Clinical informaticians key to digitised health service

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Picture: Sydney Local Health District chief medical information officer Angus Ritchie

eHealthNews.nz editor Rebecca McBeth

eHealthNews.nz editor Rebecca McBeth visited Sydney Local Health District in June and reports back on how the district is building a network of clinical informatics leaders to drive and lead digital health projects. 

The district

Sydney Local Health District believes that clinical informaticians are integral to support and sustain a highly digitised health service.

The district operates a clinically led governance model, and in order to make this work they need people to serve as the bridge between ICT services and clinical staff.

Back in 2014 it established a health informatics unit, bringing together executive leaders in clinical informatics into a team to work more closely with ICT services.

The unit includes a chief medical information officer, chief nursing and midwifery information officer, chief pharmacy information officer and a chief allied health information officer.

CMIO Angus Ritchie says this allows clinicians to take a lead role in governance over the clinical information systems they use. 

“One of the most important aspects of this structure is that we function like a multidisciplinary team,” he tells eHealthNews.nz.

“As far as we are aware, there is no other health service in Australia that has a similar unit or has invested as much in health informatics.”  

Each of the major hospitals also has a multidisciplinary health informatics team, which helps to manage and support the clinical information systems day to day and coordinate activity across the health district.

“Following implementation of electronic medication management hospital wide at Concord Repatriation General Hospital in 2015, we also realised that to support and sustain a highly digitised health service we needed a new team of clinical informaticians at the facility level that could serve as the bridge between ICT services and the clinical staff,” Ritchie explains.

SLHD believes that from a strategy point of view, this approach retains deep expertise in the organisation and is more sustainable as it moves from a project (CAPEX) funding cycle to an operating expenditure model.

“We have expanded this principle to now recruit key project clinical leads as either permanent appointments or on terms that run well beyond the implementation dates, as we have found that their knowledge and skills are as important or more important after go-live for continuous improvement and optimisation of clinical information systems,” he says.

The hospital

The SLHD model of multidisciplinary health informatics teams was pioneered and refined before being applied to Royal Prince Alfred Hospital after it went live with electronic medication management in 2017.

The hospital first went live with some of its Cerner electronic medical record more than 25 years ago and the hospital’s chief information officer, Richard Taggart, says clinical informatics roles started to grow organically from there.

More recently, the hospital has made a sustained investment in the clinical informatics team and now has a number of CXIO positions filled by medics, allied health, pharmacists and nursing to drive change management.

As technology moves on, the hospital is investing in projects involving telehealth, robotic process automation, mobility and self-check-in kiosks, and the CXIOs have become an invaluable resource to pull from, he explains.

RPA associate chief nursing and midwifery information officer Tat Garwood says these clinical informatics roles ensure that any digital solutions built or deployed work with clinical workflows.

“They have a foot in the EMR and the change management clinical perspective; having a person on the ground who understands both sides of it is invaluable,” she says.

They are also able to clinically prioritise work for the IT department, helping to ensure better patient outcomes are always the primary focus. The team’s biggest problem has become that the users are now constantly asking to do more electronically.

Despite the sustained investment and support for clinical informatics roles, Garwood says there is still no clear pathway to move into them. Mostly, clinicians are trained to become superusers or trainers of a new system and progress from there through internal pathways, she explains.

The state

NSW Health employs about 30 CXIOs across the state’s public hospitals and health facilities. eHealth NSW is responsible for overseeing the state-wide digital health strategy.

eHealth NSW chief clinical information officer and executive director clinical engagement and patient safety Mark Simpson says CXIO roles have expanded over the past six months, recognising the role digital health plays in delivering improved patient care.

NSW Health support is encouraging the creation of these positions through the CXIO executive leadership group.

“[This] will provide an opportunity for CXIOs to not only network, but also to provide strategic advice on digital health strategy, policy, safety and quality, programmes and projects, informatics and data analytics.

“It is envisaged that the group will foster sharing of information and experiences in an open and supportive environment – especially where exemplary systems and/or services have been developed locally in any of the districts or networks around NSW Health.”

He says another key role for eHealth NSW is to support individuals.

“Many of the clinicians who are CXIOs are already in senior clinical roles and have expertise in digital health. CXIOs need a broad range of skills and knowledge, encompassing strategy, policy, quality and safety, clinical informatics, data analytics, research and leadership. Additional support and training will support these roles into the future and help ensure a career path.”

Simpson sees CXIO roles as key to human-centred design, which emphasises the importance of understanding the needs of the end user – both prior to and during design of the systems.

“CXIOs and similar-type roles provide clinical leadership in digital health – they were created to act as a champion for the healthcare workforce, to ensure that technology solutions that are being delivered in to clinical settings will meet the needs of clinicians and support safe, high-quality health care for patients and consumers.

“In effect, they enable human-centred design at an organisational and strategic level by identifying end-user priorities across their organisation.”

The benefits

Ritchie says that while the direct benefits of SLHD’s approach are difficult to measure, the key outcome is that the health district has adequate staff to sustain and support a highly digitised health service, while having capacity for continuous improvement and optimisation.

The development of the unit has allowed SLHD to support development and implementation of increasingly complex applications such as cardiovascular diagnostics and medical oncology with minimal support from external parties, he says.

It has also increased their research output and led to the creation of a medical informatics department with an accredited training position in medical informatics.

“Clinical informatics is an integral part of clinical governance, business continuity, incident management and safety and quality activities,” Ritchie says.

“It has led to improvement in clinical engagement and education and training in use of the electronic medical record, including the implementation of an advanced training environment and smart room to simulate and train in the use of technology in clinical care.”

Ritchie says the creation of the unit has also had external benefits in that the district is able to take a leading role in advocacy for health informatics nationally and internationally.

If you would like to provide feedback on the above feature article please contact the editor Rebecca McBeth.

Read more features:

Karen Blake CiLN: Workforce development crucial for future of clinical informatics

Ryman’s inhouse approach to technology

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