Talking Tech with William Edwards of NHS Greater Glasgow & Clyde

William Edwards, the director of eHealth at NHS Greater Glasgow and Clyde, won the Digital Leader Award at the Holyrood Connect Digital Health and Care Awards 2019; which have been established to celebrate excellence and innovation in the growing digital health and care sector in Scotland.

Since joining the NHS board in late 2016, he has led the development of an ambitious digital strategy to make health and care services ‘digital as usual’.

However, he argues that if health tech projects are to succeed, they must be inspired and led by clinicians, and his award was made for “hugely strengthening” clinical eHealth leadership at the board, as well as his work on the strategy, regional and national developments.

InterSystems caught up with him to find out more; and started by asking about the role of TrakCare at NHS Greater Glasgow and Clyde, which serves 1.14 million people, employs 39,000 staff and has an annual budget of £3.1 billion. It was one of the first five boards in Scotland to contract for the patient management system almost a decade ago.

Q: NHS Greater Glasgow and Clyde’s digital strategy says TrakCare is a “cornerstone” system. Why is TrakCare so important to your health board?

A: “TrakCare is fundamental to this organisation. It is how we manage waiting times and appointments and patient flow. Before it was introduced, we had bed managers running around looking for beds, but with TrakCare we have real time views that enable people to make decisions based on real time data.

“Our order communications and results reporting are also delivered through TrakCare. And we have done some innovative things with it, such as weekend handover. This was suggested by a junior clinician. It identifies the sickest patients, who need to be seen first, at the weekend, when there are potentially fewer staff on duty.

“InterSystems worked with us to develop that; but it was our clinical engagement model that generated the idea. That is my mantra: you have to be willing to engage with clinicians and to listen to what they want.”

Q: How have you embedded clinical IT leadership into NHS Greater Glasgow and Clyde?

A: “This is one of the largest healthcare providers in Europe, and we also provide tertiary and specialist care to other NHS Boards. The only way to make sure that change happens in an organisation this big is to make sure it is clinically supported.

“We have put in place a comprehensive clinical leadership model, reporting to myself and the medical director. Instead of a single chief clinical information officer, we have a number of people from different disciplines working two to four sessions per week in clinical IT leadership roles.

“We also have clinical links. We have 250 professionals who link-in and help on various IT and technology projects: for example, we ran sessions with them to develop the digital strategy. All these people play into different governance groups including providing informal feedback, from medicine to nursing and general practice.”

Q: You just mentioned the digital strategy, what does it say?

A: “We developed the IT strategy to focus on five areas: building a fully shareable health and care record; supporting self-care and remote-care; using our data, machine learning and IT to enhance safety and quality; and then workforce and business systems and IT infrastructure.

“For each of those headings, we have peppered the strategy with things that clinicians hold near and dear. For example, on health and care records, we have been focused on joining up information, not just across our six health and social care partnerships, but from beyond the board’s boundaries as well.”

Q: Why such a big focus on a fully shareable health and care record?

A: “What people want now is the ability to view data held about a patient regardless of historical physical place of treatment and to contribute to the record. The big message coming from clinical staff is that it should not matter what organisational set-up they are working in; they should be able to pass the baton of information about a patient onto the next professional who needs to care for them.

“For example, there are many people living with chest conditions [COPD] in our community. We have developed the sharing of data that set out what should happen in a crisis. So, if they come into A&E, we might not have to admit, because we can get their GP or specialist to help.”

Q: When the digital strategy was launched, press and public communications really focused on what it might mean for self-care and remote-care. Why was that?

A: “The days are gone when people were willing to be processed through healthcare pathways: to get an appointment letter and come in when it said. So, we wanted to embed remote consultation in the strategy to support services to be more responsive to the needs of our patients.

“We also wanted to make sure that people can manage their own conditions as much as possible. These days, most people own a smartphone, and fitness and health apps are popular, so the bar is set quite high in terms of what the ‘computer in the pocket’ can do. So, we need to make sure we are using digital technology to support people’s desire to be active participants in their care.”

Q: What does the IT look like to do all this?

A: “TrakCare and our clinical portal are important parts of our stack. But we are looking to work with any organisation and with any device. To do that, we need to detail the data landscape, so we can engage with SMEs, and they can connect into what systems we have. Clearly security of data is paramount.

“NHS Greater Glasgow and Clyde has been active in working with a number of partners in providing interfaces, and that work is now being further refined by NHS Scotland, to create the digital platform described in the latest eHealth strategy for Scotland. That will change healthcare in the future, by creating a disruptive but positive environment.”