CCIO thoughts

Again I find myself deviating from the original purpose of this blog and writing an original post. It is a companion piece of sorts to my previous thoughts on the AMEE Hackathon in Glasgow and continues its ruminations on technology and health. It is also very much a reflective piece and not only are these opinions not those of the CCIO, the HSE, or any other institution I may have links with, they are barely even those of myself.

On Wednesday 16th September I attended my first full CCIO meeting. What is a CCIO? Put simply, it is a Council of Chief Information Officers and its role is summarised by the HSE (Health Services Executive, for non-Irish readers the body that manages public health care in the Republic of Ireland) thus:

A Council of Clinical Information Officers has been established to provide clinical governance to the delivery of eHealth solutions and in particular the Electronic Health Record (EHR) Programme. Its role is primarily as an advisory group, supporting the primary governance and oversight provided by the Office of the CIO and the eHealth Ireland committee

I won’t get too much into the content of the CCIO meeting – essentially discussing the question of governance of eHealth.  Essentially presentations alternated with small group discussions that focused on specific questions on the governance issue. In our group there was a great depth of expertise and experience and the discussions grew somewhat beyond the specific questions.

It was an interesting contrast with the Hackathon which I previously blogged about. By comparison with the tech-evangelisation of the Hackathon, the CCIO’s level of discussion was impressively realistic, and open to the pitfalls of technology as much as the promise. Indeed, there was clearly a high level of experience and expertise in the room. As a clinician with a (sometimes quite sceptical) interest in technology, rather than hands on experience of eHealth and with pretty much no actual IT experience,  it is interesting and a little challenging to be in that room. I am not involved personally in any local IT project and indeed my clinical work is very much paper-and-pen based.

In one of the groups I did try and make a point about expertise in information management that currently exists. Sometimes pen and paper files are talked about as if they are beneath contempt as a solution. Of course, if they are available at the right time, are legible, and reliably contain the relevant information, paper files are a reasonable and effective solution. The problem is that they are not reliably any of those things.

However, the information ecosystem of paper files has developed in a way that may reflect local practices, may reflect workflow issues, may reflect industrial relations practices (ie which staff member gets the file) but also may reflect something about the overall system that is worth knowing, and perhaps worth retaining. I am still working out my thoughts on this.

I am a very sporadic tweeter, but have begun following the  CCIO twitter feed. As so often, Twitter tends towards a certain slightly overcaffieneated enthusiasm. eHealth has become one of those motherhood and apple pie things that almost no-one objects to and tends to attract social media enthusiasm that I suspect can be rather frothy (I may also blog at some point about the recent OECD report on technology in education, and the rather dismaying social media reactions exhibiting a bad case of confirmation bias). It is interesting to contrast this with the nuts and bolts of the actual discussions. Richard Corbridge, the CIO , gave a closing peroration which combined enthusiasm with a sense of the challenges that lie ahead, and also a reflection that from the feedback given by the small groups, a lot of what the HSE Is currently doing isn’t getting through to the staff on the ground.

I am quite sceptical of terms like “transformation” and “revolutionise” in general, and particularly when applied to technology’s impact on healthcare (and education) I was interested to read Richard Corbridge’s blog post on transition, transformation and continued development. The distinctions between the three are well made, and Corbridge particularly focuses on the “enthusiasm” element of transformation.

This has got me thinking that perhaps my resistance to the discourse “transforming” and “revolutionising” health/education/whatever may (almost certainly does) reflect my own beliefs about and reaction to those words – that perhaps my own expectations of “transformation” are too high, and somewhat utopian. Therefore I resist the transformation concept as setting an impossibly high standard, one which dooms one to disappointment.

I was also struck in the CCIO groups discussions how many (nearly all?) of the challenges are cultural and involve managing people. Ultimately it all comes down to relationship management. I have been involved in other change management situations in which cultural factors are acknowledged, but often in a very superficial way that implies changing culture is simply a matter of people deciding one day to believe something totally contrary to what they believed before. I am glad that Richard Corbridge and the CCIO team are more aware of the challenge.

Finally, in my Glasgow/AMEE blogpost I wrote that the pitfall of the tech driving the process, rather than the clinical need, is perhaps a trickier problem than it first appears. The dynamic of technology being “in the driving seat” is more complex and more difficult to manage than a simple case of telling everyone to in some way think differently (clearly there is an overlap with my thoughts on culture above) The CCIO somewhat modulated my thoughts on this. The CCIO members are, by definition, interested and enthused by this area, and are also very aware that the tech does NOT come first.