The Royal Free London NHS Foundation Trust  is a London NHS foundation trust comprising of the Royal Free Hospital, Barnet Hospital, Chase Farm Hospital, as well as clinics run by the trust at Edgware Community Hospital, Finchley Memorial Hospital and North Middlesex University Hospital.

In July 2014 the Barnet and Chase Farm Hospitals NHS Trust was acquired by Royal Free London NHS Foundation Trust, making it one of the largest Trusts in the UK, employing more than 9,000 staff and providing services to nearly a million patients.

Will Smart is Director of Information Management and Technology

When did you start your current role?
August 2010

What is your reporting line?
Chief Executive Officer

Do you meet with and discuss business strategy with the CEO every week?

Are you a member of the board of directors?

What other executive boards do you sit on?
Trust Executive Committee, Patient and Staff Experience Committee, Clinical Performance Committee, Finance and Performance Committee

Does your organisation have a CDO?

What non-technology responsibilities do you have in the organisation?
Corporate Governance responsibilities as part of Executive Team, Reporting and Analytics, Performance Management

How many employees does your organisation have?
Circa 10,000

What number of users does your department supply services to?
Circa 10,000. The Directorate's services underpin the delivery of clinical service, research and teaching across thirty clinical sites in North London, Central London and Hertfordshire and support the delivery of more than 1.5 million care episodes per annum.  

How do you ensure that you have a good understanding of your business and how your customers use your business's products?
As a member of the Trust Board and Executive Committee I have a good view of the strategic and operational issues facing the organisation and have the opportunity to engage in a senior level dialogue as to how informatics services can support the needs of the business – clinically and operationally.

My directorate is present at key business meetings from corporate, through clinical divisions to local service lines, which again provides an opportunity to engage with the organisation at all levels.  We also operate specific ‘user group’ meetings, including a Clinical Advisory Group, Operational User Groups and System Manager forums.  These provide the ability to share the forward work programme and progress against key milestones, and the ability to gain insight into user issues and requirements for new developments/enhancements. Junior Doctors are often the best source of intelligence of what is happening ‘on the ground, and we meet with representatives of this group monthly to address informatics issues impacting their ability to deliver care.  We have recently appointed a Chief Clinical Information Officer (and an equivalent nursing post is about to be recruited to), who will lead a Clinical Design Authority within the organisation. This group will review all proposed developments and changes to ensure that these deliver real improvements to services for users and ultimately patients. Where we have implemented patient-facing technology, for example check-in kiosks, we have run specific sessions with patients and carers to discuss the impact of these changes on them.

Technology strategy & spending

Describe a disruptive measure you’ve led or played a major part in?
The aim of the EDRM Programme is to help create a high quality, safe and efficient healthcare service by transforming the way patients' information is accessed, collected and used. The EDRM system will replace paper medical records with scanned, electronic records that are accurate, complete and accessible across the whole trust. This will support improved clinical care and patient experience.  Based on the OpenText Content Server platform the system enables clinicians to access digital copies of the legacy patient case notes and filed and indexed day forward notes and documentation in any Trust location.  We have also engaged a scanning partner to deal with the 750,000 legacy sets of case notes on the Royal Free site.  Since the system went live, over 220000 patient notes have been uploaded onto the system, and on a weekly basis approximately 150000 pages of new documentation is scanned and uploaded as well as approximately 10000 set of historic case notes.  The next stage of the programme will see the platform extended to Barnet and Chase Farm Hospitals, and the extension of the functionality to include higher capabilities such as text analytics, semantic search and navigation of the case notes.

What major transformation project has been recently completed, or is underway at your organisation?
In July 2014 the Royal Free London NHS Foundation Trust acquired Barnet and Chase Farm Hospitals to create one of the largest NHS Foundation trusts in the country.  In addition to the usual integration projects that one would expect following a transaction of this nature, the Trust is, working closely with partner organisations in primary and community care, undertaking a major programme of clinical pathway redesign.  Responsibility for the redesign of these pathways has been delegated to the clinical services themselves and their objective is to develop and deliver transformed clinical services built around the needs of patients.  Informatics services will underpin the delivery of this transformation through the delivery of IT platforms that enable key clinical data to be shared securely and efficiently with care providers across all parts of the care pathway regardless of where care is delivered, whether in a hospital, in a GP surgery or in the patient’s home.

What impact will the above transformation have on your organisation?
The vision for service transformation is to achieve meaningful and complete integration of the clinical services provided by the new organisation. This integration will involve radical service redesign with shared and consistent service delivery across the new merged organisation, serving the total patient population. The service will provide leadership for healthcare across the entire system of care including the delivery top decile performance, developing innovative, comprehensive pathways utilising new technologies to enable better demand management and delivery of care closer to home.

What key technologies do you consider enable transformation?
The key challenges facing the NHS over the coming years will require organisations to be able to seamlessly and securely share clinical data across organisational boundaries.  In this context, the deployment of Healthcare Information Exchanges to manage the availability of data will be critical.  

Are you increasing the number of cloud applications or infrastructure in use at your organisation?

What is your information and data analytics vision for the organisation?
Information and Data Analytics is a key strand of the Trust's IM&T Strategy.  Over the past years we have invested in data warehousing and business intelligence capacity and capabilities having deployed Business Objects as the core BI platform in the Trust.  We have also automated a number of the standard and routine reporting tasks within the organisation, as well as undertaking some advanced analytics projects.  For example, as part of the design work for our Accident and Emergency Department redevelopment we commissioned and developed a comprehensive simulation model to enable us to understand the impact of changes in demand and workflow within the department.  We have since extended this to a hospital-wide demand and capacity model.  The next stage of our strategy is to use 'Big Data' analytic approaches to combined patient reported outcome data, clinical safety and avoidable harm data and financial reporting in order to achieve the transparent reporting of quality, value and clinical safety and increase the availability of real-time alerting of clinical risk events.

How is mobile and social networking impacting operations and customer experience?
From an employee perspective our biggest challenge is providing a common experience of our systems and services across all venues of care, whether these are owned by the Trust or not.  Part of this will enabling the delivery of clinical services to mobile devices that can be used at the patient's side.  Over the coming few years we will see the integration of specific clinical apps and wearable technologies into the clinical pathways which will require the interoperability of data between an individual clinical apps and our core clinical systems.  Finally, as a newly enlarged organisations a key challenge will be the deployment of social tools internally to support collaboration and cross-site working.

Describe your strategic vision towards shadow IT and BYOD. How do you influence and engage executives and employees around choice?
Due to the sensitivity of the data held on our systems we do not allow non-Trust owned devices or systems to connect to our core clinical networks and systems.  We do allow staff to connect their devices to our network to access internet services, and the next step will be to look at enabling access to some services on our core network.

What strategic technology deals have been struck and with whom?
In June 2014 we were the first Trust to exit the National Programme for IT.  As part of that process we signed a 10 year deal with Cerner for Electronic Patient Records services which will form the core clinical platform for the Trust moving forward.

We have signed a partnership agreement with OpenText as part of the development of our EDRM system and UNoify for Unified Communication services.

Who are your main suppliers?
Cerner for EPR services
SAP for Business Intelligence
Unify for Unified Communications
HP for servers and storage

Has your organisation detected a cyber intrusion in the last 12 months?

Has cyber-security risen up your management agenda?

Does your organisation understand the potential cyber-security threats it faces?

Has this led to an increase in your security budget?

What is the IT budget?
Circa £16m per annum revenue and capital on an ongoing basis

How much is the IT operational spend compared to the revenue as a percentage?

What is the strategic aim of the CIO and IT operations for the next financial year?
The strategic aim over the next 12 months is to continue to execute the Integration and Clinical Informatics (Electronic Medicines Management, Critical Care, Medical Device Integration etc.) Programmes and to continue with the integration of the informatics services into a single common service across the new combined trust.

Are you finding it difficult to recruit the talent you need to drive transformation?

Has recruitment and retention risen up your agenda as a CIO?

Are you looking for recruits in the EU to fill the skills shortage you have?

The CIO's department

How would you describe your leadership style?
My leadership style is collegiate - my role is to help others succeed.

Explain how you’ve supported and developed your senior leadership team to support your overall objectives and vision.
I have sought to recruit a senior team that have the skills, knowledge and values to succeed in a very complex environment.  They understand their technical discipline much better than me and I see my role as setting direction and being available to them when required.

How many employees are in your IT team?

What is the split between in-house/outsourced staff?
90% internal