and simplify our standards across all the sites. We want aligned digital processes, and delivering a consistent reliable serviceand trying to unlock some of the benefits of collaboration between the two organisations.”

However, whilst simplifying is a core priority, Matt noted that it is important to take care that simplification does not take precedence over innovation, with too much focus on streamlining it may lead to missed opportunities to try something new. Here, he underscored the value of data and utilising business intelligence across both organisations as much as possible, to identify opportunities to improve patient outcomes across Liverpool and beyond.

Matt also emphasised the importance of having an engaged clinical workforce when it comes to innovation. “We really do rely on our strong clinical engagement network. We are lucky to have some really excellent clinical and nursing leaders within both organisations, and they help us to prioritise opportunities to innovate as they come along, because they can tell us what will be useful to staff. It’s a real team effort – it’s important to say that and to recognise it.”

Data at the heart of everything

Coming back to the topic of data, Matt reflected: “Data is at the heart of everything – it really reinforces why we do things, it measures our progress against an intended objective, it illustrates the benefits of an initiative or tool. Without data, it’s just a matter of perception, and that can be misleading at times.”

The biggest impact in this space has been seen when the group has “put data at the fingertips of those who really need it”, he continued. As an example, Matt highlighted that the group’s maternity assessment unit had a target indicating that 90 percent of patient triages should be completed within 15 minutes.

“The problem was, this data wasn’t in the hands of the clinicians and maternity staff, so it wasn’t being acted upon,” he said. “People were going about their daily business, doing their jobs and trying to achieve that, but without the oversight of where particular challenges lay when it came to meeting that target. We developed a real-time dashboard placed right in the centre of the department to help tackle this. It was interesting because at first, that dashboard was inaccurate. That was because the data in the system wasn’t always accurate – and that in turn was because the data hadn’t had this value placed on it before and staff are busy, so ensuring that data was inputted and correct wasn’t always prioritised.”

Having the dashboard in place “helped improve that, because staff could see the consequence and meaning of the data they inputted, and over time it had a real impact on the delivery of service. We are now exceeding that target and completing over 90 percent of maternity assessment triages within 15 minutes, consistently. The maternity team is rightfully very proud of that.”

As healthcare moves forward into exploring new ways of providing care, Matt added that population health data “is going to be so important. We need to be able to make the right decisions for our local communities with the funding that we’ve got, so that we can move away from being acute-focused and towards providing the right care in the right setting.”

Cyber security: optimising resources and building capabilities

Matt commented on the complexity of the current landscape when it comes to cyber security, acknowledging geo-political threats as well as the usual cyber threats that exist on a daily basis.

“If we are to be as successful as we can in reducing the risk and minimising the impact on patient services – because we can never truly eradicate that threat – we need to ask how we can make the best use of our resources. That includes staffing, knowledge and financial resource.”

If individual organisations all “go off and do their own thing”, there is a missed opportunity in Matt’s view. He pointed to the national NHS offer around cyber which includes a range of services from free on-site assessments to virtual perimeter security, stating that the resources are “really beneficial to strenhthening the cyber posture of organisations”.

From an ICS perspective, Liverpool has developed its cyber strategy aligned to the national strategy, with a view to making the best of what is already offered nationally and augmenting that to regional needs. “We know, for example, that third party supplier management is a key priority when it comes to cyber, particularly as we move into more cloud-hosted services,” Matt explained. “We are potentially being exposed to new risks in this way, risks we didn’t historically come into contact with. So there is an opportunity here to deliver some of that support at ICS level, and put in some principles around supplier managements. We can baseline where organisations within a footprint may have some commonality and provide economies of working together to address any gaps. We can also better understand risk, as we have a wider picture.”

In this way, the ICS focus on cyber security is very important in Matt’s view, and it comes down to having a clear strategy that organisations can align themselves to.

One programme the ICS has recently invested in, to support 14 trusts across the region, will see the introduction of a healthcare cybersecurity platform from supplier Cynerio. Matt noted this provides “comprehensive visibility into all networked devices across our ICS trusts” and forms part of investment in defences to better protect patient data, minimise vulnerabilities and reduce disruptions to care. Here, the platform is designed to offer continuous monitoring to detect and mitigate threats specific to medical and IoT devices within healthcare environments as well as real-time threat intelligence and automated response mechanisms, “helping us enhance our security posture” Matt added.

In Cheshire and Merseyside, the stance on cyber is that “you are only as strong as your weakest link”. Matt elaborated: “We live in an interconnected NHS world. I don’t think we should be focusing just on getting in tools and systems to solve problems, but rather focusing on developing some capabilities within the ICS to provide wrap-around support to local trusts, augmenting their own capabilities.”

Funding for cyber

Tying into this point, and picking up on the financial side of cyber, Matt noted that funding has typically been capital-fed, which tends to feed into plans to buy more tools. “We end up with a landscape of so many tools, increased complexity and not enough cyber staff to manage them; actually, what we need to do is develop the right capabilities so we can maximise with the resources that we’ve got. With this in mind, it would be more helpful if we had a revenue-based model that would allow us to build for the future.”

It’s not just for the national team to provide funding all the time, he pointed out. “Where we’ve got ICSs working on digital planning across a footprint, there needs to be a sustainable funding models that organisations buy into to allow a degree of centralised resource and capability within the ICS.”

Whilst on the topic of cyber funding, Matt considered how digital leaders can communicate the financial rationale between cyber security investments to colleagues who might not necessarily see the direct impact of the money spent.

“It’s about articulating the risk, and highlighting how it’s about clinical risk management ultimately,” he stated. “In particular, it’s key to have a strong route to the trust board, with strong cyber awareness and the risks articulated and understood at that level.”

Investment in digital tends to come hand-in-hand with a return on investment in terms of delivering perceived benefits, Matt said, whether that benefit is increased efficiency, quality, safety, or a financial benefit. “With cyber, it’s a bit different, because the purpose of cyber is to stop something from potentially happening. That’s why I think it’s a question of articulating that properly. You need to focus on the impact an attack could have on clinical services, and unfortunately the NHS has a number of examples from the past couple of years where clinical services have been significantly disrupted because of a successful cyber attack. Make sure you’ve got really robust cyber planning in place, that you can answer the ‘so what?’ question.”

Something else that can also be overlooked is “really emphasising the ‘secure by design’ principle when buying digital innovations”, Matt added. “When we buy new innovations, are we really considering the cyber requirements at an early stage?” As an example, he pointed out that where previously clinical systems have been hosted internally and locally across different organisations, healthcare is now moving towards convergence with a more centralised cloud-hosted offering capable of servicing the need of many organisations. “It’s good in many ways that this convergence is happening, but are we considering the cyber risk associated at every stage? If this centralised cloud solution is compromised through a cyber attack, the impact will be significantly greater than if an internally hosted solution was hit within one organisation.

Getting the most out of digital: advice for health leaders

When it comes to digital innovations and projects, there is a tendency to view go-live as the “defined outcome”, Matt reflected. “We staff and we fund for that period, based on a programme approach. But if we do that, we end up failing, because we don’t adopt and optimise those systems. When we put new systems in, we’ll get a lot right, but there will also be a lot that we need to shape as we move forwards. So it’s about being committed to digital as a way of life; seeing it as intrinsic and central to the things we do in terms of delivering care. We need to invest in sustainable digital teams for the long term.”

Matt also emphasised the need for collaboration along with the right to fail and try again. “It’s okay to make mistakes. It’s about being open and honest about where we could do things differently, do them better; learn from it.”

Leaders need to “stay true to the course, and see digital as a real enabler”, he concluded. “That means ongoing investment around staffing. That doesn’t just mean ‘digital’ staff, but all roles that have an important part to play in digital transformation moving forwards.”

Many thanks to Matt for taking the time to share his thoughts.

For a recent interview, we caught up with Peter O’Halloran, Chief Digital Officer at the Australian Digital Health Agency (the Agency), to learn more about current projects and priorities, what’s in the pipeline for digital and data across the next five years, progress toward Australia’s National Digital Health Strategy, and more. 

Peter offered a brief introduction to his role and some of the recent projects he’s overseen with the Agency, saying “I’ve been at the Agency for about two years now, but have worked in healthcare IT for more than twenty years”. Referring to what he calls a “digital health revolution” in Australia at the moment, he told us that the Agency has a plethora of ongoing projects across the health and care space, adding “I’ve seen more activity in the last two years than I did in the preceding twenty years”. 

Specific projects under way at the Agency include “rearchitecting Australia’s entire digital health ecosystem”, modernising the My Health Records platform, and introducing a full national Health Information Exchange (HIE) which he estimates will take place over a period of five years. “We’re doing all of the design work for that now, and we start the first bit of coding in January,” he said. 

Another area of focus is healthcare interoperability, according to Peter, “so that involves a lot of work with national identifiers for healthcare providers, consumers and organisations, as well as with standards and clinical terminology – we have a FHIR accelerator, and although FHIR was invented in Australia we’ve done very little with it until now; now we’re trying to leapfrog everybody else!” 

Finally, Peter shared that the Agency is working on offering consumers choice, with the my health app that he describes as a “digital front door for all things healthcare in Australia”, and planning for a go-live this month for “the next big step”, which is e-prescribing. “That’s probably a decade’s worth of work we’re trying to get done in the next two or three years,” he added, “but the time has come, and we can’t wait any longer.” 

There’s work at the Federal level to bring in new legislation, Peter added, “which is set to mandate that pathology and diagnostic imaging test results must be shared with consumers through their My Health Record – with some exceptions based on consumer preference, clinical concerns, safety concerns, or technical issues – and there’ll be big financial penalties for diagnostic providers who don’t do that.” 

Collecting and utilising health data  

Peter shared with us some details around how the Agency currently collects and utilises data, pointing to the fact that most of the data currently collected is for primary use, through pathology providers, diagnostic imaging providers, hospitals, specialists and GPs sharing data with the national system. “That’s something we’ve been doing for well over ten years in Australia,” he said. 

Another important thing to consider for data is that “around 90 percent of Australians have a My Health Record”. A lot of the last ten years has been looking at how to ensure that includes “the right information”, according to Peter, “that can be surfaced at the right time, when that clinical care is being provided, to assist the clinician in providing exceptional care”. 

As a consumer, patients have the option to control who has visibility of information contained within their My Health Record, and can create an alert directly to their phone to let them know every time someone looks at their record, Peter said. “I could also go into my record and control which parts of my record are visible,” he continued, “so we have a really good mechanism in place for that, and the true power of that is in our strong consumer control legislation.” 

Updates to the My Health Record and my health app functionality 

When it comes to recent developments on My Health Record and my health app functionality, Peter talked about current modernisation efforts, including efforts in the last three months to introduce new functionality to enable aged support plans for those in residential aged care. “Those can now be shared with their clinicians and representatives through My Health Record,” he said. 

Peter’s team has also been looking at how paramedics “could better use the My Health Record”, he went on, “and whether we need to design something specific just for them”. Additional functionality has just gone live to enable patient data to be sent along with them in the ambulance for the paramedics when a patient is moved from aged care to acute hospital care, in the form of an Aged Care Transfer Summary, he said. 

“The my health app is even more exciting,” Peter noted, “and we’ve got upcoming work around medicines, emergency contacts – looking at our roadmap we’ve got about four years’ worth of work to do in the next twelve months!” Now is also the time, he said, to look at the functionality that consumers are wanting which isn’t available yet, “and we’re enjoying feedback which tells us how this additional functionality we’re putting in is making the lives of those using it much easier”. 

Industry collaboration and procurement 

“We’ve got a whole range of procurements happening at the moment,” Peter said, “and they’re looking at how we take everything we’ve got and modernise it”. Talking specifically about  a recent Request for Information (RFI)  put out for application support and maintenance, he told us that that was part of finding out from the software industry and vendors  “what the newest and greatest ways of doing things are, because ultimately, we’re not the source of innovation, we’re learning from our colleagues across the sector”. 

In parallel with that is the Agency’s work on consumer engagement, Peter told us, “because everything in the my health app is actually co-designed with consumers, patients, and carers. What we’re hearing from them about what they’d like to see from digital healthcare infrastructure is they tell their story once, to one clinician, after which everyone else just knows it and has all the information, so healthcare isn’t one of those things that takes time away from them enjoying their lives.” 

This engagement has led to procurement processes to see how the Agency can do that, Peter continued, “to bring all of that information together, allow data to be retrieved on demand, and build newer, better ways for our clinicians to view that information – it might be using AI to allow them to talk to the system and have it pull out the data they’re looking for – we want them to be able to just dive in and pull out the bits that they want. We’re hearing from that RFI now just how technically we can do that.” 

On whether he feels there is enough space for industry collaboration in Australia, Peter mentioned a recent briefing the Agency held for the healthcare and IT sector, in which it presented its vision for the future, took on board feedback, and “answered hundreds of questions”. A consultation document has also recently gone out with “about 140 pages of architectural genius, if I believe my staff”, he said, “talking about the architecture for the health information exchange”. 

All of this work has been directed at “getting the best out of industry”, Peter told us, “and we also hear regularly from clinicians and consumers on what matters to them – now we’ve got those ideas it’s about how we make it easier for industry to work with us, including publishing an annual procurement plan which lets vendors know what we’re looking to buy at various times across the year. 

“We’re also doing other things to try and encourage that digital healthcare ecosystem in Australia, embracing global standards, and remaining ruthlessly focused on ensuring absolutely minimal local customisation to allow companies developing in the Australian market to sell their products globally. We’re trying to reduce the time it takes vendors to connect to our national infrastructure and to My Health Record, down to one month,” Peter highlighted, “and we’ve already shaved nearly six months off that time.” 

Embracing industry in the health sector in Australia is integral, Peter said, “as there are so many problems to solve, and I don’t have enough smart people to do it – I need all the help I can get”. 

Progress toward Australia’s National Digital Health strategy 

Directing his attention to the nation’s progress toward its National Digital Health Strategy, Peter hailed some of the “great progress” to have happened over the last decade or so, saying, “we have things like digital radiology, digital pathology, an active EPR market, and some really strong legislation around data sharing – I think all of those things, plus our central My Health Records system have set us up well, but they’re only the foundational building blocks.” 

Implementation of the National Healthcare Interoperability Plan will take place over the next two or three years to “start to join all of that together”, Peter shared, “and then when we start working on technology modernisation and moving to FHIR, upgrading all of our systems; that’s when I think Australia will excel, because at the moment we have lots of islands of digital excellence, but they don’t operate as one system yet.” 

Joining all of those pockets of care together will be key, Peter went on, “whether that be disability care, care for veterans, or just day-to-day visits to a pharmacist, GP, or hospital – that’s really what Australia is focusing on now”. Within ten years, he said, “I hope Australia will be a nirvana for health tech globally. We’re embracing international standards; we have an aggressive plan to modernise; and we’re really looking to develop what we’re doing, working with industry and building on what we know about what consumers, patients, and clinicians want.” 

What that looks like in practice is “not talking about health tech, but just having that be a natural part of conversations about health”, Peter said. “So we won’t be talking about e-prescriptions or how one system talks to another; we’ll be talking about what clinicians are doing with data and how they’re treating consumers differently because they have access to all of these systems and services to facilitate that.” 

One of the major challenges in reaching that point will be the “vast distances” the Australian health system is required to cover, according to Peter, “because we have long distances from one part of the country to another, and it’s how we promote access to services, and how we use digital technology to reduce that distance and achieve health equity. It’s also how we use things like digital twins to allow clinicians to provide that next level of care, that precision medicine, but at a population level.” 

Looking ahead: Health tech in Australia over the next five years 

Peter told us that his team are currently doing the design work for incorporating data from wearable devices like Fitbits and Apple Watches into the My Health Record system. “Moving to FHIR will help us immensely with that,” he considered, “and we expect to have a FHIR-based database in place probably within 12 months.” That work will mean that consumers will be able to share data from their wearable devices with clinicians, “and they can also store it, because they might want to use it themselves in a few years’ time to interrogate”, he said. 

The Agency will be working to move “all of Australian healthcare” over to FHIR in the next five years, Peter shared, “so we’re looking at the substantial uplift of primary care systems across the sector, and they’re being rearchitected at the moment by the commercial suppliers – we’re also expecting those who provide the systems for acute hospital trusts or the equivalent to look at how we implement FHIR from day one.” 

A project Peter voiced his particular excitement for is the native integration of clinical terminology. “That means things like SNOMED CT and Australian medicines terminology being embedded natively into all of our systems, so we can put the “plumbing” in place technically to enable the data flow from Point A to Point B. Having the data used and described in the same way, using the same clinical terminology which is globally interoperable, means clinicians are comparing apples with apples.” 

The Agency is also active on an international basis, Peter said, “and I spend about half of my time working with development organisations globally and with other nations. At the moment we’re looking at how to implement International Patient Summary, so if someone travels from Australia overseas they can have their clinical records available through the app on their phone. If they need to share key data they can generate an International Patient Summary from their phone to be sucked in to the system of the location or clinician that’s treating them.” 

The Agency is also involved in work on the European Health Data Space, “and with America as they go into their next phase of the Trusted Exchange Framework and Common Agreement (TEFCA) – so there’s a huge amount happening in the standards space!” 

On interoperability, Peter highlighted challenges around implementing the  National Healthcare Interoperability Plan  for Australia, “a five-year vision with 44 actions addressing the steps we need to take – everything from changing legislation to terminology, identifiers, and even things like consumer engagement to ensure there’s actually a social license to share the data”. Today, however, “nothing is interoperable in many respects”, he said, “and we rely on HL7 version 2 messages that were cutting edge 30 years ago – the majority of information at the moment moves around by fax”. 

There are also challenges around primary care IT systems, Peter shared, “which probably aren’t as advanced as they are in the UK”, talking about the difficulties which arise “even in transferring data from one GP practice to another”. With all of the work going in at the moment around healthcare identifiers and standards, however, “we expect in the next two years to be in a place where all of our systems will actually be interoperable”, he noted. 

The limiting factor for many countries is national infrastructure, Peter observed, “and the hospitals themselves, rather than some of those new companies who are innovating and wanting to share this data more readily. One of the other things we’re working on is how to build a digital twin for every Australian – when looking into new and innovative treatments we can’t afford to do the traditional “try it and see how it works”; we’re looking at how to collect that data and make it comparable to get those digital twins in place for clinicians to run those scenarios and see what would happen with different treatment options.” 

Bringing all of this together over the next five years would hopefully mean “better care, better access, and better outcomes for patients”, Peter concluded, “and we can maybe move to address some of our workforce challenges alongside that with technology like ambient scribes, because we’re already seeing AI technologies being used in administrative processes. As a healthcare consumer, I’m a lot more comfortable that my GP appointment might be prioritised using something like that in the background than deciding what treatment I get.” 

Whilst this rapid pace of innovation is likely to lead to “some need for catch up” from a legislative standpoint, what the Agency is looking at is “how we can ensure some of those basic guardrails are there, so whilst we don’t have detailed legislation for some of these things yet, we have those broad parameters that everything fits into, that can still make it safe.” The exciting part, he went on, “is whether the government can keep up now the horse has already bolted to some extent”. 

We’d like to thank Peter for taking the time to share these insights with us. 

We recently caught up with Kate Renzenbrink, Chief Clinical Informatics Officer (CCIO) at The Royal Victorian Eye and Ear Hospital (Eye and Ear) in Melbourne. Kate shared insight around recent digital projects, priorities, and the wider digital health landscape in Australia.

Kate recently started working for the Eye and Ear having previously held similar roles in other public hospitals in Victoria, and shared how she “leapt from clinical into digital health because I saw the opportunity to really uplift clinician capability to support the quality of care. I also liked that it is an advocacy role; I’m that bridge between clinical and ICT. Digital healthcare means a lot of different things, but for me the core is information sharing and using technology to do it.”

With a qualification in health informatics as well as a Bachelor of Nursing, Kate explained that a lot of her role is “being that liaison, being that advocate, so that people’s work and importantly the way in which they work is reflected in the design of implementation and the tools that we end up using”.

Whilst there is “a lot of innovation” out there that Kate has been able to tap into, she emphasised that “it’s not just about innovations related to the expensive shiny new things or major projects – for me the interest is in the small stuff that can make a difference, and the iterative change that sustains change and improvement. The people who I work with all absolutely understand the problems that they face in their roles and know what they need to fix them; but they may not have a voice at the table.”

Culture is “a big decider of what gets done”, Kate added, “and my role is often helping to navigate that; seeing those opportunities, helping people with their projects.”

In line with this, one of Kate’s main focuses is on Electronic Medical Record (EMR) implementation. “That’s been so interesting, because I immediately saw that the EMR is never going to solve all of the problems we have. It’s everything around it that we need to tackle and take into account, like interoperability, connected care, and right at the centre of everything, the patient voice. A lot of concerns in this area tend to revolve around access to information and simplifying processes. So I have done a lot of thinking around that, when it comes to service redesign and using that feedback so staff and patients have a better experience.”

Focus on data at the Eye and Ear

What is happening with regards to data at the Eye and Ear and what are the key priorities?

Kate reflected that the hospital differs from most major hospitals, “as most of our surgeries are day surgeries, and the length of stay overall is really short. But we still need to use our resources to provide expert specialist care to the community. We still need to look at our data in detail; we need to understand who’s coming in, what the trends look like around required surgeries or conditions, how we plan for that, workforce needs, and so on.”

She shared that the hospital is “currently undergoing a big infrastructure uplift – we are awash with data, and everyone wants dashboards, everyone has data queries. We needed to put the tools in place to help people self-serve and get access to the data they need, making it more efficient for them and for our digital team.”

Kate highlighted a particular project she is working on which involves reaching out to patients before their presentation in clinic and after cataract surgery, using a mobile phone questionnaire and triaging their scores to “pick up those patients who need earlier clinical assessment”. Looking at that data and organising it in the right way “helps us use our resources really efficiently and safely”, she said.

In the surgical service, another project also underway looks at waiting lists for surgery. “We are working on increasing visibility of who is waiting and how long they are waiting, and strengthening communication between patients waiting for surgery and their care teamin the community, whether that be GPs or communitycare,” she shared.

Kate acknowledged the importance of data with regards to research at the hospital. As an example, she referred to a project focusing on development of a cochlear implant that administers steroid medication via the electrode that is placed in the inner ear. “The research evidence is showing that the implant offers more longevity, and addresses an important problem with previous cochlear implant surgeries because the surgery itself can cause inflammation and scarring which impacts underlying natural hearing. Pushing ahead with bringing research data into clinical practice can help us work out what we can do better to keep improving people’s hearing.”

Kate also pointed to the importance of joint projects between different teams or different organisations, noting that they “really strengthen and uplift that shared capability. It is particularly important since we are only going to see patient populations growing along with demand for healthcare; so we have to be smart about how we use data to help us work out areas of need.”

Part of Kate’s role as CCIO over the next five to 10 years will be helping to deal with this increased demand. “I’m thinking about what kind of skills we’re going to need in our workforce and how we bridge what we’re doing with more virtual care when it is safe. It needs to be more seamless, more connected, and we need to be taking on board patient needs and feedback too.”

The digital health landscape in Australia

We asked Kate for her thoughts on the wider digital health landscape in Australia: is there a particular challenge she would like to see solved, to make a difference to staff and patients?

“Patients need to have visibility of their health information, as often they are the only continuity in their own care,” she said. “On a related note, I would like to tackle secure messaging and the ability to share information so that practitioners can have that information they need to care for the people in front of them.”

Transitions of care is another space which offers room for improvement, she considered. “Our GPs have different software and capabilities, and we haven’t really addressed those transitions very effectively, which is often down to an information visibility issue.”

In Victoria, Kate shared, there are plans to implement a health information exchange. “This will recognise how networked information is, and we will also need to look at making sure the consumer has complete access, so they can challenge things if needed,” she said. “I see a lot of information summarised, reduced for efficiency, that ends up being incorrect. This incorrect information can get stuck in systems, and once it is in there digitally, it’s hard to remove – there’s a long process to get rid of inaccurate data.”

Digital leadership

On what it means to be a digital leader, Kate commented that she truly enjoys her role. Previously, she said, she has “not always been able to give people the care I know they need because of limitations and constraints. So this role feels like a great opportunity to share knowledge and help problem solve.”

When it comes to the CCIO role, Kate reflected that whilst the focus tends to be on the digital health tools themselves, she has always been more interested in people and helping them to do “more of what they want to do”, as well as releasing time to care.

“Money comes into it, and we’ve got to be responsible; but we also have a responsibility to look after people, keep them safe, and respect their humanity, their choices, and their beliefs,” she said. “It’s always about the people, and as I see it, digital means we can reach more people.

Kate pointed out that many healthcare organisations are “living with the decisions that were made 10 years ago, when it came to buying the systems we have; and things have changed since then. We are trying to re-imagine our future. It can be frustrating, not having what we want in place right now. You know what you haven’t got and what you would like to see, and you get to have interesting and useful conversations with people about the opportunities for doing things differently and improving.”

Looking to the future

Kate said that improving usability of systems across the hospital is a “big priority” moving forward, and added: “We’re talking about the data t a lot too, because we’re seeing emerging technologies and applications of these like machine learning, and there’s some momentum now for where and how we apply them, ethically and safely.”

For data, Kate stressed the importance of looking at “how clinical work shows up in systems, and particularly nursing. Here in Melbourne, like the rest of the world, we are facing a clinical workforce shortage; Nursing makes up half of our overall healthcare workforce and so if the clinical work completed by nurses doesn’t show up in our systems, then we are at risk of not realising the value of nursing.”

The key to moving forward and supporting new models of care, Kate concluded, is to “codify nursing knowledge, embed nursing and clinical terminologies so that we can share data effectively. This is critical for shared understanding and becomes building blocks for interoperability. We need to move toa networked way of thinking, and take advantage of the many pockets of incredible expertise that are out there to provide healthcare that adds health and wellbeing. Sharing experiences is so valuable, and I think we have an obligation to do that.”

We’d like to thank Kate for taking the time out to share her insights with us.

HTN sat down to talk with Louise Croxall, chief nursing information officer for Calderdale and Huddersfield NHS Foundation Trust, to hear more about the trust’s digital priorities, the data work that has led to achievement of HIMSS stage six validation, thoughts on developing a strong digital workforce, and more.

Louise has been CNIO for Calderdale and Huddersfield for around two and a half years, having come to the role from extensive experience in emergency care. She first came involved in digital work with the trust’s implementation of its electronic patient record, which went live seven years ago, when she became the A&E workstream lead and helped design the A&E module of the EPR.

“I enjoyed getting into digital, so when the CNIO role came up I went for it. I enjoy seeing the trust as a whole and being able to help the different teams with their digital work,” Louise shared. “I work closely with our health informatics service on new projects, identifying how projects can help clinical staff in their jobs rather than hinder them, because you’ve got to be able to see the benefit of the project. I also work with clinical staff, exploring how digital can help release time to care. I’m essentially the clinical translator for the digital team, and equally the digital translator for the clinical team.”

Louise also highlighted how she collaborates with Calderdale and Huddersfield’s chief clinical information officer, making sure they are aligned in terms of priorities and the direction moving forward for the trust. “We’re very much on the same page when it comes to where we are and what we want to do,” she said. “Seven years down the line, we need to optimise our EPR and make it easier for the clinical staff to use; but our staff understand the potential of the system now and their skills are at a higher level.”

Digital programmes at Calderdale and Huddersfield

Louise highlighted how the team has recently reconfigured the nursing admission system and involved nursing staff throughout the design of it. “It’s been a really successful implementation,” she noted. “We’ve done exactly what they wanted, and they’ve really embraced it and come forwards with it. The feedback has been really positive – patients are not receiving a more comprehensive assessment and care is being given to meet their individual needs.”

In terms of other work around the EPR, Louise shared that Airedale NHS Foundation Trust is set to join Calderdale and Huddersfield and Bradford’s domain. “We’re in a change-freeze at the moment with our EPR whilst that happens, and they are planning to go live in September. Whilst in the freeze, we are a 12-month programme of intensive ward intervention work with clinical staff to make sure they are using the system to its full potential.”

Over the last 12 months the trust has also been implementing an electronic controlled drug (CD) register, Louise shared, but “deliberately taking a slow implementation approach with that. We’re taking it ward by ward, making sure all the staff on a ward are trained, competent and confident before we move on to the next. It’s an approach that has proven really successful for us.”

She also highlighted how Calderdale and Huddersfield worked closely with the supplier’s design team when developing their electronic CD register, focusing on making it personalised and fit-for-purpose, with clinical staff involved in the entire design process. “The staff on the wards where the register has gone live have been really positive about it,” Louise said. “They tell us that it’s reduced the amount of time they spend on audits and it alerts them when needed, for example if a drug hasn’t been signed for. Overall, they find it much easier to maintain.”

Louise went on to discuss how Calderdale and Huddersfield procured a patient portal at the start of the year which went live in April. “We’ve been really busy with that, getting the functionality of our previous portal replicated in the new one. We set up appointment letters in spring and we are now looking at enabling access to other documentation and patient health records; that’s due to go live in September. From there, we’ll be able to focus on the more exciting opportunities around the portal and looking to optimise the experience for patients. We’ll be exploring features such as video consultations and information around health promotion and education. For example, if someone attends A&E with an ankle injury, we’ll be looking to use the portal to supply the patient with information and guidance on helping themselves recover from that injury. It’s all about achieving patient-centred care.”

Data, and achieving HIMSS stage six validation

In May, HTN covered how Calderdale and Huddersfield achieved HIMSS stage six validation for its use of data (Adoption Model for Analytics Maturity – AMAM). We asked Louise to share her perspective on the data work that led the trust to this point.

“We’ve always been a data-rich organisation,” Louise reflected, “but previously I don’t think we always used it to its best potential. Now, we have dashboards for staff to check and use to help them make decisions or identify where work needs to be done. Our nursing staff use the data extensively in their day-to-day working lives now; for example a nurse in charge of a ward will be looking at a dashboard to identify which assessments have been completed and which are still outstanding so that they can keep the work flowing. Every day, our ward managers and matrons are logging on to the dashboards to look at the data and use it to improve care quality and safety.”

The dashboards include feedback from friends and family on patient care, Louise added, with the trust placing focus on what the available data means for patient experience.

“We use a lot of data in our collaboratives, particularly around areas such as pressure ulcers, falls and deteriorating patients, to try and reduce challenges like this. We will look at our data and see which teams are best placed to help, which areas are struggling, and what we can learn from the data trends. It’s about triangulation of the data as well – for example if assessments aren’t completed properly, that means the care plans in turn aren’t completed properly, which could be a reason for an increased number of falls in an area. We explore all of our data together across different dashboards to try and work out what is happening and then take action.”

The falls dashboard in particular has been successful, Louise noted, with a reduction in falls observed “just by using that data and learning from it”.

Are there any future opportunities Louise would like to see harnessed, when it comes to data? “I think there is a wider opportunity around different organisations working together,” she considered. “We have a lot of our own data within Calderdale and Huddersfield, and we should be sharing that with the ICB and local health councils. We should all be working more closely. They’ve got a lot of data, we’ve got a lot, and I think if everybody came together we could really focus on preventative health and tackling inequalities. We do a lot of work around those areas within the trust, but bringing everyone’s data into play would be really useful in terms of drilling down and exploring why inequalities exist and what we can do about them.”

She added: “I’d like to see more work with data across the community in general – for example, if there’s an area within our footprint that has high levels of respiratory disease, we should be targeting flu vaccinations in that area.”

Developing a digital workforce

“You need to work very closely with your data quality team and your health informatics team. There is a lot of disparity from trust to trust when it comes to digital teams,” Louise said. “Some trusts in our area have a massive digital team; some have barely any digital representation in the workforce and are in a position where they need to build that up. I think that nationally, there should be dedicated funding for each trust for a digital team. It’s the direction that every trust is going, and I believe that along with bookmarking funding for it there should also be national guidance on what a digital team structure should look like.”

When Louise first started in her role, she explained, she was the only clinical and digital representation; now she has managed to develop a team including five full-time equivalent members of staff focusing on change and transformation, as well as a digital matron. “Building my team from the ground up has meant a lot of business cases and a lot of hard work,” she pointed out. “Having more support on this from a national perspective would be really helpful in building a strong, extensive team.”

Emerging technologies

The trust started using artificial intelligence in radiology interpretation in 2023, Louise shared, and also utilises robotic process automation to help reduce the administrative burden.

“We’ve done a lot in that area, and now we are looking at going a bit further – going into divisions within the trust and actively looking for how RPA could help,” she said. “For example, we’re using RPA to add reasonable adjustment flags to patient profiles where needed.”

Work in this space is “ever evolving”, Louise acknowledged. “We want to increase our RPA use, but again, it comes back to completing business cases to try and get funding. But there is certainly a huge appetite for it within the trust.”

Regarding AI, Louise shared the view that it is an “exciting time”, but stressed the need for caution. “I don’t think we should take decision-making away from clinicians, and I think we also need to be very careful around using AI for documentation. We shouldn’t be using it for copying and pasting into notes, because our clinicians need to have the knowledge and oversight of what we are writing and sharing in there, as well as any information in there that needs acting upon.”

Priorities for the future 

Louise and her team are due to write their new digital strategy over the next year, which will be based around the What Good Looks Like framework.

“Our work on the patient portal is a priority,” she noted. “We need to keep pushing in that area to deliver as much benefit as we can.”

Another priority is continuing the ward intervention work. “As part of this, we are also planning to embed wristband scanning for our drugs administration, and bringing in a medication scanning to add to the full closed loop system.”

Finally, Louise highlighted the focus on building digital literacy across the workforce, along with furthering the HIMSS stage six validation. “We achieved AMAM – the Adoption Model for Analytics Maturity. We’ll be going for the other models next, to try and get level six across the board. It all comes back to our focus on patient safety.”

Thank you to Louise for taking the time to join us.

For our latest interview we were joined by David Hammond, deputy chief strategy officer, and Claire Wedge, chief nursing information officer and deputy chief nurse, both from Wirral Community Health and Care NHS Foundation Trust. David and Claire joined us to discuss their work using data around falls and frailty.

David has the trust’s programme management office as part of his portfolio and is a strategic project lead for a range of projects, including one around population health management and proactive care which he and Claire went on to discuss in more detail. He described himself taking a “very practical” approach: “With strategy as a key part of my role, I always keep in mind that unless you can turn it into something meaningful, it doesn’t add real value. ”

Claire has been a registered nurse for 24 years and has previously worked in NHS acute, research and community settings. She is also a Florence Nightingale scholar and leads a broad portfolio within the trust including clinical digital transformation, quality and safety. She shared that she has recently commenced a professional doctorate with the intention of focusing on how to ensure clinical safety when working with multiple partners across the system, which she noted “may highlight some areas where we can enhance the use of digital technologies”.

Picking up on David’s point about needing to add value, Claire said: “It comes back to the question of ‘so what?’ It’s so vitally important to ask that. Whatever we do with digital and data, it needs to add value for our staff so that they can deliver services to people in our settings and our community.”

Digital and data at Wirral Community Health and Care

Claire: Our work in this area is all underpinned by our three-year digital strategy, which we developed in 2022. There are four key aims within the strategy; firstly, supporting teams to deliver efficient, safe, high quality care, by making best use of shared service platforms. The other aims focus on helping people to access services easily and manage their own health and wellbeing where appropriate; to improve wider population health; and to improve the environment for our workforce, so that staff feel psychologically assured that they are accessing real-time information that can help them make clinical decisions.

From a CNIO perspective, these aims have led to a number of digital workstreams, including how we use technology and remote monitoring to support access and how we have developed and enhanced internal governance via the use of dashboards supporting increasingly mature triangulation of data and data analysis. That’s trust-wide and runs across all services; it’s centralised on one accessible platform, the Trust Information Gateway, and it provides assurance that all staff can access the same consistent information irrespective of role or location.

We’re currently reviewing our clinical systems to identify opportunities for streamlining digital systems, to ensure that they are intuitive and provide a positive end user experience. Coming back to the point about practicality; they need to work, and they need to work well.

A key project Dave and I will discuss today is the development of the falls predictive risk tool, which was a collaborative project with system partners.

The challenge of connectivity

David: Over the past five or so years, within the Wirral system, I’ve been focusing very much on how we can provide better services for people who are particularly vulnerable to experiencing health inequalities. Numerically, older people with frailty are one of the largest groups who may face this – particularly those at the more moderate-to-severe end of that frailty spectrum. That is where people are most likely to need the support of health and care services, and where people are most likely to have quite a lot of engagement with services.

I think a challenge in the wider NHS lies in coordinating care around these individuals. They can receive lots of input from different teams, organisations and services, but often it is done in quite a haphazard way. I would probably say that this has increased since 2019 with the development of primary care networks and all the additional roles within the PCN footprint, such as physiotherapists and advanced nurse practitioners. It means we’ve got even more complexity in the system. About three years ago, we did some work with our local PCNs which aimed to explore the range of services that may be involved for an older person with moderate or severe frailty. The lack of connectivity between those services was quite stark.

More recently, we have been working with three of the PCNs and with one in particular, looking at how we can provide well-coordinated, person-centred and proactive care by making the best use of the information that we already have. We found that when we looked at a case study of one individual, it was not difficult to piece together all the component parts of a holistic assessment; but it did take a long time, because all of the information wasn’t in one place and it required searching through uncoded data, attached files, letters between providers, and the like. What was particularly absent was any log of what mattered to him as an individual, or what mattered to his loved ones.

We identified that whilst we might have all the different pieces to the puzzle for understanding what a person might need, based on what we know and what’s already being done, we weren’t putting them together. There’s a massive opportunity to do that, and that’s been a real focus of the project I’ve been leading: what does a genuinely integrated approach look like?

Developing the falls predictive risk tool

Claire: During my career I’ve had a passion for working with older people, and I’ve previously worked in falls prevention services within the community. Falls can have a devastating impact on people, leading to social isolation, reduced activity and deconditioning, which in itself can increase the risk of falling.

Along with colleagues in the system from across Wirral, we started to analyse data regarding admission to hospital following a fall. That helped us to identify learning themes, but it’s retrospective. With a view to taking proactive action, I started to explore how we could use the available data to develop a bespoke tool to predict the risk of a person within the community experiencing a fall likely to put them in hospital, over the next 12 months.

There are other tools that clinicians can use, but we didn’t have anything centralised that could bring in a whole system view of all the data these different services have.

We developed this tool over 12 months; it was clinically led and digitally enabled, with a multidisciplinary team working on it. We had lots of roles involved such as occupational therapists, physiotherapists, nurses and medical input. All these people formed a group and we met regularly. It was important to ensure that we had structured, robust governance throughout and clear communication flows – we asked staff for their experiences of frontline clinical practice and what data would they need to be accessible to inform their decision making. Then we worked with a technology supplier to help us develop this into an intuitive tool to support that decision making.

The tool that we have developed is very visual; we’ve used theographs which are visual representations of the contacts that an individual has had with health and care services over a particular period. Using that visual representation, you can look at whole PCNs, practices or an individual level. You can start to understand activities and map it across geographical areas, looking from an inequalities lens, to really understand where you need to focus attention and how you can maximise clinical support to particular areas or individuals within GP practices. From a multidisciplinary perspective, that really supports you in taking a proactive approach.

It started off from a falls perspective, but the tool can be adapted to other settings – for example, it works really well with Dave’s frailty work. The future will see us hopefully test and incorporate this tool into that area of work.

David: I think that’s the challenge – you can be data-rich, but you need to have a means of doing something with that data. It needs to be part of somebody’s job to do something with it, and they need to understand it, to view it as a core part of their toolkit and not something additional.

Using the tool within an integrated team

David: That’s been the thinking behind the work we are doing with Moreton and Meols PCN. What is the functionality that is needed on a PCN footprint, to provide really good, well-coordinated, person-centred care? We need to 1) collectively recognise those people who are going to benefit from that particular approach, 2) bring existing information about them into one place, 3) consistently do really high-quality assessment and care planning, and then 4) the output of that can be shared and individuals can be tracked within that PCN. That way, we’ll know who’s had what level of support and what assessment and care planning may be needed; when they are due a review; and also if something happens in the meantime, they can be quickly followed up. It comes back that idea of ‘care traffic control’ and understanding who requires this level of proactive support and how we can actively coordinate that.

Over the course of a few months, to test this model, we have developed an integrated frailty team including a paramedic and pharmacist from the PCN, a nurse practitioner for older people and a combined admin and clinical role as well as a senior matron. This team uses a combination of risk stratification and referrals to identify people in need of support, and the falls predictive tool is going to be one of the component parts of their armoury.

It’s early days, still; the team formed in January, but I would say it’s been a joy to see just how engaged they are, and how fast this approach has been developed.

One member of the team is really confident with using EMIS, and it’s been really interesting to observe how she has been able to build searches within EMIS to pull coded information from the health record to inform fast clinical decision-making. It has become a core part of the triage process, and so much time that was taken up by trying to share information manually has been cut. We’ve had someone comment that they feel as though they were working in an analogue world and they’ve suddenly stepped into a digital world – they feel that it is helping them to rapidly make change happen.

Next steps

Claire: We have subsequently taken the falls predictive tool to a GP practice and they have tested it out on a small caseload of their own. It was found to be accurate in terms of identifying people who are at risk and it resulted in some significant assessments.

Our next stage of testing will be to incorporate it into our wider frailty work so that it becomes a main tool for those teams. At the end of the day, with tools like this, it’s all about adoption; so many great pieces of work end up not getting used. But I’m really hopeful that this tool will prove to be effective and continue to develop.

We need to see the outcome of this pilot, and then we aim to scale up use of the tool at pace. We need to make sure that we listen to people’s feedback as they use it and take it on board, learning and collaborating as we go – that includes patients and carers. It needs to be holistic, both for the people we are providing services to and our frontline staff.

Ultimately, we’d love to get to a point where we can roll the tool out across the Wirral system, dependent on the data and feedback we get back. And I think we can be bold; if it works at Wirral place level, surely it can work at ICB level and maybe even nationally.

Tips for other teams

Claire: With regards to advice for other trust teams who may be looking at implementing data-driven projects, it comes back to engagement and collaboration, particularly ensuring that you have that in place from the earliest part of the process.

I think it’s important to acknowledge that there are different levels of knowledge across the system and different levels of digital readiness – we need to be mindful of that and work collaboratively with people. You need to have very clear aims on what you are trying to achieve and think about how you are going to evidence the success of the project.

David: There is absolutely no substitute for regular, detailed discussion with the people who are actually doing the work, and approaching the project with a quality improvement mindset. I was involved in a hospital discharge project where we made six significant changes to a pathway based on frontline feedback, and I think any project could follow that same path.

With data, I think it’s key that people can track progress as well as make comparisons. We’ve been looking at the data from A&E visits and unplanned admissions for people with severe frailty (based on the electronic frailty Index) and we’ve been able to break that down to practice level. We’ve then developed a ‘control group’ of sorts – by that I mean other PCNs in the Wirral area with a similar level of frailty within their practice populations. As the months progress, we’ll be able to compare this data as well as tracking the changes for Moreton and Meols PCN specifically.

Ultimately, the use of data like this must become part of the day job; and in order for that to happen, it has to be really simple and straightforward for staff.

Many thanks to David and Claire for sharing their insights.

For our latest interview we caught up with Kate Warriner, chief digital and transformation officer at Alder Hey Children’s NHS Trust and chief digital and information officer at Liverpool Heart and Chest Hospital. Kate shared insights on current projects and digital priorities across both organisations, around the digital, data and technology workforce, patient engagement, data use, and more.

Introducing herself, Kate shared that she has been at Alder Hey for five years now, and at Liverpool Heart and Chest for four years. She got into the world of digital “purely by accident”, after getting a job as a ward clerk during her time at university studying music.

“In the second year of my degree I got a job in NHS primary care, going around GP practices and doing note summarising. When I graduated, I got a job as a trainer on digital systems, and then I got a great opportunity to do a masters degree; a that’s what started my career in digital. It was never part of any grand plan, but I really enjoyed working with people and seeing how technology could make a real difference for patient care.”

In the last 12 months at Alder Hey Kate has had “a bit of a changing role,” she said, as a result of the overall transformation agenda across the organisation. “It means my role has expanded somewhat, which is really great in terms of thinking about how digital can play such an important role in some of the services that we are developing.”

In fact, Kate shares that she will soon be joining Alder Hey on a full time basis, focusing on digital transformation and developing new models of care, with her new transformation role set to commence in July 2024.

Ongoing digital projects

Moving on to share insights into some of the recent digital projects across both her organisations, Kate highlighted how Liverpool Heart and Chest has recently achieved HIMMS Level 7, following the same achievement at Alder Hey three years ago.

“HIMMS updated their criteria following the pandemic, making it a lot tougher, and we were delighted to be the first hospital in Europe to get accredited just a few weeks ago. There were some fantastic things that came out of that with some of the technologies that we put in place, particularly from a safety point of view; and also on how we use our data in terms of looking at our services and looking at how we can improve.”

Kate also told us about how the HIMMS presentations helped to showcase some of the work going on at Liverpool Heart and Chest, including in closed loop medicines, which “saw some great reductions in medicines administration errors”, and in patient engagement tools.

“We saw some great examples of our healthy lung project around the early detection of lung cancer – we’ve detected about 400 lung cancers early that have been treatable in Cheshire and Merseyside, and technology has played a real part in that.”

At Alder Hey, Kate said that they “had a big year last year, in that we had a major overhaul of our electronic patient records, and we’ve been doing a lot of work in terms of optimisation. We’ve just done a refresh of the whole strategy for the organisation, so we’ve now got our roadmap to 2030, and digital and technology cuts through all of that like a stick of rock.”

This roadmap is “building on quite a lot of the brilliant work that we’ve done so far,” Kate said, “but we are also looking forward to harnessing new technologies. We’re working with children and young people, many of whom can use an iPhone before they can read now; so the generation that we are caring for have got different expectations of us in digital and technology. We’ve got some really exciting developments in the works.”

Digital priorities

On priorities around digital for the next 12 months, Kate highlighted the importance of ensuring that the basics remain in place whilst also pushing forward with the technology agenda, in terms of new developments such as generative AI.

“We’re excited about some of the possibilities that can help with transforming some of the services that we are delivering in both organisations,” she acknowledged. “We’re starting to explore the art of the possible with some of our clinicians and patients. The NHS is free enough in our thinking and in our strategy to have the courage to take the plunge with some of these things, and I’m excited to see where that goes.”

Kate highlighted that the data agenda is particularly exciting over the next 12 months. At present, both organisations are using data and data analytics for decision-making, with examples including the use of Power BI and utilisation of real-time dashboards to enable staff to see key performance metrics such as the number of patients waiting. “We want to see how we can make the most of our data, because we’re very data rich,” she said. “We’re looking at how we can use our data even more than we already do, not only to give us insights into operational service delivery, but also to take our services into the future.”

In terms of appetite for new technologies, Kate told us that clinicians and “really fantastic” digital teams from both organisations often play a role in driving change and bringing new possibilities to light.

“It might be something that I’ve seen, or another clinician has spotted, or it might be a number of us. Then we tend to get our heads together and start a bit of an MDT conversation around it, followed by an assessment of whether or not we should give it a try. An example of that is generative AI – we’ve got a few clinicians that have been trying it out in their personal lives. Through the ICB we’ve had some workshops facilitated with experts in the field, bringing together different ideas, which now is starting to craft into thinking about early priorities and a programme of work around it. I think the key with any innovation is being open to allowing that creativity, whereby anyone can bring ideas to the table that will be listened to.”

With regards to patient engagement, Kate noted that tools such as patient portals and mobile apps play a sizeable role in her organisations’ efforts to engage patients. She also commented on the role of COVID in enabling the roll-out and development of digital opportunities for patients at-scale.

“Prior to that, I can remember sitting in a room discussing online consultations, and we were looking at one or two small service areas. Then suddenly we were talking about every service area and offering it out for everybody. The NHS has continued to build on that momentum, and I think it potentially taught us a lesson around not being afraid of not knowing exactly what is going to be there. We can be OK with the ambiguity of that and just get on with the rollercoaster. Our children and patients expect that we are doing this, so we need to be led by that.”

Overcoming challenges around digital 

We asked Kate what challenges there were around digital, and what plans there were for her organisations in overcoming those to guarantee space for digital transformation over the next five to ten years.

“I think a lot of it is about staying ahead of the game in terms of the pace of change,” she considered. “We work in a fast-paced environment; I think certainly in acute care, the pace of working means you’ve got to be able to be agile.

“Also from a digital point of view, I think there are some workforce challenges, and that’s hugely important to bear in mind. There are a lot more people with natural digital skills compared to ten years ago, because of how people use technology in their day-to-day lives, so in many ways there has been some ‘mainstreaming’ of digital skills. But harnessing some of those real expert and professional digital roles is a key challenge that we need to get ahead of over the next few years.”

Kate shared that there is an integrated service supporting both of her organisations called Integrated Digital, with a number of  shared roles and shared teams. “We host graduate schemes and apprentice roles as well, and through our learning and development teams at both organisations, we’re keen to be working with schools and other educational institutions to try and attract people into these roles. We’re also part of the North West Skills Development Network; we really encourage our digital colleagues to have mentors and access to coaching in order to harness talent and expertise.”

When it comes to opportunities for staff members to get into digital, Kate commented that hers is “quite an open team”, always looking for people to work with, even if it is not necessarily in a formalised role.

“If there’s someone who comes forward and wants to get involved in a project or piece of work, there are constraints around whether you’ve got vacancies or not, but there’s often creative ways that you can get people involved,” she said.

In terms of staff engagement, Kate said that she feels “lucky” with the clinical leadership teams at both organisations, as they play an important role in supporting engagement with colleagues, listening to challenges and working through concerns.

“We’ve also got some fabulous digital colleagues who are well known and well-embedded throughout both organisations, so they’re good points of contact for staff. We have good governance and a digital forum where we do project spotlights – for example, we might bring in a speaker to talk about something that has gone live or an initiative that we’re working on.”

To conclude the interview, Kate shared a few parting comments on her hopes for digital in the future. “I think it’s a really exciting time for digital health and the transformation opportunities that digital can help to enable. There’s a lot to watch with the new and emerging technologies that are coming out, and a lot to be optimistic about. The NHS has been on quite a journey over the last few years, but I think that there is a lot to be hopeful for. For us, working with children and young people is key – they keep us motivated and energised, and that’s why we’re here: to make a difference for our patients.”

We’d like to thank Kate for her time in sharing her insights from Alder Hey and Liverpool Heart and Chest with us, and wish her the best in her new role!

In a recent interview, we got chance to catch up with Henrietta Mbeah-Bankas, head of portfolio at NHSE, to find out more about her projects, programmes and priorities for 2024, a year after she joined us for a discussion at HTN: Now on innovation and training in the health workforce.

In another of our recent interviews, we sat down for a chat with Ricardo Baptista Leite about the potential and considerations for artificial intelligence, key learnings from his career and his thoughts on the digital health landscape in Portugal.

On education, NHS Education for Scotland has announced the launch of “paperless placements” for nursing students at the University of Dundee, thanks to a digital tool developed by the NES Technology Service in collaboration with the NES Nursing and Midwifery pre-registration and practice education team.

We recently caught up with Joss Palmer, OneLondon programme director, to learn more about projects and progress in the capital. Joss shared with us the latest on initiatives including the London Care Record, the Universal Care Plan, work on mental health and on the OneLondon Secure Data Environment.

OneLondon’s projects

Joss discussed some of the current projects underway with OneLondon, including the London Care Record, which is based on Oracle Health’s Health Information Exchange (HIE) platform and now “regularly sees two million views per month”. She noted that OneLondon has been increasing the number of organisations sharing across the capital and has also been working with some organisations outside London.

Regarding outcomes, Joss shared that the team hears feedback from clinicians and health and care professionals about how they find the London Care Record “game changing”, as well as feedback on how staff members use it on a daily basis.  “We’ve brought some of those testimonies to light on our website, where we’ve shared some in-depth case studies, so that’s really great. But one of the things that we do struggle with sometimes is how we can prove those benefits or outcomes, and how we measure them,” she acknowledged. “We’ve recently done an economic evaluation of the London Care Record with the help of Queens University Belfast, who have helped us to demonstrate the value of what that means for frontline staff.”

Joss also highlighted the Universal Care Plan that London has delivered with Better, which initially went live with a focus on urgent care and end-of-life. “Since then we’ve made it accessible via the NHS App, which is a brilliant step forward. Our most recent go-live has been to support care for sickle cell – and further enhancements are planned.”

Joss also shared new pan-London work to support the Mental Health Act where OneLondon will be working with Thalamos, London’s mental health trusts and a range of other partners across the capital. “The current processes for the Mental Health Act in London are very manual and heavily paper-based, so our work is a positive step forward and we know from other parts of the country that this will deliver benefits to patient care.”

Use of data for decision-making and planning

We asked how London is currently making use of data and data analytics across its projects and whether she could share any insight into progress on the Secure Data Environment.

“There’s clearly lots of work that’s happening in London and across the country on SDEs and we are working closely with national teams and colleagues from other parts of the country,” she said. “Our collaborative work in London is being led from North East London and North West London. This is a big pan-London effort. But everybody is part of that. It’s challenging, as it is a big endeavour, but it’s making good progress.”

Joss explained that each of the five London ICSs has a “significant history of making use of data to support clinical decision-making, so some of the work around this secure data environment is not coming on to a greenfield site – because people have been using data insights for planning to support direct care for quite a while.”

She added some insight from sessions in 2023 with the OneLondon’s Citizen Advisory Group  specifically focused around the use of data for research. “Our work with the public provides important learning for us, which is why involving Londoners in our work is absolutely key.”

Key takeaways from the sessions included that people expected the NHS to share data, and “people are very supportive when they can see the value of information being shared. We definitely got a really strong message on the importance of making sure we’ve got robust processes, in terms of how people are granted access to use that data, and on using it in a way that the public can feel confident that it’s legitimate and will bring value.”

Talking about some of the challenges London has faced when tackling these collaborative projects, Jocelyn mentioned scale as being a key complexity.

“There’s always that challenge of collaboration at scale, because it might be hard to do something within a single trust – but that expands even more when we are working across the whole of London region. The number of people, priorities and perspectives is key. So it’s all about to how keep everybody on the journey, and a lot of that comes down to continuing to build and look after trust and relationships, and also perhaps realising that you can never do too much communication.”

Looking ahead in 2024

For the Universal Care Plan, Jocelyn shared how OneLondon has been focusing on the clinical strategy and “making sure that we have a real clinical focus, and that the delivery around ageing well is something that meets what our London Clinical Networks need and want”.

She added: “We’re also looking at how we can improve the richness of the London Care Record, and strategically at whether we need to do any consolidation or improvement work for the London Care Record. We also need to consider how we can better support areas like mental health or maternity care, and support organisations like London Ambulance who span all of London.”

In terms of work around the Mental Health Act, Joss talked about the past year seeing the first go-lives in North East London mental health trusts, closely followed by other London trusts.

Joss finished by saying that “it’s great to be a part of the OneLondon collaboration, there is so much exciting and positive work that we are doing, and I really love working with colleagues from across London’s ICSs!”

We’d like to thank Joss for taking the time to share the work of OneLondon with us.

For a recent HTN interview, we caught up with Dr Sonam Vadera, specialty registrar in clinical radiology at University Hospitals of Leicester and fellow in clinical artificial intelligence at the AI Centre for Value Based Healthcare in London.

Sonam shared with us some insights and details around her current research, key learnings and takeaways from emerging AI applications in radiology, and the barriers in translating research on AI into practice.

To begin, Sonam offered a brief introduction to her role and background, including completing her medical education at UCL medical school, before returning to Leicester for her foundation years and radiology training.

“I’m currently an ST4 in radiology, specialising in MSK, and in July 2023 I started a fellowship in clinical AI. Currently I have a hybrid work pattern, so I work forty percent of the week doing my fellowship and sixty percent of the week in my usual radiology role. My fellowship project is based at University Hospitals of Birmingham.”

Research focus

Sonam told us that her focus at present is on AI safety monitoring frameworks, adding, “it’s really important that once an AI system is integrated into any particular clinical workflow, we continue making sure that it’s functioning as it should be, and that we’re picking up on any changes in its performance that need to be addressed”.

“It’s a method of real-world post-deployment safety monitoring, and we’re applying a framework called the medical algorithmic audit, which was developed at University Hospitals Birmingham. That provides a set of steps to follow to ensure that AI medical devices are monitored effectivelyand any deficiencies in performance are detected. We’ve applied the framework to real-world applications ofa couple of tools within the trust which we will then later publish, so that hopefully across other trusts we can start to integrate a uniform framework for safety monitoring that can be accessible to clinicians, and to multiple stakeholders working within the field.”

The benefits of this work, Sonam continues, are in helping to boost uniformity around AI safety monitoring, “because currently there’s a lot of a discord; people are working on different things, they’re doing safety monitoring in different ways, and there’s not really much uniformity across the system. It’s also really important to pick up any changes in performance over time due to data drift, and to detect any biases that may result in disparate subgroup performance.”

“My main role has been centred around AI safety monitoring of an autonomous chest X-ray reporting tool, which is essentially an AI tool that reports chest X-rays it feels are normal with high confidence, and removes them from the workflow, so they will not require a report from a clinician.”

Applying the tools to real-world data is another important step in the process, says Sonam, since “it’s one thing to have these tools and to know the sensitivity and specificity performance on the external test and training sets, but it’s another thing to then apply them to real-world data where they often perform differently, and that’s exactly what we’re doing with the audit framework”.

“There are a couple of other really interesting projects I’ve been involved with at the University Hospitals Birmingham, and one of those is the Standing Together project, which is focused on looking at the diversity of datasets and ensuring that they are diverse, generalisable and inclusive. Often there’s not transparency of the data that AI tools are trained on, and there are subgroups which might have been excluded from that particular dataset, which means that if we go and apply the tool to another population, it won’t perform the same and may not be representative. So the Standing Together team hase produced a set of standards to follow that would help ensure that there is transparency in reporting of the datasets.”

Another project Sonam is working on looks at the involvement of patients and the general public in decision-making around AI, setting up a “platform” where manufacturers can reach out to patients and members of the public with a background of literacy in AI in healthcare, to help them make decisions and get feedback.

Challenges around AI in the NHS

One of the challenges that Sonam noted specifically around AI in the NHS was the lack of education and training on the topic, since “most staff in the NHS receive very little education or specific training on digital healthcare”.

“At medical school I didn’t receive any training on digital healthcare.Although I know there are now more initiatives looking at how that can be incorporated, speaking from experience, most clinicians don’t have much insight into the applications of AI. There’s also a lot of anxiety from clinicians around adoption, especially among radiologists, in making sure that they are still valued and still kept in their role, and also knowing patient safety isn’t compromised. One phrase that always stands out to me is ‘learning to work with AI’, and I think that those clinicians who are open to working with AI might be more likely to succeed with this change in the future.”

In order to help the workforce become “more amenable” to adoption, Sonam states that it is important to make sure it’s not “overloading them with yet another thing that they need to learn, yet another thing they need to train in, in an already overstretched, overworked workforce”.

Another challenge Sonam mentioned was that “it’s really difficult for small and medium enterprises to actually break into the NHS, and I think that’s one of the biggest barriers, because they’re coming up with really novel, really interesting technologies, which could have a real impact”.

“When it comes to getting those technologies or solutions actually approved by the NHS, there are a lot of regulatory barriers, a lot of red tape, as well as massive financial constraints and IT issues. It’s one thing doing these things in a test environment, but when it comes to actually getting them into the real world, often SMEs don’t have the funds or the resources to necessarily be able to do that.”

“Things like the AI Diagnostic Fund and incentives to try to encourage these SMEs to enter the space I think are really important. There are really useful tools out there, and there is definitely a demand for them because the NHS needs help; but it’s a case of recognising those and giving them a way into hospitals, because that’s how they can thrive and gather the relevant data that they need and be applied in the right settings.”

There are also challenges when it comes to integrating AI tools into existing workflows, Sonam shared, “because we have these really defined, rigid workflows, and actually slotting in an AI system is difficult”.

“Furthermore, once you do change the workflow, and see the outcomes change, how do you go about monitoring what it was like with the AI system versus without, and are we being fair in saying that the device is having a certain impact? Not to mention the challenges aroundlarge language models and generative AI, which are theirown entity.There are enormous difficulties in safely bringing generative AI into healthcare, because how do you monitor something that has infinite outputs?”

Key learnings

We asked Sonam to share with us some of the key learnings she had already come away with from her fellowship. She discussed that one of these learnings was the importance of a collaborative approach in getting an AI tool “off the ground”, because “it’s not a one-person job, or even a one-team job; it requires the integration and involvement of multiple teams, as well as cross-site collaboration.”

“It’s important to learn from one another’s mistakes and experiences, and that’s particularly true of the NHS, where this sort of information isn’t always shared very well. The multidisciplinary team approach has always been valued in healthcare, but I think it’s never been more important, and that’s not just within the clinical teams, but also within the data science team, the administrative team, the IT teams. All of the meetings I’ve been involved with I’ve really enjoyed because we have so many different valuable voices to listen to.”

Also on teams, Sonam highlighted the importance of having “a solid digital transformation team”.

“At University Hospitals Birmingham, our digital transformation team’s role is to focus on bringing AI products to the hospital and looking at how to integrate them. But I know that a lot of hospitals don’t have a dedicated workforce for that, and I think that means that often the onus of bringing in these particular devices is left to the clinicians, or left to one particular person who’s interested in doing it, which can be somewhat impossible alongside clinical duties. So I think my experience has highlighted the importance of having a dedicated team who focuses on procuring and validating these tools.”

“Another thing I’ve learned is the importance of ensuring we recognise and addressbias within these AI tools,” Sonam continued, “as healthcare data is already biased, and having tools built using biased datasets will only amplify those biases”.

“One of the key things that I’ve taken away so far is how we can start to go about mitigating this bias, making sure datasets are diverse and transparent, ensuring that we do the safety framework monitoring to assess for disparate subgroup performance, and so on. Another thing I didn’t mention about the medical algorithmic audit is that a key component of that is a failure modes and effects analysis, which looks at all the different ways in which a tool could fail along the clinical pathway. We map that out, even prior to deployment, and the effects that could have downstream, to help us be prepared for those eventualities, and I think that is really important.”

AI for future healthcare

As a closing question, we asked Sonam what she was most excited about for the future of AI in healthcare, both within radiology and beyond.

“I’m excited about the impact that it could have on things like remote care, reaching rural populations, or improving diagnosis. I think it’s easy to focus on the UK and more developed or privileged countries, but actually I’m really excited about the impact on less developed or smaller countries that don’t have developed healthcare systems. Hopefully it can enable people to get faster diagnoses and get the healthcare that they need, because in some countries, you might have one radiologist serving thousands and thousands of people, and I’m sure that goes for other specialties as well.”

“From a local perspective, I’m excited to see how we can reallocate the time savings to streamlining the workflow. A lot of clinician time is spent doing administrative tasks, and I’m really excited to see how AI can smooth out those processes and take over some of these roles.I’m particularly excited to see the role of generative AI in that space. I think there is the potential to transform healthcare,releasing time for clinicians to give more time back to patients, and improve patient safety, not to mention give them time to focus on novel areas. I hope this will promote innovation in healthcare that we would never have time for without the AI assistance, and ultimately improve patient care.”

We’d like to thank Sonam for her time, and for sharing her insights with us.

Over on our sister site HTN International, we shared our interview with Inderpal Kohli, vice president and chief information officer at Englewood Hospital, New Jersey, to hear his insights on digital transformation, projects, priorities and challenges in the digital health space.

Inderpal introduced himself by explaining how his career has been in the IT sector since leaving high school, including roles in programming and project management, and that crossing over into the health sector came up as a chance to work on a IT project for healthcare.

“I landed at one of the best places I could have, Columbia University Medical Center, where cutting-edge informatics research was taking place,” he shared, “and I got my first insight into how all of the innovations we were working on behind the scenes in the lab were actually delivered in terms of patient care by the bedside.”

Inderpal has worked in the healthcare sector ever since and noted that he had amassed more than two decades of experience in driving innovations and working on enterprise information systems, working within his current role at Englewood to provide strategic direction and oversight of IT functions, advance tech infrastructure, and support the growth of the organisation.

Digital transformation at Englewood Health

Inderpal shared some of the major digital projects that have been undertaken at Englewood Health during his time as VP and CIO, including patient engagement and self-serve opportunities, including the expansion of electronic medical records, imaging solutions, and medical device technology.

“One of our overall goals has been to reach out to our patients and make their interactions with our system more digital, so that they can interact with us when, where, and how they want to interact with us,” he said.

Inderpal commented that the COVID pandemic accelerated digital transformation in Healthcare, describing how his team “delivered three years’ worth of transformation in three months”, with the pandemic leading them to rethink their strategy and emphasising the importance of agility. It also had an impact on attitudes: “Most people now realize that virtual care is not a bad thing and that patients don’t always need to attend in person for many things.”

Recent digital projects

We asked Inderpal what digital projects he and his team had been working on recently. He talked about how one of his initial priorities was developing a comprehensive digital strategy for the organisation and a roadmap to follow, which formed a multi-year plan.

“One of our goals is to offer patients our services or interactions in the way that they want,” he said. “Healthcare is obviously more complicated than ordering food; but that doesn’t mean patients don’t desire that experience and that kind of ease. That’s our goal. We are focusing on that digital front door, on our outreach to patients, offering them solutions and service capabilities, and getting them engaged in their own care.”

With the organisation spanning 150 locations and over 600 providers across a range of specialties, Inderpal spoke of his hopes to provide a seamless experience for patients. “Once you are with us, my goal will be to take the best care of you whether you need a specialty appointment or a diagnostic test. We want to take care of that in a seamless manner for you.”

Inderpal also shared his aims to promote “a merging of analog and digital care,” creating a consistent experience between virtual and in-person interactions with patients.

“Remote patient monitoring is a program that we are expanding – we want to help you when you are not physically at one of our locations with technology-enabled care management outside of our four walls. We need to be nimble enough, and our execution needs to be nimble enough to roll in some of those digital initiatives. So far, our work in this area has supported this and allowed us to start working on including exciting initiatives like generative AI into our strategy.”

Moving on to discuss electronic patient records at Englewood, Inderpal told us that the organisation has a single patient record across the entire continuum of care so that “the experience remains the same no matter where staff is interacting with the patient”, and so that information is available wherever patients are in the organisation.

Using information and data analytics to inform decision-making is “inherent in how Englewood operates”, he added.

“We use data for running our operations and making strategic and growth-related decisions, and we also use it to identify gaps in our patient population, for improving patient experience and improving care quality. We look at infection rates, we look at patient satisfaction rates. Data drives a lot of decisions and our initiatives to make sure we keep improving our care and our care delivery to patients.”

Digital priorities for the next 12 months

What are Inderpal’s priorities for the next 12 months around digital and data?

On the continued expansion of the organisation’s digital front door and patient engagement initiatives, he said: “We’re working on various campaigns, whether it’s something like mammography or missed annual screening. Or if patients have not followed up on an order from their doctor, we’re looking at different ways to reach out to them and to make it really easy for them to schedule an appointment.”

Inderpal also shared priorities, including the expansion of the organisation’s generative AI tool, with plans to provide some level of automation, helping clinicians but also expanding it to offer more to patients in terms of capabilities.

“We’re looking at developing a generative AI-based virtual agent, where patients can have a normal conversation and get the information they’re looking for, to schedule an appointment, or ask to talk to someone on the phone. Then there’s the idea of running a large language model to synthesize a large amount of data within our patient record, to present relevant patient information to the clinician at a point of service.”

He continued: “We’re also exploring ambient charting, where instead of a physician sitting on a computer taking notes from conversations with patients, there’s an ambient listening agent. It will draft a fully structured clinical note for them to review in less than a minute, even suggesting coding or identifying care gaps. That would not only help physicians in their work but also give them more face time with patients.”

We asked Inderpal what role things like patient portals and mobile apps played in his organisation’s efforts to engage with and empower patients.

“Our digital patient portal is our first entry point, which holds comprehensive patient information, test results, visit summaries, doctor’s notes, imaging access, and appointment scheduling,” he shared. “The digital part of it goes beyond that, proactively sending text messages and emails to remind patients of upcoming appointments and such. The reality is that we all go and see someone when we’re sick; but it’s the preventative care that we need to focus on, and that will manifest itself in a healthier population.”

Ultimately, Inderpal said, his job is “to ensure that my organisation runs smoothly, balancing that with growth and supporting growth with technology. I go to technology to help me run my organisation as much as I can, automating monitoring, adding new tools. We need to make sure that when we build something, we can scale-up quickly, so that’s again the planning part of it, and transformation is key. Everyone likes the big transformations, but I feel the impact starts with small transformations – you build support, and then you can keep building from there.”

Sharing learnings

As a final thought, we asked Inderpal what piece of advice or learning he would like to go back and share with his younger self from his journey in digital health to date.

“In healthcare, technology is not the job,” he stated. “Technology is not the primary focus – it’s there to assist with the care of patients. So a tool or a solution that would be implemented in a few months in any other industry may take well over a year here, and for a very valid reason. The tool needs to conform to the workflow of taking care of patients. I learned this initially with some level of frustration on how much time we spend on optimizing workflows and optimizing the tool to meet the workflow needs. You need to be even more nimble about your approach and try something out to see if that clicks with your population, then expand it, rather than looking for a ‘big bang’ deployment.”

We’d like to thank Inderpal for his time and insights.

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