CIO Tracey Scotter has two icebergs in her Sheffield office. It is in fact a mild day in the Yorkshire city once famed for its steel foundries and now set to become a centre for carbon fibre production. Scotter is Director of ICT for the Sheffield Teaching Hospital, which comprises the largest single site hospital in Europe as well as four other major hospitals and community services. The vast site amongst the leafy streets in the south of the city combines gothic red brick Victorian grandeur with the latest architecture and a smattering of institutional 1960s and 70s concrete blocks.
The icebergs represent the twin challenges the Director of ICT has in her role. They are common challenges to any CIO and in particular to those in healthcare. Scotter uses the imagery to demonstrate the natural state of Sheffield Teaching Hospital ICT, she does not use the iceberg to infer that this is a healthcare cruise liner sailing towards fate.
The top of Scotter’s iceberg is the current demand – £18 million worth, which she says with typical frankness, includes the replacement of Theatre, Maternity and Laboratory systems. Like many NHS Trusts, Sheffield Teaching Hospital has a number of key systems approaching the end of working life and they range in scale from digital dictation systems to networks and all are essential.
“The requirements today are totally different and we have to make sure that we make the most of the opportunity,” Scotter says of ensuring new systems are not just replacements of like for like, but take the operation of the NHS trust forwards and improve patient care and efficiency. Scotter is adopting as-a-service based models at every opportunity.
The clinical user base is changing too, just as enterprise CIOs have to adapt, NHS technology leaders must provide for the changing methods of new doctors.
“Doctors want to do everything on one page and they want their systems to be intuitive and designed around the way they work, which is a big challenge for systems suppliers,” she says. Innovations in the consumer technology space are part of that demand and like a number of technology leaders in healthcare that Horizon has met, Scotter is interested in how technologies such as the Alexa voice operated technology from Amazon will revolutionise healthcare.
“At the moment you’ve still got this clunky device between the doctor and the patient,” she admits. As in any sector, the constant change in culture as a result of technology is a significant challenge for CIOs in large healthcare organisations. Scotter tells of how in a previous strategy her team installed 80 PC devices into bays in a ward, but the doctors were not used to working on a computer in front of the patient, so doctors continued to leave the bay and head to a central desk, away from the patient. The doctors had demanded the technology, but were not aware of how it would impact their interaction with patients.
“One size doesn’t fit all, it is very different treating a patient in an acute ward,” she says. As a result Scotter is on her third strategy at the Trust she joined in 2012, the doctors and trusts find their needs changing all the time. All, whether technologist or clinician, are dealing with these changes against the backdrop of rapidly rising demand and constrained finances.
“Improving the clinical experience is really important so that it becomes seamless and subsequently the interactions with the patient are enhanced,” Scotter says. The CIO has 288 clinical systems to support with the Lorenzo patient records system being the largest. To simplify and improve the clinical experience Scotter is leading the development of a portal that will bring that 288 tools together. Portals may sound a like a step backwards, it was a term that was all the rage in 2001 to 2002 amongst information management providers, but Scotter is dealing with the hard realities in today’s NHS.
“The portal will save on integration costs and will have a customised view for clinical commissioning groups (CCG) and staff at the trust. We are also working with Sheffield University to improve the human-computer interface on the user experience,” she says.
“Going from financial services to the NHS you realise the supply side is small and there are small specialist firms that have never considered scale,” she says of why a portal will save on integration costs. The portal is being developed by Orion Health, who’ve had considerable success in Northern Ireland,” Scotter says.
The Wachter review into the NHS care systems and its processes highlighted the need for the NHS to become paperless, but said the government’s deadline of 2020 was unrealistic. Talking to Scotter you get the feeling that this is an accurate summary by Dr Robert Wachter. “We are still generating plenty of paper and turning us into a paperless organisation is a journey,” she says.
Cutting paper usage is important, but Sheffield is also looking at using information to better optimise the running of the hospital. “We are starting to look at the Accident and Emergency department and are using BI tools, so now we can predict the number of patients to be admitted and discharged. Resource and asset management are being added in too, as in a way we are like a hotel with 1000 beds so we need a greater use and knowledge of workflow.
Sheffield Teaching Hospital is one of the NHS Test Beds, announced by the NHS Chief Executive Simon Stevens in March 2015 as part of a plan to create greater innovation in the NHS. Scooter welcomes innovation, but is typically honest about the scale of what can be achieved.
“The idea is that big technology companies get involved with problems the NHS wants to solve, although they need to provide their services for free. We are trialling wearable devices such as those that monitor a patient and can detect if they are likely to fall and we are collecting data that Sheffield University evaluate,” Scotter explains. Sheffield is working with GE Healthcare and IBM. The challenge is that technology companies can only do so much for free and the Government funding for test beds goes to the NHS and not the vendors, rightly so many will say, but vendors have revenue targets.
“We are very much part of Sheffield city,” Scotter says. “The local authority and us are the biggest employers, we employ 16,000 people, so we are part of the community and that impacts how we operate.” There are significant benefits in being closely woven into the culture of a community, but if that community has not been at the forefront of technology change, it can have drawbacks. Across the Peak District Manchester has successfully carved out a reputation as a technology hub in the UK and beyond, Leeds is fast developing into a tech city. Sheffield finds itself in need of technology skills but struggling to compete with the powerhouses of Leeds and Manchester.
“If I were starting my career I would work in Leeds or Manchester,” Scotter says empathising with the needs of the talent she’d like to employ. “It is difficult to recruit to Sheffield, especially at a senior level, I have one senior leader who is local and two from Manchester and as an employee you have to be prepared to do that journey every day,” she says. Investment in transport infrastructure has not kept pace with the return to competitiveness of the cities in the North and local travellers will tell you of horrific rail services and chronic road congestion.
Sheffield Teaching Hospital has both a highly local focus and a national vision, it is the number two hospital in the UK for spinal treatments, one of the UK’s most important cancer hospitals and as a result offers a wide range of treatments beyond the city.
“As a teaching hospital we have a constant flow of junior doctors and we also run a lot of community services from here. That allows us to do joined up treatment pathways for illnesses like diabetes and strokes,” Scotter says. In two sentences she has encapsulated the challenges of the NHS today, the fate of junior doctors who are disrespected by the current Conservative government and the rising illnesses of our sedentary nation that fails to provide for an active lifestyle.
Active lifestyle is not a challenge to Scotter, finding the time is, but the ICT Director says she schedules in some exercise every day just as you do a supplier or team meeting.