A day in the life of a Chief Clinical Information Officer

I have been lucky enough, over the years, to rise through the ranks to a position as Lead Psychologist and Clinical Director for our Trust Learning Disability services. I have always been drawn to problem solving and efficient design, and some five years ago I was asked if I would lead and represent our 7500 staff and clinicians in the daunting process of moving from our old electronic clinical system to a new one.  

What started as a part-time role rapidly became a much-more-than-full-time job as the complexities mounted. My information-gathering, negotiation, mediation, anger-management, problem-resolution, solution-focused, reporting and presentation skills were sorely tested over the next three years. Multiple work streams, new technical language, trying to engage effectively with 300 staff teams to ensure everyone’s (‘more special than the others’!) needs appeared in the new clinical system meant a vertical learning curve. There was immense satisfaction when the Team finally hit the ‘on’ button.

Working at the intersection of patient needs, staff needs, clinical services, and system processes – with new technical, commercial and project delivery challenges at every turn – it was also clear to me that our Trust needed a Chief Clinical Information Officer (CCIO).

Fast forward a few months, and I was again lucky enough to be appointed to this relatively unknown but increasingly important role. I have been presented with many new challenges each and every day, but also great opportunities to help patients and staff, meet needs, find solutions, and help shape the work of the Trust.

Broad themes

Well, it’s not a CIO (Chief Information Officer), who is the Head of IT, responsible for hardware and infrastructure. Rather, the CCIO is an experienced clinician, working in a senior, high level leadership position, with an expectation that they can work effectively at every level in the organisation – with patients, with staff at all grades and roles, right through service and Divisional teams, to Executive Board – across some broad themes:

• Making best use of clinical information in service performance, planning and improving outcomes, and advocating for the development of clinical informatics
• Digital transformation – how to add or build in digital enhancements to the way clinicians work and how we deliver care, and how do we improve patients’ access to care (especially during these pandemic times) their experience of care, and clinical outcomes
• Clinical systems development and performance – how to get the best out of our clinical systems processes, make the best of the ability to share clinical data effectively, how to design and build those processes to best effect
• Digital innovation – identifying clinical or process needs, and find the right solutions, or provide opportunities to develop those solutions, in partnership with our service users, staff and the designers or suppliers of new products
• Represent clinician and staff needs with those internal and external providers who can best meet those needs – linking and bridging the ICT team, clinical systems and information teams, to develop and provide systems and processes which optimise our care, enable opportunities to develop new ways of working, digitally empower patients and staff, and improve our outcomes. 

The CCIO role has steadily gathered momentum across the NHS. During the pandemic, digital transformation has only enhanced that profile, and accelerated the need to find aIternative ways of working, establish new channels of communication, and resolutions to the challenges of accessing, creating and reporting clinical information in this Covid-19 world.  

A typical day

I begin at 7.45 am, clearing the decks. Overnight, a brief email conversation with one of our service leads, sadly reporting the Covid-related death of a patient, and offering support to her and the team if needed. I review a number of Covid-related and bed management data sets, to plan ahead for admissions, discharges, emergency planning within CNWL and across NW and North Central London. I consider the daily Covid situation report to check if there are any issues with reporting from the clinical system, or any other issues where our Covid-reporting template or clinical records will need to be amended.

There’s an early flurry clearing the junk emails, and reviewing, accepting or dumping the persistent pitches from digital companies offering perfect solutions – sometimes to problems I didn’t even know we have!

By 8.30 am I’m gearing up and into the day, the usual email and call churn:

• Setting up a project team to evaluate and deploy a Digital Platform for our young service users, rather than coming into clinics for face-to-face clinic appointments;
• Reviewing documentation with our IG lead in respect of a project enabling medical access to inmates in prison for the purposes of conducting online assessments;
• Mapping out the Trust website for our new Digital Innovation Group, to create a ‘go to space’ for digital innovations, pilots of new apps, proposals for new app evaluations, and setting up a network of Digital Champions for regular webinars and conversations;
• Working with our Digital Innovation Lead, setting up quarterly pitch-fests, where staff can propose new apps or ideas for development, and where suppliers and developers can pitch their apps to our staff to see who might want to partner up;
• Drafting a document to capture all the emerging health information exchange platforms in one place, so staff can see whether, and what information is available from other sources outside of our Trust, and how to access that clinical data.

12.30 pm: outside for some fresh air and to grab a sarnie, and then joining the Electronic Prescribing and Medicines Management group on MS Teams, to define the processes, and link those clinical requirements with the SystmOne team, who will configure, design and build them in the electronic patient record. In a conversation with our Clinical Safety Officer (CSO), we review the latest batch of his reviews of our Health IT apps – clinical safety cases have to be written up for all IT platforms which have clinical content, or which are used for clinical working. Another Teams call with potential suppliers of RPA (robotic process automation) platforms helps me draft a document on our repetitive clinical and admin processes, which could benefit from a bot doing the work rather than a human!  

Next I prepare for a demo day, where suppliers will show us their wares. A Zoom session with my deputy reviews new apps he has been scoping, requests for services to adopt apps, and begins some digging on the ones we don’t know anything about. I field phone queries about staff and patients wanting to use a range of Videoconferencing platforms (some good, some not so good), and Zoom with our SystmOne Team and a service piloting a new Videoconferencing app to see if it really does what it promises on the box. 

I check in with Procurement team and service leads over progress on the rollout of Dragon digital dictation for the 80 staff in Wave one of the Project. I join a call with the Project team setting up access to our clinical system for another Trust, to better manage emergency admissions. And I re-draft a Clinical Message of the Week, reiterating the importance of securely managing access to clinical information, and providing links to guidelines.

By 5.30 pm I scrape out all the junk mail, pick up on any urgent issues and check on any early actions for first thing in the morning, and try get out for a walk before it goes dark.

So is this for you?

There’s a whole new career opportunity out there for Psychologists, which is typically a part-time role in the NHS, with encouragement for the CCIO to sustain clinical work too.  The role of the CCIO is one perhaps for those experienced clinicians who also have an interest in effecting change at a broader systemic service and organisational level, representing patients and staff, and finding solutions for the challenges they face. I have found it challenging, but also hugely satisfying, to work at problem solving and service developments at the interface between clinical needs and internal, external, academic and industry partners.

If you want to know more – speak to your NHS Trust CCIO or Digital Leads. Get involved in digital or transformation projects, join your Trust’s digital working groups, seek a mentorship, and join the NHS Digital Academy to get a sense of whether this might be a role for you!

-       Dr Scott Galloway is Chief Clinical Information Officer and Consultant Clinical Psychologist with Central and North West London NHS Foundation Trust. [email protected]