BLOG: Moving towards centre stage

2018 has only just started, but already it’s been quite a year for health informatics in Wales.


We’ve had a Welsh audit office report, a Parliamentary review with key recommendations relating to informatics, a data centre outage that affected both primary and secondary data centres and some unexpected outcomes to major procurements of digital systems.

All of this points to the central role that informatics (or digital) now plays in the delivery and running of health services. There is an increased reliance, greater expectations and competing priorities for the people who deliver IT services. However, it does seem we are at a tipping point with technology, culture, digital skills in the workforce and managerial focus aligning to make things happen in a way that we who have been at this for some time have longed for. This does mean that there are increased responsibilities and pressures that we will need to manage in different ways.

Here are some common themes that we can draw from the above events:

- Informatics can transform the delivery of healthcare;

- Sharing data between systems is required to maximise benefits;

- Increased reliance on IT systems;

- Change management skills are needed;

- Clinical leadership helps;

- Greater investment is required; and developments need to be prioritised.

I suspect that none of these themes are a shock to anyone interested in reading this article.

The Welsh Audit Office report and the parliamentary review have given us a real opportunity to be honest about the challenges and recognise how important informatics is. Indeed they recognise that we are not going to manage to face the demands on our health and care services without addressing the need to digitally transform services by giving our staff the information to do their jobs in new ways and giving our citizens the ability to engage digitally. Integrated care needs integrated information

As we achieve our ambitions and meet these requirements then our profession must develop to be - well - professional.

'One system unavailable in one department isn’t news, but all systems unavailable at the same time is.'

The move of GP IT systems from the surgery to the data centre is vital to provide the safeguards required against cyber attacks and to allow the data to be available for sharing with patients and other parts of the health and care service. However when problems occur (and they will) suddenly the profile and significance of the failure is multiplied. The recent network failure at the data centres hosting our systems proved this. The systems were unavailable for three hours but affected clinicians in every care setting. One system unavailable in one department isn’t news, but all systems unavailable at the same time is. So although total availability is much higher than the days when systems were unconnected and dispersed, the impact is now so much greater. This perversely is a measure of success albeit a very unwelcome one.

The need for communication has increased and diversified. There was a time you could expect the users to be familiar with the help desk and for the help desk to be aware of all the affected users, but now as we link systems and increase the user base that familiarity has gone and they are as likely to take to twitter to record their disappointment as to find out through “official” channels. It is also true that as users don’t experience downtime as frequently as they once did, they are rightly less tolerant of any unavailability and less practised in what to do when it happens. There is also a need to link the IT contingency plans to the major incident arrangements in our hospitals. There are lessons here for how we train, prepare and think about system design, both technical and organisational. We must address how we develop our people and make digital skills available for all, while also asking how we ensure that those activities that are underrated (service management, integration, service desk) get the investment they need.

We’ve wanted to be centre stage for sometime, and as we move in that direction new skills and thinking are required to make sure our performance is enjoyable both for the actors and the audience.

Andrew Griffiths

Chief Information Officer, NHS Wales

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