clinical informatics and digital delivery in health …...4 | clinical informatics and digital...

Clinical informatics and digital delivery in health and care: career stories October 2018

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1 | Contents

Contents

Introduction............................................................................................................ 2

Margarita Flora Akyla, RM MSc and Principal Trainer for the electronic health records system ...................................................................................................... 3

Paula Anderson, RN and Clinical Applications Team Lead ................................... 5

Jane Benfield, Chief Nursing Information Officer ................................................... 7

Amanda Claeys, Chief Nursing Information Officer ............................................... 9

David Davis, FCPara, FFCI National Clinical Lead ............................................. 11

Theo Fotis, Principal Lecturer and Course Leader .............................................. 13

Nick Hardiker RN PhD, Professor of Nursing and Health Informatics ................. 15

Roman Hausner, Floorwalker (Healthcare Support Worker and Informatics Trainer) ................................................................................................................ 17

Sarah Judge, Allied Health Professional Digital Lead ......................................... 18

Michelle McIntosh RN, Clinical Systems Designer .............................................. 19

Sam Neville, Digital Lead Nurse .......................................................................... 22

Dr Natasha Phillips, Chief Nursing Information Officer ........................................ 23

Arran Rogers, Chief Nursing Information Officer ................................................. 25

Keith Strahan, Social Worker and Council Member, Faculty of Clinical Informatics ............................................................................................................................ 27

Katie Tracey RN, Clinical System Designer ........................................................ 29

Jackie Whittle, Chief Clinical Information officer .................................................. 31

Llying Zing, RN, Systems Builder ........................................................................ 33

2 | Clinical informatics and digital delivery in health and care: career stories

Introduction

The stories collected here highlight the journey of pioneering nursing, allied health

profession (AHP) and social care colleagues to digital and informatics roles across

several different areas of the NHS, including education, operational delivery,

research and strategic management.

They bring to life the roles outlined in Clinical informatics and digital delivery in

health and care: a career framework outline for nurses and allied health

professionals, for nurses and allied health professionals aiming to specialise in

clinical informatics and digital delivery in health and care settings.

Drawing together the career framework has made it clear many of these roles have

developed as a result of staff members’ personal interest in digital transformation

and what it can do to improve patient safety and outcomes. They may have been

involved with digital systems or undertaken rollouts in clinical environments, for

example electronic staff record or patient record systems or e-prescribing or

observations systems. Some have been self-taught while others have gained formal

education to support their roles.

For future generations of informatics clinicians there is a great opportunity to draw

from these experiences and build a more defined route into health and care

informatics; from undergraduate through to postgraduate skills, knowledge and

behaviours.


Margarita Flora Akyla, RM MSc and Principal Trainer for the electronic health records system

How I got the job

After I qualified as a midwife in 2005, I started

working for the NHS in 2008. I worked in a variety of

roles and settings and in the same time I completed

my postgraduate studies in midwifery and neonatal

care. Following all this, I was looking forward to

another challenge to my professional development.

It was then that a consultant midwife suggested I

look into clinical informatics or research for

inspiration. At the time there was an opening in my

trust for the role of the principal trainer for the new

electronic health records (EHR) system. I was motivated by the fact I could merge

my two passions: ongoing learning and adult education.

The recruitment process included an initial computer test, which covered

mathematics, basic code and critical reasoning, followed by an interview. There

was no need for prior code knowledge or to be exceptional in IT skills. The

programme provided six months of training, which also included training in the USA

for a short period of time.

What I do

I am part of the training team currently developing the curriculum for more than

10,000 members of staff in University College London Hospitals NHS Foundation

Trust. Our job involves being the communicators between the different clinical

system designers’ teams, the subject matter experts who provide their expertise

from different specialties and other stakeholders. We identify the learning needs of

the staff based on their role and create all the appropriate materials for them.

We also organise, schedule and deliver the curriculum in an appropriate timeframe.

Mapping the patient’s journey across the hospital and keeping it relevant to the

build of our new electronic system is vital for our work too.

Finally, as I am currently employed part time in the digital team, I am also able to do

some clinical shifts and be up to date with my registration and three-yearly


revalidation processes. Theoretically, I can do a homebirth one day and be back in

the office the next!

The best bits

I think the best bits of my job include being able to expand my knowledge around

the different roles, jobs and specialties that co-exist across the trust and being able

to acknowledge and get familiar with a variety of exceptional people in the NHS

who are making a tremendous impact on patients’ lives, such as play specialists or

palliative care specialists.

I was also able to get an insight in development and delivery of education on a

large scale, which I think it is a huge opportunity for anybody considering a pathway

into an academic career.

My message for future digital/informatics nurses, midwives or allied health professional colleagues

I would like to encourage more of my colleagues to chase opportunities in clinical

informatics and similar roles. Do not be intimidated by poor IT skills or

understanding of the digital area. There are opportunities for growth.

There are no obstacles, just a better chance to define new limits for yourselves and

provide care to your patients in a different capacity. We are still clinicians who use

their valuable clinical experience and theoretical knowledge for the benefit of the

patients, staff members and organisations. The only difference is we are using

digital tools to do our job.

Overall, I would advise everybody to try a different approach to working in the NHS.

It expands your mind and increases the potential for job satisfaction.


Paula Anderson, RN and Clinical Applications Team Lead

How I got the job

I was at a crossroads, not knowing where I was going

in the next step of my nursing career, I took a

secondment to the EHR system team during

implementation in 1996.

Having been the training champion and quality

representative on all my wards since qualifying as a

nurse, I had the clinical qualifications, training, and

quality and audit experience the team were looking

for. This decision has taken me to a number of

different jobs I would never have thought of doing, but

it was my nursing background that laid the foundation for these roles.

What I do

Today I am a clinical applications lead and a member of the EHR system (EHRS)

team. We focus on the configuration of inpatient clinical applications and

interoperability with the aim of improving patient and staff experience, to help

University College London Hospitals (UCLH) become the hospital of the future. I

manage a team of 25 people, both clinical and non-clinical, who work with subject

matter experts to design and configure the system to meet the organisation’s

needs. I use my clinical knowledge and skills to challenge how we work and why we

work the way we do, ensuring we design in best practice, not bad practice.

The best bits

Historically I have appreciated getting experience and knowledge in areas of

nursing I had no clinical experience in: working on improving a prison clinical

system, gaining an understanding of prison healthcare and its challenges. I also

worked on the redesign and delivery of rural and urban community services for both

nursing and allied health professional (AHP) services, including configuration of

clinical systems to support the changes in working practice. One of the most

interesting challenges was going to work for an American clinical systems supplier,

learning about business in the private sector and working my way through different


roles, starting with implementation consultant then functional design, and finally

ending up as the international software engineering manager, despite no hands-on

software development experience!

Constantly learning has also been one of the best bits of my informatics roles: how

to run EHRS procurements, the legalities, the ‘commercials’, all things I had not

experienced as a nurse; new technologies and how we can apply these to

healthcare to improve patient safety, delivery of care and patient and staff

experiences.

Currently, it is the happiness on a team member’s face when they work out how to

configure something on the system that they had been struggling with.

My message for future digital/informatics nurse or AHP colleagues

Take all the opportunities offered. Don’t be fearful and afraid to fail ‒ you never

know where the experiences will take you or what you will experience and learn.


Jane Benfield, Chief Nursing Information Officer

How I got the job

At a young age my school careers adviser

suggested Hollywood actor might be an unrealistic

and challenging career choice and asked me if I had

any other thoughts. I finally chose nursing and I am

so glad I did. It is such a rewarding career with

brilliant opportunities to make a difference.

I started my nursing journey as an enrolled nurse,

soon converting to a registered nurse. I spent my

early years in a busy emergency department in the

West Midlands, then moved to Gloucestershire as a staff nurse in intensive care.

This was a massive learning curve and it took me six months to a year to feel

confident, but I loved critical care medicine and continued to develop further. I

consolidated my skills and knowledge in both adult and paediatric critical care,

studying at the University of the West of England.

As I progressed to matron for critical care services, patient quality and safety were

fundamental. One of my earliest improvement projects involved setting up a

bereavement follow-up service. At first, we had a significant amount of opposition:

this is not our job, why change, we have always done it like this ‒ the usual

resistance to change ‒ but the service is now going from strength to strength.

It is imperative the nurse has a voice promoting patient safety, quality and the

development of clinical excellence, and the implementation of an electronic clinical

system is a fantastic opportunity. Our patients are at the centre of everything we do:

an EHR would ensure that we will continue to get better at delivering services and

treatment plans designed around the patients’ needs. I was given the opportunity as

a secondment ‒ the chief nursing information officer (CNIO) role is one of the most

challenging jobs I have undertaken, and I love it.

What I do

Our digital journey in Gloucestershire has been difficult and challenging at times.

For a trust that is very paper reliant the culture change is and continues to be

massive. The first stage of the implementation was to replace the 30-year-old


patient administration system. This was not very attractive to the clinicians. They

did not see many benefits to their everyday job and it has led to more administrative

work so there have been lots of grumbles. However, we have had a recovery period

for resolving issues and appraising our lessons learnt.

Part of my CNIO role is to implement and transform nursing documentation through

the EHR, enabling the delivery of safe, clinical technology using electronic patient

records (EPRs). This will improve the quality of patient care and performance,

limiting costs and optimising efficiency. It will also enhance the quality and accuracy

of nursing documentation, reducing potential risk and harm to the patient and

increasing patient safety. At the moment I am working with an e-documentation

group to review nearly 1,000 paper documents. By transforming our endless paper

copies, we are condensing duplication and inconsistencies, which will alleviate

some of the burdens on nurses, freeing them to concentrate on direct patient care.

A huge part of the CNIO role is implementation of the EPR. Moving from paper to

digital healthcare is not a one-person crusade, it is an inter-professional team effort.

The executive board, non-clinicians and clinicians, patients and relatives need to be

engaged in all stages all the way through.

The best bits

The best bit for me is working in a fantastic team. I am honoured to be leading our

nursing and AHP teams through the digital transformation, knowing it will provide

real-time information about any patient’s condition, treatment plan, diagnostic

results, scheduled clinics and much more – providing timely and relevant advice

and handover to help clinical teams make the right decisions at the right time.


Embrace your digital journey in healthcare, guaranteeing you as a nurse are

leading the way clinically, enabling the use of technology to promote safe, efficient

and timely patient care.


Amanda Claeys, Chief Nursing Information Officer

How I got the job

I began my nursing career in 1988 in Broadgreen

Hospital, Liverpool, working as a registered

nurse originally, then as a registered midwife,

and later as a health visitor. During my health-

visiting career I completed a postgraduate

diploma in health informatics, which some years

later led me to become the lead nurse for

implementing an electronic care record for

health-visiting and school-nursing teams. This

role, although initially a short-term secondment,

lasted for two years and culminated in the

implementation of an in-house developed solution for all health-visiting and school

nursing services.

From there I moved to another organisation as lead nurse for EPR and then into my

current role as CNIO.

What I do

As a CNIO I work closely with the chief information officer (CIO), chief clinical

information officer (CCIO) and the divisional CCIOs in the organisation, as well as

other clinical and informatics colleagues. I act as a source of clinical knowledge for

informatics staff and a source of informatics knowledge for clinical staff. Both

clinical and informatics staff use unique languages and one of the key skills in this

role is being able to interpret issues from both perspectives and create a common

view/purpose. We have just implemented an EPR in our neonatal unit and I acted

as the lead for informatics, working closely alongside the clinical lead (a consultant

neonatologist) to ensure the system was developed to its full potential for

implementation.

The role does not, however, stop there. It will involve periods of supporting the

service to embed the solution, then a period of optimising use of the solution. In my

mind, this part of any implementation is just as important and key to its ongoing

success.


The best bits

I wanted to work with digital technology as I truly believe if we can get the clinical

systems right then we can improve the care we deliver to our citizens, so for me this

is one of the best bits. The CNIO role is an emerging role and, as such, being part

of shaping the role is really exciting. I do believe we are somewhat behind our

medical colleagues in this leadership role but nurses/AHPS are a huge workforce in

the NHS and pivotal to care delivery so having our voice out there loud and proud is

vital.

My message for future digital/informatics nurses

Get involved and have your say so we can be part of shaping the future of the NHS.


David Davis, FCPara, FFCI National Clinical Lead

How I got the job

I’ve worked in a few national roles with a

focus on digital healthcare and clinical

informatics – it’s not what I expected to

specialise in when I left my role setting-

up and managing key accounts in an e-

commerce start-up in the 1990s. I joined

the NHS mostly because I was frustrated

with the care that had been provided for a

family member; I knew we could do better

for patients. I opened the paper and saw

an advert for the ambulance service and before I knew it I was registered in one of

the newest professions as a paramedic in 2004.

After leading development of the stroke clinical pathway across a region, I became

involved in the national stroke campaign as stroke lead for the College of

Paramedics. I was part of the national stroke group getting involved in data

collection and interpretation.

After this, I had the opportunity to work as clinical lead for clinical telephone

triage/assessment for a region’s 999 call centres. This exciting and challenging role

really saw me face to face with technology, clinical practice and patient care, as

well as working with clinical systems, data and information. During this time, I also

took a leading role in developing a postgraduate education course for nurses and

paramedics working in telephone contact centres. I became the representative from

the College of Paramedics to the National Clinical Governance Group, overseeing a

national telephone clinical decision support system and involved in the oversight of

the prioritisation of 999 calls in England.

Following this, in many ways by chance, I applied for a role in the Department of

Health and Social Care as an AHP informatics national clinical lead, transferring to

the Health and Social Care Information Centre (now NHS Digital). I then became

AHP National Clinical Lead for Clinical Informatics within NHS England and over

the last few years have led the joint NHS England and Health Education England


workforce programme for the NHS 111 services within England ‒ creating a

blueprint for this workforce that includes a national standardised career framework.

More recently my role includes clinical assurance of a national digital development

programme across arm’s length bodies

What I do

As an AHP clinical leader working in clinical informatics in NHS England, I have the

opportunity to influence national policy, clinical systems and programme delivery

focused on the workforce competences and technical systems that deliver care to

large numbers of the population. The NHS 111 workforce, for example, delivers

care to over 16 million patients a year.

In the past, I have been part of the CCIO Network and have worked as a peer with

consultant clinical colleagues from a range of disciplines. I recognise, however, that

this has been without the benefit of an established clinical informatics and digital

healthcare career framework to validate my consultant clinical practice status and

this is why I welcome the nursing and AHP career framework. As well as being a

fellow of the college of paramedics, I am a founding fellow of the Faculty of Clinical

Informatics and will be keen to ensure that AHPs have a strong voice in this new

multiprofessional faculty.

The best bits

I am very proud to be an AHP, a paramedic, working in a national leadership role in

the digital healthcare and clinical informatics environment. I’m not a ‘techie’ and not

a programmer, but what I do understand is how technology can support the delivery

of patient care and complement clinical practice. I also really enjoy frontline

paramedic clinical practice in green!

My message for future nurses and AHP leaders

Clinical informatics and digital healthcare aren’t as well understood today as they

need to be, but with every day that passes, it improves. One of my colleagues, only

recently, told me I should think about leaving behind being a paramedic – perhaps

they just didn’t understand that clinical practice includes strategic and population-

level clinical informatics – or perhaps I needed to explain it slightly better. That is

why it is important that we work together across all disciplines and professions to

raise the status and understanding of this important area of practice.


Theo Fotis, Principal Lecturer and Course Leader

How I got the job

I qualified as an airforce officer registered nurse in 1997,

graduating from the Greek Armed Forces School of

Nursing where I served in different clinical and

managerial positions and peacekeeping missions. Having

always had an interest on innovation in healthcare, I

completed my MSc and PhD in healthcare services

management, exploring the impact of innovative surgical

procedures on patient outcomes and health services

finances. Being passionate about research and education

I got my first academic post in 2005 at the nursing school

I had graduated from, where I started teaching as a

lecturer and in 2009 continued at the Nursing School of

the University of Peloponnese.

In 2012 I left the Airforce as squadron leader to pursue an academic career. I

moved to the UK to teach at the School of Nursing, University of Brighton (UoB) as

a senior lecturer where my research activities moved from clinical innovation to

more focused digital health solutions. I am currently Principal Lecturer at the UoB

School of Health Sciences and Course Leader for the MSc Health and

Management.

What I do

As an academic it is exciting to be able to work as both an educator and a

researcher. The most exciting part for me is the chance to contribute to and

influence the digital health agenda from multiple aspects:

• As an educator I am teaching both undergraduate and postgraduate

nursing students how to carry out research and digital health technologies

for healthcare. I supervise, MSc, MRes and PhD students on projects

related to digital health subjects.

• As a researcher I lead and collaborate with other academics, national and

internationally, in research projects on digital health, disseminating our

results through publications and conference presentations.


• As a digital health adviser, I review business proposals submitted to

Innovate UK for funding, contributing to the allocation of government

funding that shapes the digital health environment of the future.

I am currently the Director and academic lead of the Brighton and Hove Digital

Health Living Lab where working with citizens, the NHS, clinical commissioning

groups, academia and industry, we co-create digital health solutions to prevent

escalation of care by reducing the number of A&E visits and hospital admissions.

The best bits

I can think of two best bits of what I do. The first one relates to networking and

collaborating at a more strategic level: Recently I was named one of the Top 50

Digital Health Leaders in Europe by HIMSS Europe. Supported by IBM Watson this

initiative provides the Future50 community with ‘a platform to promote the eHealth

agenda at a European level’. Being part of this community we ‘share expertise,

collaborate across borders and foster innovation both individually and as a group’.

The second relates to the Digital Health Living lab where we work in the community,

with the community and for the community. At the core of what my team and I do, is

user-driven innovation, where citizens lead the digital health developments. It

reflects one of the fundamental principles of nursing of having the patient at the

centre of everything we do.


Digital nursing is the future. Disrupt the way you practise and be the innovator at

the ‘bedside’ who will lead the change for our patients’ benefit.


Nick Hardiker RN PhD, Professor of Nursing and Health Informatics

How I got the job

I qualified as a nurse in 1987 and worked in a

range of settings in the UK and abroad. This gave

me a good understanding of the realities of nursing

practice that would prove to be essential in my

future academic career. In the late 1980s, a

number of attempts were made to ‘computerise’

healthcare. I saw this as an opportunity for nursing

and decided to retrain in computer science.

But nursing was never far away. I continued to work on the ‘bank’ to support my

young family through my studies. And I even developed, for my final year project at

university, an automated computer-based duty rostering system that would take into

account individual preferences, skill mix and other factors.

After graduating I worked briefly as a regional clinical coding tutor before securing a

position at the University of Manchester as a research associate on a ground-

breaking project exploring how electronic record systems might support the shared

care of older people. Subsequent projects took me into the evaluation of electronic

record systems and the development of standardised languages to support nursing

practice, which has remained my main area of informatics research ever since. I

was lucky to be able to study for a research master’s degree and a PhD at the

same time.

After around 10 years, I completed a ‘Return to Nursing Practice’ course to ensure

that I was still in touch with grassroots practice. Several research projects,

publications and PhD supervisions later, I was promoted at the University of Salford

to reader and then professor. I have also been an associate dean for around seven

years and was recently recruited to the School of Human and Health Sciences at

the University of Huddersfield.

What I do

As Associate Dean I am responsible for implementing the research and enterprise

strategy of the school. As a professor I teach informatics classes both in person and


online to nurses and other health professionals; I lead and participate in research

projects; write and publish articles and book chapters; and supervise master’s and

PhD students. I provide consultancy on informatics issues to organisations such as

the International Council of Nurses, and I act as Editor-in-Chief for the journal

Informatics for Health and Social Care. I am also a member of several national and

international technical standards bodies and thinktanks.

The best bits

While I miss some of the rewards that come from clinical practice, I feel incredibly

lucky in being able to work on initiatives that I truly believe will help to transform

nursing for the better and improve health. This is a long game with no quick fixes.

While I have been working on nursing informatics projects for around 25 years,

there have been many things to celebrate on the way. And the rewards can be

enormous: a penny dropping in class; the acceptance of a journal article for

publication; the approval of a grant application.

Perhaps the best part of my job is to be able to work, every day, with people I

respect and admire, on local, national and international projects that we know will

make a real difference. Universities are competitive places but as an academic

discipline, nursing informatics is known for being open, friendly and highly

collegiate.


Informatics is the future of nursing. Help to make it happen.


Roman Hausner, Floorwalker (Healthcare Support Worker and Informatics Trainer)

How I got the job

I was approached to become a trainer for a

digital system we were looking to roll out in the

organisation. I think she thought I was chatty

and had a good way of getting people on side.

My clinical lead told me I could do this role

very well and that helped my confidence.

What I do

I am working as a healthcare assistant and

was seconded to be trainer during roll out.

Since the successful roll out, I have stayed in

team as clinical support for almost two years. I

really enjoy the work and helping staff of all levels do their role to help patients. I

basically problem solve every day. It is nice that when staff see me they always

have a question for me.

Best bits

Being able to apply my experiences from working as a healthcare assistant to a

different field of work and enable colleagues across multidisciplinary teams to see

the benefits of new systems in relation to patient care.

My message for future healthcare assistants?

You can do it!


Sarah Judge, Allied Health Professional Digital Lead

How I got the job

I started work as a junior physiotherapist at West

Suffolk NHS Foundation Trust in 2000, and soon

progressed to clinical specialist in trauma and

orthopaedics. This specialty never stands still and

there were always pathways that needed

streamlining or new projects to work on. Throughout

this, I had been the unofficial tech adviser for our

department so when the option came up for a

secondment to the design and build of our trust-wide

EPR in October 2014, I was the logical choice.

I worked with our whole allied health professional (AHP) team during the

customisation of our EPR to fit our needs, promoting the needs of our staff in the

overall deployment plan. We went live in 2016 and since then I have been working

on major upgrades for AHPs in particular; ensuring we can use outcome measures

and the EPR data to influence our practice with patients.

What I do

I work with nursing, medical and pharmacy colleagues in an interdisciplinary clinical

team embedded in IT. My focus is on ensuring the EPR works for AHPs and the

wider workforce from a user design point of view, but I also make sure AHPs are at

the forefront of future developments. Many EPR suppliers are US based and so

adapting the EPR to the NHS is critical. Creating new content designed specifically

for UK AHPs has been a large part of my recent work.

The best bits

Knowing our AHPs are working with a system that has been designed with them,

for them. By nature, AHPs are problem solvers so it is a delight to work with a

forward-thinking, positive group of staff.

My message for future AHPs

Embrace change and innovate. The opportunities to use the power of digital

healthcare are endless so get involved.


Michelle McIntosh RN, Clinical Systems Designer

How I got the job

My journey into nursing began in 1994, when I migrated

from Trinidad and Tobago to the United Kingdom. From

London, my journey continued to Scotland and after

spending three happy years there, I qualified as a nurse.

In 1999, I got my first job at UCLH working at Queen

Square Hospital in the specialist field of neuroscience

and neurology nursing. Over the years, my career

steadily developed gaining clinical and leadership

experience as a deputy ward sister, clinical nurse

specialist for traumatic brain injuries (TBI) and Ward

Sister. UCLH became my work family and I was privileged to work alongside great

teams to provide high quality care to a variety of patients with diverse healthcare

needs.

In 2015 I was the Senior Nurse on the Special Project and in 2016 joined the

Exemplar Ward Programme and was the Quality Improvement Darzi Fellow for

Enhanced Therapeutic Care, also known as ‘specialing’. Being a Darzi Fellow and

part of the Exemplar Ward Programme team was one of the highlights of my career.

The Exemplar Ward Programme was an exciting opportunity to be productive and

maintain sustainable solutions in caring for patients and staff. The Darzi Fellowship

was an incredible journey of NHS systems thinking, co-production, enhanced self-

awareness, leadership development skills and increased confidence in change

management and quality improvement (QI). I gained a better appreciation and

understanding of how my organisation and systems within the NHS operate. I

developed deeper skills in resilience and empowering others.

Following completion of the Darzi Fellowship, I was equipped with a wealth of new

QI knowledge/skills and keen to find a role in which to continue developing my

professional development. I felt innovative and wanted a role to propel me out of my

comfort zone. It was important to me that this role contributed to improving patients

and staff experience. During my uncertainty about what was next, roles available to

me were either returning to my previous role as ward sister or becoming a matron,

but these roles did not resonate within me as ‘the job’ where I would be truly happy.

Finding myself at a crossroad, I discussed career options with my fellowship


supervisor who suggested the option of joining the digital team. I felt it was all ‘IT’

and thought ‘where is nursing in IT’? During this career dilemma, I visited and had

meaningful conversations with the representatives from the digital project about

becoming a clinical systems designer. The conversations resonated with me. My

curiosity was piqued. I felt this role would provide a unique opportunity to unite my

clinical experience with the future (digital transformation) and clinical informatics

nursing. The deadline to apply was that day, and despite doubts about my

capability of not being IT ‘suave’, I applied for the job, sat a bizarre exam on critical

analysis, interviewed and was successful.

What I do

My job title is Clinical Systems Designer for ASAP (Emergency Department [ED])

module. This means I am a ‘builder’. Not very nursing, is it? But this is a job title. In

essence, the purpose of my ‘builder’s role is to undertake process design, configure

or modify applications and adapt it to the working practices and standards agreed

by the trust at direction settings forums. I liaise a lot with the ED as we move from

paper to electronic documentation.

Meetings can be varied: I’m actively listening to what the team want, while at same

time furiously typing away to capture vital clinical content information to replicate

this into a completed Orion task in the system. Integrated areas include reporting,

printing, testing, training, data interfaces and business continuity planning. Testing

the system thoroughly is also a key component of a builder’s role. Testing ensures

the system is safe, usable, secure and robust and it works as expected.

As a nurse, I am in a prime position to provide answers to ambiguities in key clinical

practices, ensuring what I build is purposeful for end-users so that staff can be

liberated to have more time to lead and care for their patients, each other and

themselves. As a ‘builder’ I am also required to present patient workflows to be

validated and approved. It’s a great feeling knowing that I form part of a wider team

at UCLH, whose ultimate goal to develop a future state using one-system software

to eliminate waste, streamline processes, and improve patient care by allowing

clinicians/departments to access all relevant patient information in one place.

The best bits

There is no one ‘best bit’ for me: there are highs and lows. For example, highs for

me were passing all my exams; receiving my certification to be able to ‘build’;


making cups of teas/coffees or giving hugs to colleague at a low ebb; and arriving

to work and feeling exhilarated to be working alongside a terrific diverse skilled

team with professional leadership to help build a world-class digital architecture to

deliver the best service to our patients. A low can be feeling overwhelmed by the

number of blockers preventing me to complete a task for service benefit. In low

times, the best bit is the support I receive from my CNIO, colleagues and other

system management staff.

I enjoy engaging with my subject matter experts such as ED clinicians. I have

always been a ward nurse and never worked in ED. Varied staff interactions with

the ED team have enabled me to learn so much about how they work, and I truly

admire their resilience, their competence and the great culture of teamwork.

Listening to them speak passionately about the work they do, their challenges, their

high/lows have enabled me to have an understanding of the importance of the four

hour waiting targets; the workflow for patients with mental health issues and the

transitional assessment facility; breaching, etc. Another best bit is receiving a

‘thumbs up’ following a presentation. Thumbs up symbolises that the workflow will

be adopted. Hooray! And there is always a great sense of jubilation, smiles and

happiness from all involved. Why? Because it is a team effort and we all feel elated

that the build is complete, and I can move on to another.

Message for future digital/informatics nurse or AHP colleagues

I am part of a huge digital transformation project which will be going live in March

2019. Some nurses are passionate about direct frontline patient care and some, like

me, can be curious about digital nursing. My message is don’t be scared of the

unknown. Digital nursing is not only ‘IT’. It is a future career option where as a

nurse you can help shape clinical content into a system for the benefit of patients

and frontline staff. To do so, you still need to engage with key stakeholders and

work in the clinical environment. Maintain your visibility and availability. Digital

nursing can be the best of both worlds.

Be brave, as I was, and jump into the world of digital nursing informatics. It is

waiting for you.


Sam Neville, Digital Lead Nurse

How I got my job

I worked my way up the nursing grades to matron for

medicine/surgery and found there was more and more

paperwork for ward staff. So, when I heard about an e-

noting observation project being developed in the

trust, I applied for the clinical lead. I was also

approached by my Director of Nursing to see if I would

be interested in it. The role was originally a

secondment for the life of the project, which can be

daunting when you are substantive, but I knew I had a

role to return to if I did not like it.

The project ran smoothly and was everything I was looking for in relation to making

nursing documentation ‘paper-light’. The benefit of having a nurse working with the

IT department was also recognised by both the Director of IT and the Director of

Nursing, so they offered me the post on a substantive basis. Knowing that digital is

an ever-evolving world, I took this opportunity with both hands.

What I do

I currently have fingers in many pies via the clinical and IT routes. I am the clinical

liaison who translates IT language for clinical staff and vice versa. I also provide

advice around risks, patient experience and staff issues. Generally, my week would

involve ward visits to see that systems are still working as they should and on-the-

spot education for staff, governance and project board meetings, networking with

other sites and liaising with the nursing division and IT services.

The best bits

The best bits of my role are being able to see an overview of the digital

improvement agenda across the organisation and being able to share it with

staff. Also, to see that ‘light bulb’ moment when a member of staff suddenly

understands a system or process and believes in it.

My message for future nurses

Don’t give up on your aspirations!


Dr Natasha Phillips, Chief Nursing Information Officer

How I got the job

I am a nurse who has always taken an active role

in quality improvement, starting with small local

projects to improve care on the ward to larger

projects like leading the productivity ward

programme and implementing an EHR system. I

have always been interested in the human

response to change and this led to work to support

ward leaders and taking up learning opportunities

to become an organisational development

practitioner.

I explored these issues further through doctoral studies and a theory of ward

leadership around the need for leaders with the skills to lead in complexity.

I created a ward accreditation scheme that supports a shared understanding of

ward performance as well as local responses to local challenges. This required the

development of a complex dataset working with informatics colleagues. The path

has naturally led to this next step as Chief Nursing Information Officer at UCLH.

What I do

I am not a 'techie': I took up this role because of my drive to improve nursing

practice and I collaborate with techies to make this a reality. I bring together

colleagues in clinical practice and IT to develop the best possible EHR system to

improve patient outcomes and experience and staff experience and provide new

research opportunities. I work as part of a clinical leadership team that includes a

chief medical information officer and a chief research information officer. Our

combined experience and organisational knowledge enable us to provide the

necessary leadership and expertise to deliver the organisation’s ambitions.

I work closely with nursing colleagues in practice and education to develop and

implement a robust care-planning system with standardised terminology. This will

support nurses to give the best evidence-based care and, also, importantly, enable

them to generate evidence to improve patient care and demonstrate the unique

contribution of nursing.


I support a team of over 20 nurses and midwives working on our EHR system to

ensure that professional practice is at the heart of what we do and that together we

can shape and articulate their contribution to patient care and the profession.

The best bits…

… Working with clinical staff and seeing their delight when you show them the

workflows we have built with and for them. Often this means they see daily

problems of communication or duplication resolved and they can see the

opportunity for improved patient safety and their work life.

Nurses are central to the co-ordination of care, but they spend a lot of time chasing

information. I enjoy seeing how we will resolve this so that we have more

opportunities to do what we love most ‒ spending time with the patient.

What next

I want to stay here for a while as there is a lot of work to do. This includes:

• further developing our nursing practice intelligence and using the Exemplar

Ward Accreditation model with the patient-level data to further enable nurse

leadership and continuous quality improvement

• collaborating with our practice educators to redesign our practice

development so that we have a nursing workforce skilled for the digital age

• developing informatics opportunities for nurses, from apprentice nurse

informaticist to CNIO and professor of nursing informatics

• developing a research portfolio enabled by the standardised nursing

terminology we have embedded in our system

• improving population health through use of big data, to deliver the vision of

the nurses who established the profession to provide support not just for

the sick but also for people to live healthy lives.


I hope to use the informatics and digital technology and learning within health and

social care professions to inform how the wider profession approaches the

opportunities and challenges to improve patient and public outcomes.


Arran Rogers, Chief Nursing Information Officer

How I got the job

I began my nursing career at the Royal Berkshire

Hospital in 1998. Technology in healthcare has

always interested me and so I chose to work initially in

cardiac care. This allowed me to develop my interest

in developing patient pathways and using data and

systems to drive change. From there I moved into

different roles in project management, and as matron

and head of patient experience.

As Royal Berkshire was a ‘fast follower’ on the Global

Digital Exemplar (GDE) programme, the CNIO role

needed to be filled. Previously in my matron role I had chaired the bed view

subgroup, which was a project to design functionality into our existing EPR system.

It allowed ward-based teams to document practical patient information for the

patient journey and have a system-wide overview of patient flow. I was approached

by my Director of Nursing to take up this role as she believed it was the right fit for

my skillset.

What I do

As the CNIO I work across all directorates and clinical specialties providing

leadership and staff education in the development of clinical practice in relation to

the trust’s digital hospital strategy. This means taking a lead role in the

implementation of the EPR as it relates to clinical practice, while serving as a liaison

between the clinical and technical teams.

As the nursing and AHP lead the role supports and facilitates the design and

delivery of digital systems. We are implementing the clinical documentation and

electronic prescribing system in the next few months and the engagement of the

nursing and AHP teams has been critical in designing the system to meet our

needs. This also encompasses taking a leading role in formulating implementation

plans and ‘go live’ strategies, ensuring that patient care is not compromised by the

introduction of new ways of working.


Engagement is key in the role as the EPR system will change how all our teams will

practice. This means a lot of my time is spent with the clinical teams, understanding

each of their individual requirements and working with them to make sure they are

as efficient and effective with the system as they can be.

The best bits

CNIO is a new role in our trust. This makes the role very varied, with lots of new

projects but the main focus on the digital hospital programme. The most satisfying

part of my role is when nursing and AHP staff can co-design the EPR and are

actively involved in shaping how they will design their practice with the introduction

of the system. Already we are seeing the benefits of a digital system with our

pioneering work on sepsis red flags. Also, for me, the CNIO role has an emerging

community of passionate dedicated nurses who are amazing at sharing insights

and support for this field of nursing practice.


Data is a powerful tool for improving patient safety, outcomes and nursing practice.

Make use of it.


Keith Strahan, Social Worker and Council Member, Faculty of Clinical Informatics

How I got the job

In May 2018, I was elected to the Council by

faculty members who are predominantly doctors,

nurses, pharmacists and paramedics. It was a bit

of a surprise to be elected as I am at present the

only member of the faculty from social care.

However, it now gives me a great opportunity to

highlight the wide range of professionals that work

in this sector. Did you know the adult social care

workforce is larger than the NHS? It includes

approximately 1.25 million people working in the

independent care sector, eg care homes and

home care and includes over 40,000 nurses.

I am still a registered social worker with experience working in various community

teams, acute trusts, mental health trusts and primary care settings. I try never to

forget these experiences and the fantastic professionals I have worked with in my

career.

It was when I was working as a primary care social worker in a health centre that I

received an offer from health and care leads who wanted me to improve

information-sharing on a larger scale in the locality, using information technology.

Over time, I was then asked to do the same across London. One project I led

included the secure sharing of standardised information between 60 acute trusts

and local authorities, which was awarded a national award. More importantly, it

really seemed to improve the experience for everyone involved.

What I do

I now work in the Social Care Programme at NHS Digital. My main focus is

improving secure information-sharing with social care providers; such as care

homes and home care organisations. This is necessary because information-

sharing with social care providers often only happens by post or fax and

consequently is not safe and puts people at risk of coming to harm.


Early on I realised work was required to produce information governance and cyber

security guidance, tailored for the social care sector. We have now delivered this in

collaboration with care providers. The offer of NHSmail for social care providers is

also now in place. I instigated this years ago and it just shows that if you really

believe in something, it is worth persevering. This is just one system, of course, and

increasingly there will be opportunities to enable more digital solutions, working

alongside the social care sector.

I have represented social care at the Professional Record Standards Body (PRSB)

since it was formed. Recently, I have been highlighting the benefits of person-held

records called care/hospital ‘passports’ and ‘About me’ information. This led to a

presentation alongside the father of a man with profound learning disabilities at the

Royal College of Nursing. Through an app the father showed his son having

epileptic seizures and how his family comforted him. Showing this video to staff in

hospital helped staff to have a better idea how to care for his son. I have since

contributed to the development of the PRSB digital care and support standard and

made sure it included an ‘About me’ section.

The best bits

I really couldn’t pick, there have been so many….

My message for future health and social care professionals

The national priority for a more integrated health and care system demonstrates

what patients/citizens have assumed was already happening. Namely, ‘one system’

that puts a personalised service first, with health and social care working together.

Social care needs to be an equal partner for this vision to be realised.

Finally, my son has just started a paramedic science degree course. Before he left,

I spoke with him in general terms about how technology comes into this and he

said, “You can’t separate any of it, it’s what you need to do the job.” Summed it up

well, didn’t he? And then he showed me how to fix our printer.


Katie Tracey RN, Clinical System Designer

How I got the job

I saw the job advertised and thought it sounded

interesting. I researched the electronic system and

found out exactly what it was and what it would mean

for our hospitals. I work in the intensive care unit (ICU)

and some of the duplicate paperwork combined with

duplicate computer systems were really a stress,

particularly on discharging patients to the wards. I saw

immediately the benefits an integrated system would

give to us – it would streamline all our documentation

and our working processes, giving us more time to

actually look after the patients, rather than filling in the same set of observations on

four different pieces of paper.

I took the electronic system assessment test that the vendor company ask for to

enable you to work with the system in practice. This was mind-boggling, and I’m not

sure how I passed it, and then was invited for interview. I had to prepare a small

presentation about why I wanted the role of clinical systems designer, in which I

outlined the benefits of the system to both patients and staff. I chose to work with

theatres and anaesthetic teams as it was closer to what I do in my usual role. Then

I was offered the job!

What I do

This job is very different to anything I have done before. We do a lot of research

with the staff in the hospital to work out their current practices and workflows.

Where they are happy with how things presently work, we show them what the

electronic system will look like and try to replicate what works well. Where the staff

are frustrated with how things are working today, we try to work out a new workflow

and design that, and then take it back to them to review and evaluate.

On our team we are lucky; as most of us have a clinical background we quite often

design something after conferring among ourselves.


The best bits

The ‘building’ – it is really fun and satisfying to make something and see it working.

It’s also great when the system managers come and review it, and are really happy

with what you’ve made. Our pre-assessment nurses, in particular, are super excited

about getting started: that is a great feeling. Hopefully, once we iron out all the

teething problems, it will really make their working lives easier and give the patients

a great experience to start off on their surgical journey.

I have also really enjoyed learning about the hospital, as a whole, rather than just

my little area within critical care. I have learned so much about how the NHS works,

and all the interesting stuff that goes on behind the scenes, from clinical safety to

business and reporting.


It’s not like bedside nursing! Your background is really important: it helps you

connect to your specialists on a level that the system representatives and

administrative staff can’t, but it really is a change. The project environment is not

like finishing a shift and leaving work at work – email never goes away!


Jackie Whittle, Chief Clinical Information officer

How I got the job

I am a critical care nurse by background and

went into an operational management post in

1998. My career path has taken me into a

number of senior nursing roles, both

operational and corporate, over the past 10

years and I have led a number of trust-wide

change projects. This has allowed me to

build up a range of networks across many

clinical teams.

As Head of Nursing for Professional Practice, Standards and Patient Safety, I led

QI programmes focused on improving patient safety, outcomes and experience. In

this post I held the governance responsibility for nursing documentation and spent

many a frustrated hour thinking there has got to be a better way of doing this. Why

are we unable to accurately evaluate nursing interventions because we do not have

robust data?

I am fortunate to work in a large trust that recognised the level of transformational

change required to deliver the Five Year Forward View and therefore created a

senior post within the informatics team. I became Head of Nursing for Informatics in

July 2016, working alongside the CCIO. In December 2017 we restructured the

department and, again to reflect the transformational change agenda in relation to

digitalisation, as a team we agreed that we would have CCIOs to reflect different

portfolios: academic, innovation and research, medical, nursing and AHPs. As

CCIOs we have discrete portfolios but work across professional boundaries.

What I do

… Enhance care by using technology to improve safety, experience and outcomes

for patients and staff. As CCIOs we work on a local, city and regional basis to

ensure the patient remains at the centre of what we do and the clinical voice is

represented at every stage of decision-making, prioritising workstreams,

development and implementing new functionality.


I lead the implementation of new functionality that supports the EHR development

in our trust: I strive to ensure technology supports clinical teams to continue to

deliver safe and effective care, while releasing clinical time to do the things that only

they can do, using their skills and expertise appropriately.

I work with clinical and corporate teams to work through how we as a team are

going to deliver and be able to evidence delivery of all that is asked. This may be

linked to Commissioning for Quality and Innovation national goals (CQUINs),

national audit data or a ward-level quality improvement programme.

The best bits

… Working with our teams to develop something that makes a difference and

seeing it adopted and embedded across our organisation because staff want it

rather than because they feel it’s imposed on them.


Be brave, be ambitious and be change agents.


Llying Zing, RN, Systems Builder

How I got the job

I was very excited when I saw the electronic

systems transformation information on the intranet

for my organisation. I thought it could be an ideal

opportunity to improve my IT skills as a clinical

research nurse. I was very thrilled when I was

informed that I got the offer as a clinical systems

designer a few months later, but not aware of any

coming hardship until I got the training, then had

examinations to be certified.

At one point, I was thinking of giving-up and going back to nursing in which I

already have 30 years’ experience. Fortunately, I was encouraged by colleagues to

keep going and organisational leaders offered me unconditional support. I

eventually qualified and since then I have been able to build the new system.

People had faith in me.

What I do

I am a clinical systems designer in the cardiology team, responsible for

collaborating with the cardiology consultants and other clinical staff to translate their

needs into the electronic medical record procedural workflows for their areas. I

apply my new skills in daily clinical practice. I want to continue learning and

improving while I am working in this team and I offer support daily to all my clinical

colleagues in using the new systems.

The best bits

… Moving out of my comfort zone and loving it.

My message for future digital/informatics nurses or AHP colleagues

It is never too late to learn. Prepare well for new challenges. Ask for help when you

are stuck.

© NHS Improvement 2018 Publication code: SL 18/18

Contact us:

NHS Improvement Wellington House 133-155 Waterloo Road London SE1 8UG 0300 123 2257 [email protected] improvement.nhs.uk

@NHSImprovement

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