Mike Fisher has seen his chief clinical information officer role at Royal Liverpool and Broadgreen University Hospitals NHS Trust expand from engaging clinicians in IT projects to helping to plan an EPR deployment, win a global digital exemplar bid, and underpin a new model of health and social care with technology. He talks to Lyn Whitfield.

Mike Fisher was one of the first wave of chief clinical information officers to be appointed by NHS trusts. The consultant cardiologist jokes that he almost fell into the role five years ago, after acting as the clinical lead for a project to embed order communications across his organisation.

“After that I became the de facto person that people came to if they had an issue with their IT. I didn’t have a focused role or protected time, it was just something that happened,” he says. “So when the CCIO idea was floated, I was very supportive of it. And since nobody else was remotely interested, it fell to me.”

Pioneering the CCIO role
The CCIO concept was based on the chief medical information officer role created by US healthcare providers as they started to introduce electronic medical records. The idea was that the CMIO could act as a ‘bridge’ between IT teams and clinicians, making technology deployments more likely to succeed.

Engagement was certainly an early focus of Fisher’s work at Royal Liverpool and Broadgreen University Hospitals NHS Trust. In an interview with digitalhealth.net in 2013, he said his “single most important task” was to “talk to colleagues, both in formal and informal settings” to get their buy-in to projects.

Critically, these included a shift towards paperless working ahead of a move to a new, £425 million part-PFI funded hospital with no medical record store.

Since then, though, Fisher’s role has become “much more formal and wider”; taking in the trust’s digital strategy and its new role as a global digital exemplar. “I now report formally to the IT director, and talk regularly to members of the board,” he says.

“I was very involved in the selection of our electronic patient record, and with our GDE submission. We want to promote a wider vision of what IT can do in healthcare. The GDE submission is not just about the Royal; we want to promote innovation and integration across the Cheshire and Merseyside health economy.”

From best of breed to InterSystems EPR
When Fisher started his CCIO role, Royal Liverpool and Broadgreen was following a ‘best of breed’ strategy for creating an EPR. In other words, it was looking to retain its existing IT systems and then add to them; pulling everything together through a portal to provide a front-end for clinicians.

In November 2014, however, the trust joined two others in Liverpool to issue a joint tender for an integrated electronic patient record system, worth up to £70 million. In March, it was announced that InterSystems [a Highland Marketing client] had won the bid; although the paperwork is still being sorted out.

Fisher says this was a change of tack. “From an informatics point of view, we were more and more sold on the idea that while an EPR was great for not moving piles of paper around, and for giving people access to notes, that’s not where the real benefit lies,” he says.

“Instead, we came to realise that the real benefit lies in clinical decision support. And to do that properly you need your decision support system to have access to all of your other systems; not just the patient administration system, or the imaging, or the results… And we realised it was just going to be too hard to do that using a best of breed approach.”

Integration, integration, integration
Introducing the new system will not be easy. The ambitious project to build a new Liverpool Health Campus has been delayed, and the Royal will not move into its new buildings until next summer.

That’s partly because of construction delays – a large amount of asbestos was found on site and had to be removed – and partly because the trust does not want to move when the buildings are ready in mid-winter, when NHS services are traditionally under pressure.

Even so, the trust will need to move before it implements its new EPR. “It’s still a paperless hospital, so there are no medical records, and we will be using all the systems we have deployed over the past three or four years,” Fisher says.

“It would be an exaggeration to say that we are totally paperless at the moment, but we are an awful lot closer than most hospitals in the UK. Then, we will need to deploy a new IT system. So, we will be telling people: ‘All those systems that you have just got used to using? Well, they are going away again, and there is going to be something new.’” He pauses. “I am going to be so popular.”

Still, Fisher is convinced the change will be worth it. “To slightly misquote Tony Blair, [the benefits will be] integration, integration, integration,” he says. “It’s not just the decision support.

“We have written into the contract that on day one we will have bi-directional link into Emis Web [the system used by GPs in Liverpool] and LiquidLogic [the system used by staff working in community services].

“However, we want to develop a real relationship with InterSystems, to secure genuine interoperability, not just with health and social care but, eventually, with other services, like schools or the police.”

Expanding Healthy Liverpool
Liverpool has already done a lot of work on joint working. In 2013, the city’s mayor launched a health commission to produce a ‘vision’ for an integrated health and social care system for the city, with more opportunities for people to look after themselves and a bigger focus on preventing illness.

This has been taken forward by the Healthy Liverpool programme and, since July 2015, an agreement to create a ‘single-service, city-wide’ delivery model, focused on the medical campus.

Similar ideas have now been embedded into the Cheshire and Merseyside sustainability and transformation plan; the region’s proposals for taking forward the Five Year Forward View’s ideas to save the NHS as a whole £30-billion by 2020-21.

Local IT leaders have said that the Royal’s bid to become a global digital exemplar was designed to support this work.

The GDE programme was launched following Professor Robert Wachter’s review of NHS IT last year, and will see 12 acute and seven mental health trusts funded to implement new IT systems and spread best-practice to ‘fast followers.’

But at eHealth Week in Olympia this year, David Walliker, the chief information officer at Royal Liverpool and Liverpool Women’s Hospital NHS Foundation Trust, said it was keen to explore ideas such as shifting work from outpatients to digital channels and making more use of telehealth.

“The money [the acute GDEs have been promised £10 million of central funding] is for the local health economy,” he said. “The GDEs may look acute focused, but in Liverpool the Royal is just where the money sits.”

Innovating for health in the 21st century
Fisher absolutely agrees with all of this. He says the GDE bid had two streams, one of which was innovation. The trust is looking to contribute to the new NHS Digital Academy that is being set up to train a new generation of health IT leaders.

It is also looking to work closely with both the University of Liverpool and the cluster of research and life sciences organisations are being gathered into Knowledge Quarter Liverpool, or KQ Liverpool, around the hospital campus.

The other stream is that wider healthcare economy piece, which Fisher says is now vital to the future of the health service. “The Cheshire and Merseyside STP borrows heavily from Healthy Liverpool, which recognised that if you want to do something about health, rather than illness, you cannot do it from a hospital,” he says.

“People have finally stopped pretending that we can continue with an 18th century model, in which quite young people get ill, and come into hospital, and leave again, and apply it to the 21st century world, in which much older people live with multiple conditions, often for a long time.

“To look after them, we have to do things differently. We have to get to them before they get ill, and end up in hospital, or work out how to look after them once that has happened, without it happening again.

“So we are moving towards a more integrated system with primary and community care; and perhaps an ACO [accountable care organisation, in which an area is given funding to provide services for its population]. The GDE will aim to support all of that.”

Royal progress
All of this sounds like a far cry from getting involved with an order communications project, or even trying to ‘translate’ IT projects for clinicians or clinical demands for IT engineers. Fisher agrees: but clearly relishes the CCIO role he has done so much to develop.

“I am proud of what we have achieved at the Royal,” he says. “We have built systems over the past three or four years and got them working. We are going to take a big step forward with the EPR. But the big picture is that you cannot just be proud of a hospital; to look at health, we need to look beyond hospitals.”

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