As we cross the midpoint for the NHS Five Year Forward View with the publication of this year’s “Next Steps” plan, its implementation remains critical to the delivery of sustainable high quality healthcare in the UK.
A key to this is the use of digital technology and informatics, both of which help foster innovation.
Last year, a report commissioned by the secretary of state for health from Robert Wachter, an American clinician-informatician, made recommendations to help accelerate the introduction of health information and communication systems, with a particular focus on engaging and training the workforce, especially clinicians.
His review recognised the NHS in England currently lacks clinicians with the necessary skills in healthcare improvement and redesign of care enabled by digital health and informatics.
We need to develop such leaders to help realise the full potential of modern digital technology and avoid the high profile failures of the past.
Leaders in this arena are commonly referred to as chief clinical information officers (CCIOs). This is an emerging role in health systems globally, including the NHS. Both the responsibilities of the role and the scope of practice vary across the system and remain defined by local context.
Wherever they work, however, CCIOs need a wide range of competencies in research, data analytics, leadership and management, and a strong understanding of health informatics and the health and care system.
The NHS in England needs to place such people in authoritative positions with the autonomy to make strategic decisions and to develop and manage high performance teams. Informatics must also mature from a research focused, non-vocational, or part time option to a fully professional and accredited career pathway with training, standards, and certification.
Within the NHS, a CCIO or clinical informatics leader requires competencies in both information technology and leadership, but first and foremost they must be clinical professionals with front line experience of patient care.
Clinical credibility is essential to ensure engagement with the wider workforce and to manage the culture change needed to place the digital agenda at the heart of the system transformation demanded by the Five Year Forward View.
The new CCIOs will also need a portfolio of data analytical and research skills complementing their clinical skills. This will enable them to drive systematic learning across their organisations, so that every member of the workforce routinely uses real time data and information to inform day-to-day decisions.
To achieve all this, the CCIO will need to understand the importance of user-centred design of technology platforms and understand the critical role of patients and carers in stimulating and fostering innovation throughout healthcare organisations.
Working closely with patients, carers, and the wider public will ensure that digital technology is firmly embedded in each organisation’s strategic and operational plan for delivering the triple aim of healthcare–better patient outcomes, better patient experience, and affordability.
This new type of clinical leadership role must be seen as a genuine professional opportunity, sitting alongside more traditional clinical professional roles. CCIOs must have enough authority to be able to have an effect across health and care systems. The potential benefits of a well trained CCIO extend from better direct patient care to an effective and efficient health and care system, better clinical research opportunities, and economic benefit through more effective partnership with industry.
Since 2009, the US has made substantial progress in this area.
Respected universities and healthcare organisations have increased the number of informatics fellowships by over 50%, expanded their health informatics capability, and substantially increased the number of senior leadership positions in informatics and digital transformation.
Over the past decade, the UK has seen structured careers develop in academic medicine following the Walport report, and clinicians can now train as academic clinical fellows. Leadership in informatics must now be given the same priority, with the same prospect for dual careers.
This emerging specialty requires rigorous and accredited training and professional recognition as recommended in Wachter’s review and enshrined in the National Information Board’s Personalised Health and Care 2020 programme. The launch of the NHS Digital Academy in September, a key commitment in the Next Steps plan, should help accelerate this progress, with accreditation and professional recognition coming from the newly formed Faculty of Clinical Informatics.
The academy will offer a professionally recognised training programme, aiming to develop a cohort of 300 informatics leaders over the next few years. These leaders will drive the digital agenda across the NHS, maximising the benefits of modern digital technology to improve patient outcomes and ensure sustainable and affordable health care well into the 21 Century.
- This article was co-written by NHS England’s National Medical Director, Professor Sir Bruce Keogh and Keith McNeil, NHS England’s Chief Clinical Information Officer, and first published in the British Medical Journal.