Getting more with more

February 2016

Tap with running waterJustin Richards MBCS spoke to Lee Randall, Head of Healthcare at RES Software, about the fact that there is ever more data to deal with and more that needs to be done with it.

Tell me a bit about yourself and your background.
My background is with software vendors, so working with and representing the vendor community. At RES I’m the thought leader for public health in Northern Europe, but UK and Ireland is my specific territory. So my role is to engage with these potential clients, to understand what they’re trying to achieve and, of course, events like HC are kind of pertinent because there’s a lot of changes in the air at the moment - the NIB and all the other frameworks that have been imposed on them.

It’s a dual challenge for me - firstly, it’s trying to engage with these folks and, secondly, it’s keeping abreast of what’s relevant, what’s current, what’s going to be the future and how we map to that.

How do you see the future of health informatics in your particular area?
We see ourselves as being an integral enabler for frontline, back office folks within any healthcare organisation where they’ve got more and more data sources to deal with, more and more applications to deal with, more and more complexity to deal with; yet all the goals that the UK Government and other organisations and groups are giving to our frontline people are around more efficiency, more patient-centric care, more time being spent with patients as opposed to other back office functions. Unfortunately the more we give to our frontline folks the more difficult it becomes to achieve that.

They’ve become less patient-centric and more focused on trying to meet those targets. I believe that RES have a part to play here. I see how NHS England are talking about this convergence of data, trying to make life easier for the people on the front line, but we still need to help them embrace what they’ve got - they’ve made big investments. It’s about making them more efficient with their time; with less time doing IT and more time talking to their patients.

Are we in a good place at the moment with HI?
Some of the senior clinicians I’ve spoken to, and certainly the IT professionals, are still a little bit cautious; I think if you’re a CIO or IT director or head of informatics what you’re seeing now is another challenge being laid down to you, to meet, to address what is effectively being asked of the frontline. 

For many years a lot of IT departments have been underfunded or have had misdirection or a lack of practical leadership or maybe a combination of all three and now they are in a position where they are spending too much time ‘keeping the lights on’ (a term I hear a lot) and ‘fire fighting’.

They’re both ironic terms because the people who keep the lights on are site services, generally, and for many years site services at hospitals have been very good at keeping the lights on, but if you ask any frontline personnel who their site services people are they probably won’t know; they’re seen, but not heard.

The ‘fire fighting’ analogy isn’t a good one either - if you call the fire brigade, they fight the fire, they’re heroes; they’ve never started the fires they put out. However, IT fire fighters are usually fighting their own fires. It’s the equivalent of setting fire to your own wastepaper bin, running out of the room to put a uniform on before returning to put the fire out! I think some IT guys think of themselves as being heroes when perhaps they should take a leaf out of site services and be seen, but not heard, and once they get to that situation they’ll be seen to be more of an enabler.

We absolutely see ourselves as being able to help an IT group to transform from the usual ‘fire fighting’, plate-spinning IT department to being more proactive, giving the frontline people the services they need, how they need it, as quickly as possible. It starts to remove the overhead, the burden on IT so they can concentrate on these great new frameworks that are coming online.

How do you fit into the HI arena?
We’re a software provider, and we broker the experience for frontline and IT staff. So we will take an organisation that is looking to transform and we take the risk out of that change. We help the people to become agnostic to what IT is doing, but at the same time we also give the end user community the ability to operate in a more secure way; the ability to have context-aware services delivered automatically or via self-service.

For example, if there was need for a locum doctor on a Friday night, the ward manager needing to ‘on board a locum’, it can be nigh on impossible for them - they have to be given a generic login, and password, and just hope you’ve done all the right due diligence. But what if they could effectively just go to an app store and click a button, fill in some details and have that all meet with compliance regulations, and have this doctor onboard immediately and get on with working straight away; streamlining the experience, improving the processes and masking all the great work that IT could do and are doing, by just putting that nice portal, a nice veneer across the top of it so that the clinician just gets on with doing what they want to do?

There’s a lot of talk at the moment of emerging technologies, about the internet of things, what’s your take on that?
There are a lot of words that have become kind of derided over the last year or two - things like cloud and big data. Unfortunately I think it’s wrong to raise the eyebrows to those terms - I think cloud, for example, is incredibly relevant to healthcare.

Going back to what trusts want - they want access to that data, that app, anywhere, and cloud is often the provider for that and therefore should be embraced and should be part of the DNA. Healthcare has been doing big data for longer than anyone - everything they do these days involves big data; it’s about those data sources and bringing it together.

NHS England are talking about their kind of programmes, like SPINE, and how that should be that core of first contact for anyone’s health record. At the moment it’s a point in time and it’s always going to be historical and quickly out of date. I think, for me, the next big thing is how you make that interactive in a compliant fashion so you have one source of truth or limited sources of truth. It’s about trying to collate all that information.

At the moment you’ve got so many different systems, records everywhere, more fields have got their own specialised electronic patient records and then you’ve got CERNER doing other things; there are just lots of different systems everywhere. If you’re a clinician moving from one trust to another, what does that mean for you? It becomes more difficult, involving more learning, spending more time away from doing what you really want to be doing.

And I think it goes back to the challenges that IT departments have, which are generally thrust upon them. Sometimes they don’t even get involved in the decision-making process; it’s often a case of ‘here’s the flavour of what we want, here you go Mr IT department, go fulfil our brief’. And that becomes difficult.

Where do you think we are from a security standpoint with health informatics, for example, regarding patient care records? Do you think we can overcome the trust issues that many people have?
We need to. It’s not a case of ‘can we’, we should be able to. There’s enough good technology out there with the right authentications to do that. I think, perhaps, it’s a cultural change that needs to happen here. I don’t work in the information security arena anymore, but what RES do has had a big impact on that.

For example, we can apply context awareness in a patient records system. We can ensure that the person accessing that is entitled to access it, in the place that they’re trying to access it, because even if they are allowed to, do we want them to access it in a public space? So we can enforce those kinds of security policies that can improve the security of that world.

However, the naysayers have got to stop saying ‘nay’ and at some point they need to embrace the fact that there is enough good technology out there, and make sure that it’s the right technology used in the right place, at the right time.

Three words that seem to keep popping up in talks here at the conference are: empowering the patient. But maybe the patients don’t want to be empowered just yet, maybe they don’t trust the system enough yet to let their records drift around in cyberspace. How do you think we can get those types of people onboard?
Ha (laughs), if I knew the answer to that I’d probably be on the podium! I honestly don’t know. If you look at our millennials they are used to sharing their data and having it in different places; I think it’s a generational concern.

There are only so many assurances you get given; you can only do so much. You can give people the option - if they don’t want that improved level of service, then they need to have the ability to opt out. I think if you want an improved service then it’s got to be your call - do you want to wait three days for those records to arrive by post or do you go down the quicker, more convenient route?

I think patient data over the years has become less personal, probably because of the time constraints that we put on our clinicians. This is the big thing at the moment - more patient-centric care - spending more time with the patient, and if you do that the level of trust increases and the patient becomes more proactive in their own care, especially early on. If it’s all reactive everything becomes more of a challenge.

It’s probably mainly about education?
Yes, it is. Explaining how the system all works to the public.

RES is apparently keen to empower users with automated self-service tools because you want to win their hearts and minds. How are you doing that?
Well, we’ve recently released a paper around security and we’ve got really strong messages about how we drive that pure access issue. If the general public know that the consultant that they’re talking to can only see their records in a secure environment, that no one else can look over the consultant’s shoulder, and that you can prove that (and we can) then you start to go some way down that route of assurance, which you’re referring to.

I believe that RES are absolutely addressing that and we’ve got a focus this year on securing that access and proving that to healthcare professionals. But at the same time, giving more freedom - the two can go together. In the past if you had improved security it meant something was more difficult to access, almost as if those two factors had to be mutually exclusive, but you can allow more freedom, you can allow the cloud, you can allow mobility and access anywhere, but you need to make sure it’s the right access to the right data.

What do you think is the best innovation in your particular sector within the last few years; what’s excited you?
The reason I joined RES was the vision of the IT store, the portal of portals. Like your enterprise service store. It’s very pretty and easy to understand (for most care-givers that I know). It’s icon driven, you just click a button and it does what you need it to do.

And that’s what you want, no complex interactions. People go into a phone store and buy a phone and generally know they are very easy to set up - they just click on a button and go to the online store and download their favourite apps. In fact with apps that they’ve been using for years they can just re-download.

It looks the same, feels the same, they know how to get to it and so on. So why should IT be any different? It can be just as simple and they can do it. This is what RES has done and that excites me. Other major venues are talking about similar methodologies so we know we’re in the right area, that we’re all doing the right thing.

Basically simplifying the front end?
Absolutely and making the user be where they want to be and do what they need to do. The term we use is the ‘workspace’, trying to move away from things like the ‘desktop’ or the ‘beige-box’ as it’s sometimes called - it’s just the space in which you do your work - or maybe in our world it’s more like the electronics space.

We shouldn’t care if it’s an iPad or Galaxy pad or a Toshiba laptop, we should just be able to make it what we need it to be, where we need it to be. And that’s what I find really exciting at the moment; we’re on the cusp of seeing some really great empowerment for the end user.

What’s been your highlight of eHealth week so far?
I like the common message about the convergence of many things, some call it the internet of things. I like that - it’s a similar message to what we’ve been banging out now for a number of years, which is around that simplification and efficiency improvement.

There have been lots of words that have been used in many ways, but I’m actually now seeing a slight change of the tide in that respect, with some of the great work that’s been done by NHS England and HSISC around that, the thought leadership around that portal, including the SPINE and having the information in one place.

It makes perfect sense and it’s how we see the future as well. It’s the first healthcare event I’ve been to where there’s been a similar message being delivered by many different parties, and of course the NIB is the catalyst for what these guys have been doing for a number of years.

What one bit of advice would you give to someone like yourself coming from a tech background thinking of moving into the world of health informatics?
You need to get as close as possible to your customer; you have to think like a supplier - that’s what you are internally - going back to that site services analogy we spoke about earlier. IT is a service provider within a hospital, but they’re not a provider of healthcare.

The people who work at the hospital or clinic are there to provide care and health advice and to make people, the public, better. The difference to IT is that sometimes IT can exist for IT’s sake. That self preservation of IT has to stop.

You have to think of yourselves as an internal supplier, whether that’s managing external contracts with cloud suppliers or whether that’s physically building services yourself, but you need to know why you’re doing that and the best way of doing that is to talk to the people that matter, the clinicians, maybe the chief clinical information officer, or sometimes both camps.

Maybe also to the board, because if you don’t know what their challenges are you’re never going to be able to help them to meet them. Otherwise you just become an expensive cost centre, just a ‘necessary evil’. Let’s not be like that. Let’s be proactive, let’s make sure we know what the goals are, and that our IT maps onto what the goals of that particular trust are.

You can’t think that you know one trust and therefore know them all, they all have different nuances. You will fail unless you understand what the particular challenges of that particular trust are.

What are your thoughts on health tech wearables?
I think if you look to the millennials and the younger generations they’re quite keen to understand what their lifestyle’s about and how much exercise they’re getting or not getting and even some of our more senior citizens are starting to take up this trend of wanting to improve health and lifestyle. Hopefully that will have a positive effect on what’s happening in healthcare, as we have additional challenges as the population gets older.

I can see wearables having a positive impact in future. There’s a lot of new technology that’s starting, again, to give people more awareness of their own health and wellbeing and that again plays back into how we educate the public, to having these care records in the combined space where they are available.


Image: iStock/87167740

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