Lisa Emery FBCS, FEDIP LP, CHCIO of the Royal Marsden NHS Foundation Trust and Chair of the London CIO Council, talks to Johanna Hamilton AMBCS about her career, her role at a world-leading research hospital, and how seizing opportunities in augmented reality is transforming patient diagnosis and outcomes.

‘If you've built up good relationships within the organisation, whether it's health or not, then as a first response to COVID, it was very much about speaking to the people on the ground, to the clinical and operational teams and asking, “what do you need?”’ begins Lisa Emery. ‘It was a case of “what do you need to do to keep the site safe? Keep staff and patients safe? And keep the business running?”

‘We didn't come to the table with a ton of new apps or complicated solutions, we just agreed we've got stable systems and processes that work, we just need to digitise them and make them available wherever they’re needed. We started by scaling up homeworking, making patient appointments digital and finding a platform for multidisciplinary team (MDT) meetings. We probably have about 30 or 40 MDT team meetings across different sites and different hospitals and they needed to go virtual really quickly.

‘We agreed a set of principles with the business and then we went off and worked out what to do technically and then just kept coming back and testing it. I make that sound simple, but it wasn't. We very much took a steer from what the clinical teams needed to do to keep operating and keep safe. COVID meant we had to get the right people together to make really fast decisions and get through red tape. That willingness to pivot made all the difference.’

What about the world laptop shortage?

‘Prior to COVID, we were about a quarter of the way through rolling out Office365. We knew that that was working really well and decided that if we rolled it out at pace for homeworking, it would be a great solution. But then we had the laptop problem! Suddenly we need hundreds of laptops, and there weren’t any to buy. So the response to that - and it's one of the things I'm most proud of - is that my team built tested and deployed a virtual desktop solution in nine days.

‘We had to make a solution available for people to access clinical systems on their own devices. Unlike trust devices, that are already encrypted, we had to build a security layer into the virtual desktop. That meant that although people were using their own device, all of the access to anything critical was within a sandbox environment. Nothing could be saved to individual devices and if somebody lost their personal device we could immediately wipe any sensitive content, because it was all kept in a secure, firewalled environment. Security was critical.’

With critical infrastructure widely in use, will the ‘new normal’ become, just normal?

‘We've had some really good conversations with clinicians. Initially it was really taxing getting so many people off site and working at home. The multidisciplinary team was a really good example because we'd always planned to do more virtual working, but many people were traditionalists and pushed back from not having the meetings face to face. Initially there was a little bit of reservation and hesitation, because it really “won’t be the same”, but we recently surveyed that same group and well over 70% don’t want to go back to how it was.’

How did you arrive at being a CIO?

‘The CIO role, is about people. I was never planning on being one, I never had a formal path to it. I had a scientific background, so I'm quite structured anyway and then I did programme management so I got used to creating proper plans of work and prioritising. I like people and I love health and science so it's a happy mix of things. I'm not terribly technical, as in mega detail technical, but I employ amazing technical people.

‘I don't think you can be a CIO unless you're absolutely part of the whole business. You're sort of the translator type role. It's so much more now like a transformation role than it has been a technical role.’

What is the most important thing you’ve learned?

‘About having diversity of thought in action. So not just diversity in terms of background which is massively important as in a good mix of gender and ethnicity, but also a good overall diversity of thought. If you're going to provide digital services to a population of 4,500 to 5,000 staff and hundreds of thousands of patients, you’ve got to have a team that’s representative of the people you're supplying services to.

‘Otherwise, how do you know you're doing it right? How do you know you're providing a good range of services to people? You can't do that from a position where you all look and think the same. That's been a big learning for me. It's good to have a senior team of people that have got different technical skills and the leadership skills but also who think a bit differently to each other. It's challenging but it's fun. It's the right thing.’

What is the right thing to do with learning?

‘I do like structured learning, I have to say, so I’m currently doing a masters. Aside from that, you can pick up a lot of learning from peers and colleagues and people in different roles in the organisation. Networking is absolutely essential. I am connected to a number of CIOs, and I pick up some great nuggets from their blogs, what they’re reading, how they’ve tackled problems and challenges during that week. I do stay active on social media and keep telling myself I need to blog.

‘We've got CIO groups on Signal and WhatsApp that you can always pick up great little nuggets from groups like the London CIO Council which I look after.

‘So, it's been a real mix. I'm doing a little bit of mentoring which I find equally valuable in terms of my own learning. So, whilst it's theoretically a couple of people shadowing, I always get something from every single session. I find that quite exciting, I think “oh I must go off and find out more about that” or “I hadn't thought of things that way”. Reverse mentoring is a really great way to learn too.’

So, what does good look like in digital health?

‘A quiet service desk is, to me, a really good sign of a purring team that's working well. For me, good is that golden thread of IT that threads through everything and is contributing to the success of the strategic objectives of every part of the organisation. It’s how we contribute to research, how we contribute to patient safety, how we contribute to better outcomes and the link we have to all of that. Good is showing my team that, that thing they did on Wednesday actually positively impacted a patient outcome or enabled better research.’

How has BCS contributed towards ‘good’?

‘The team is fairly focused on RITTech and FEDIP. They’re motoring on with that standard and that recognition piece. For me, SFIAplus is helping me to understand what good looks through this framework and the professionalisation of each of the job roles. It’s about understanding where we are currently, as a team, at all levels and understanding the opportunities that are going to come out of it.

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‘There's quite a bit more to do. At the moment I'm probably doing more of the informal encouragement so I tend to try and get my senior team to go to conferences I might have gone to and then encourage them to get people to go in their place. Then the other thing is trying to get people out in the business more so going out and going and meeting their counterparts in the clinical services team. It’s really about understanding what the individual needs to progress and going with that – in a structured or unstructured learning environment.’

Tell me about the Royal Marsden, AI, AR and the NHS?

‘The nature of our organisation, as part of a Biomedical Research Centre with the Institute of Biomedical Research, puts us in a fairly privileged position. They are doing a lot of cutting-edge research and, in partnership with us, we can test, trial and translate ideas into part of a routine cancer treatment pathway.

‘We employ some absolutely amazing scientists and clinicians who come to the Marsden because it is a world leading research hospital. It’s such a rich research space that promotes brilliant ideas that can gain support from our charity and also attracts a lot of external companies who want to build on the innovations.

‘We are experimenting with augmented reality to do some of the more routine work at scale. That frees up our incredibly bright staff to either look at specific cases, or to further their research into new areas such as early diagnosis or living longer with cancer.

‘For example we have one of our radiologists doing some work on AI learning for radiotherapy and radiology slices, image slices so that they can interpret a whole set of radiology images for a particular type of cancer in a fraction of the time it took them previously. One of the benefits there is, you can screen more patients and give more time to the patients who are more in need, leading to much better patient outcomes. AI or AR won’t replace the clinician, but it will free them up to be focused in a different way.’

Is digital transformation easier, or harder in a forward thinking organisation?

‘Bringing in a new digital strategy to somewhere that’s outstanding with amazing outcomes is quite hard. The question is, if it's brilliant already, then why do we need to change anything? So, when we’re having discussions about upheaval, changing the technology and upgrading systems, we’re having to frame it around “you'll get more direct patient time, we'll be able to see more patients and we'll get richer data for research”. Transformation has to be about embracing that change and running with it for future benefit.’