Dr Simon Irving on digital healthcare evolution

An interest in helping to develop his trust’s IT led Dr Simon Irving to become one of four chief clinical information officers at Bolton NHS Foundation Trust. He volunteered at the right time he tells Lyn Whitfield; since then the trust has made big strides, and is getting ready to implement an electronic patient record.

Dr Simon Irving says his interest in IT was “born out of frustration” at a particularly difficult time for his trust.

Bolton NHS Foundation Trust was put into the NHS’ ‘turnaround’ regime in 2012, after regulator Monitor found it had gone into deficit and was missing key performance targets.

Turnaround delivered new leadership, a return to financial balance and improved outcomes for patients, with the trust receiving a rating of ‘good’ in its latest CQC inspection. But on the IT front, investment in technology was not aligned with where the trust needed to be, falling to just 0.8% of turnover.

From frustrated clinician to CCIO
In the middle of all this, Irving found himself involved in an improvement project, the Bolton Improving Care System, which had an A&E strand that extended into his specialism of acute medicine.

“That got me interested in the art of the possible, but it also made me more frustrated with the way things were being done at the time,” he says. “When a new chief information officer [Rachel Dunscombe] was appointed, I went and hammered on her door.”

Dunscombe backed the idea of more clinical engagement in IT. Indeed, although the idea of a chief clinical information officer was still a relatively new one for the NHS, she pushed for a team of CCIOs to be appointed.

Irving became one of four CCIOs at the trust, with colleagues recruited from nursing, ophthalmology, and therapy backgrounds. Over the following three years, they have all been given training in project management, while Irving has taken a clinical safety officer course and is about to join the first CIO/CCIO leadership course, the Skills Development Network Digital Leaders course.

Just as importantly, the four CCIOs have become involved in clinically led IT projects and in helping to frame the trust’s technology strategy, which is built around implementing an electronic patient record and sharing information with neighbouring providers.

Xen enlightenment
The biggest of these projects addressed one of the legacies of those years of underinvestment in IT that not only affected Bolton but the whole NHS. This was an aging fleet of desktop computers running an operating system, Windows XP, that was no longer even supported by Microsoft.

The trust worked with Citrix’ XenDesktop and XenApp to deliver virtual desktops and apps to clinicians. These can be accessed from anywhere, and on a range of devices, including Igel terminals.

It also implemented single sign-on technology from Imprivata, and put RFID readers on the terminals that allow users to tap down their identity badges and instantly pick up their work from where they left off.

“We have done 3,500 desktops, which we think makes it one of the largest virtual desktop installs in Europe,” Irving says, “and it has made a huge difference on the shop-floor.

“Previously, we had Windows XP computers, and if one of them went wrong it wasn’t always easy to fix it. Now, we carry our desktops with us, and that has really released a lot of time to care.”

Modern ways to share information
Another important project has been the implementation of a Hospital at Night system from Patientrack [a Highland Marketing client]. If a patient needs urgent attention, nurses use the system to complete task forms that were previously filled in manually.

These are sent to the Hospital at Night team, which alerts the most appropriate doctor, and sends the information straight to their mobile phone. Eventually, this will help the trust to work towards a bleep-free system.

“Previously, nurses would have to bleep a doctor and then wait for a response,” Irving says. “Doctors wouldn’t know what they were being bleeped about unless they logged onto a PC. Now, they can accept, complete and even reject tasks sent straight to their mobile phone, so the process is much more effective.”

The trust is next planning to adopt an e-observations system. But while it evaluates its options, Irving is also working with the local clinical commissioning group on the Bolton Care Record, a project using Graphnet’s Care Centric technology to share information across health and social care.

Irving has been chairing the professional reference group for the project, which is working on striking a balance between gaining the benefits of sharing data and concerns about who should have access to it.

Next up, an EPR
The scale of these projects, though, will be dwarfed by the implementation of a new electronic patient record.

The trust’s five-year informatics strategy, which is aligned with the Five Year Forward View plan to save £30 billion across the NHS by 2020-21 by improving efficiency and implementing new ways of working, says the EPR will be essential if Bolton is to cope with another period of “unprecedented change”.

Nearby trusts, with which Bolton works closely, are using the Allscripts EPR; but Bolton has yet to announce which vendor it is going with. Whatever system is picked, Irving says it will be “a huge change.”

“We have ambitious plans to implement an EPR. We have a business case, and that has gone through. We’re now waiting for central funding to support the programme. When it does, it will be a massive change in culture. That’s another reason we have been making some of the step-wise changes that we have been making.

“Hospital at Night gives doctors devices and a taste of mobile working. E-obs will give nurses devices and more familiarity with mobile working. So, by the time we go live with the EPR, we will be used to doing at least some things in a digital way.”

The trust’s investment in CCIOs has certainly paid off. Rachel Dunscombe moved onto Salford Royal NHS Foundation Trust in 2015. But when she did, one of Irving’s CCIO colleagues, Philippa Winter, made the transition to CIO; probably becoming the first NHS CCIO to do so.

Winter had been the trust’s elective therapy manager, and her CCIO job has been taken by another allied health professional; this time working for the trust’s community services. Irving says this multi-disciplinary approach to clinical engagement in IT is essential, and something other organisations should consider.

“Some staff may be worried about talking to a consultant, like me,” he says. “They will find it much easier to raise an issue with a nurse, or a therapist; and, of course they will have different perspectives to bring.”

From laggard to leader
In five years’ time, Irving would like to be working 50/50 in his IT and clinical roles, and to be working with a “fully functioning EPR.”

He thinks Bolton should be “at the forefront of the IT revolution”, and that it’s already well on its way. “We have got the team to do it, and with the virtual desk-top deployment we have shown we can do it,” he argues.

“There is no doubt that we would be further on if we had been able to invest earlier. Now we have got that, we can really move forward.

“These are interesting times. I’ve just been incredibly lucky. I volunteered at the right time, and since then I’ve had incredible support to change things.”