Getting clinicians and IT talking to each other

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Picture: Chair of the eSPACE programme clinical authority Ian Martin.

eHealthNews.nz editor Rebecca McBeth

Ian Martin is chair of the eSPACE programme clinical authority, which has worked to implement the Midland Clinical Portal. 

Eighty per cent of Ian Martin’s job is “ensuring clinicians and IT people are talking to each other about what they are doing”.

He is chair of the eSPACE programme clinical authority, a group made up of clinical representatives from the five Midland-region DHBs: Bay of Plenty, Lakes, Hauora Tairāwhiti, Taranaki and Waikato.

The programme delivered the Midland Clinical Portal in July 2017 as a read-only portal of patient information and is now working on an interactive read-write version that will replace each of the boards’ clinical workstations.

All clinical questions relating to its development, such as ‘what privacy settings to default to?’ and ‘should documents ever be hidden for medical reasons?’ come through the clinical authority.

This means that where clinical decisions have to be made, it is clinicians making them – but they also need to understand the impact of those decisions from a technical perspective.

“Part of the role of the clinical authority is to ensure you don’t have one DHB overriding the others, so we’re trying to get clinical consensus around what’s important for patients,” says Martin.

“If we’re treating patients more poorly in one area than another because of the systems we’ve set up it will fail, so we need to have consensus across the region.”

A regional approach

The eSPACE programme has three authorities – clinical, technical and operational – which have meetings every few months. These are also attended by the chairs of the other authorities as observers.

This equates to a lot of meetings for Martin, but on a big project such as this, he knows it is important to ensure everyone is moving forward together.

“We do have to take the whole region along with us,” says Martin.

“We can’t deliver this as just a clinical or an IT project – we have to get the two groups talking to each other,” says Martin.

“The last thing we want is decisions from clinicians about what the IT needs to do without understanding the implications of that.”

Where there is disagreement, Martin’s job is to help the clinical authority find a way forward. This sometimes involves robust debate, as each DHB has different priorities for their IT and replacing what they have with a regional platform may mean losing functionality in some areas.

“It’s a juggling exercise and it’s a challenge, but most of the time we manage to get to a consensus fairly easily,” he explains.

Martin says getting a baseline portal live in six months from the start of the project was a great achievement and means people have something to look at and comment on, rather than just “arguing about words on the page”.

The journey

Martin wants to see health become a ‘smart system’, where a computer can do simple tasks like collating disparate pieces of patient information while the clinicians stay focused on the big decision making, because “medicine is getting more and more complicated as time goes by”.

His day job is clinical director, emergency at Waikato DHB and he has always been interested in getting some objective metrics about what the health system is doing, particularly in the emergency department.

“It’s a very chaotic environment and we tend to just wing it for a lot of stuff, but having some metrics around what we are doing is really important,” he says.

When he first moved to Waikato DHB he got the job of “doing the IT stuff for the ED”, then became a member of the clinical users reference group which sits down with the IT team once a month.

This “snowballed into being involved in the strategic oversight group”, catching the attention of the eSPACE programme, which asked him to get involved in late 2016.

He initially relied on his non-clinical time to work on the project, but as chair of the clinical authority he has been paid for 10 hours per week since the middle of last year.

A self-described “hobbyist”, he installed Linux on his computer in 2008 and has been “fooling around with it” ever since. He taught himself to programme and has developed some programmes for personal use.

“Computers are like medicine. None of it is particularly complicated, there’s just a lot to learn,” he says.

“But it’s really important that I don’t try to tell the IT people how to do their job, in the same way that I don’t like people coming up and saying they googled something and this is what we need to do.

“The need for clinicians in the IT space is not for clinicians who programme, but people who can look back and see the big picture and say ‘this is where we need to get to and this is how we need to get there’.”

Read more in the Clinicians in Digital Health series:

Rebecca George: Raising the profile of allied health

Andrew Miller: A personal perspective on patient-centred care

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