On the day these words are written, Joanna Smith has been CIO of the Royal Brompton and Harefield NHS Foundation Trust for three years, and as she told CIO UK at her West London office, these have been busy years.

Royal Brompton and Harefield NHS Foundation Trust is the largest specialist heart and lung care treatment provider in the UK, and in fact one of the largest in Europe. Split across two sites – one in Chelsea and the other in Uxbridge – the Trust is also famed for its research.

"We are very specialist as a hospital, as we take patients from district general hospitals," Smith explains of the acute treatment and care Royal Brompton and Harefield offers. The hospital does not have accident and emergency or maternity wards, as it is a centre of excellence for heart and lung treatment. The CIO says that this changes the demands on her and her team, and in one way offers some simplicity, though there are other complications in being a specialist hospital.

"We have a great success rate," Smith enthuses of the care Royal Brompton and Harefield delivers. Often, she explains, it's the last hospital patients can turn to when their heart and lung issues are critical.

Caring for patients is the number one priority, but all organisations have to pay their bills, and Smith says that Royal Brompton and Harefield often finds itself not being remunerated for the care it has delivered.

She joined the Trust in January 2013, her first entry into the public sector. Smith had spent her previous eight years in the pharmaceutical industry in a variety of senior business technology leadership roles.

She was hired by the Trust's chief executive, as he saw the need for a senior business technology leader at the trust. "They felt the need for a senior leader and I saw lot of good intention," Smith says of her entrance into the NHS.

"In essence, it was about getting the basics right, expose any muddle and then fix it. Then as we do that, transform the IT here," she adds.

Pace of change

The past three years have been a whirlpool of change for the CIO. "We have been fixing the infrastructure, putting in new clinical technology and trying to change the culture, all at the same time. It has been a big ask for all these people," she says, gesturing outside of her office.

"We haven't always been able to move at the pace I have wanted," Smith reveals of the constant financial constraint NHS CIOs live under, particularly under the current government, which has been driving widespread public sector cuts.

"I know the honeymoon is over," Smith says honestly of the freedom she's had in the past three years. The CIO has also taken on responsibility for clinical engineering and is looking for the synergies between these specialists and her team.

"These are people with robotics engineering and they provide support 24 hours a day, seven days a week, so I wonder if there is a hybrid solution for both teams?" As you'd expect in a highly specialist organisation, shadow IT does exist across the trust.

Smith embraces it, as she says there is a lot to fix. "It is about relationships. Sometimes they come to us for support, sometimes the management have come to us and asked us to take people into our team," she says of creating a culture that adopts good solutions, whether developed by IT or beyond IT.

At the time of our interview, Smith was busy preparing for the integration of a new Patient Administration System (PAS) for Royal Brompton and Harefield. "Our current PAS is over 20 years old and there are differences across the two sites. A PAS is getting the basics right, and it will also herald the beginning of a major transformation in how we do the patient pathways," she reveals.

The Trust and Smith have partnered with CSC for its Lorenzo electronic patient record and integrated care platform, which she expects to integrate during the summer of 2016.

The PAS project follows hard on the heels of Royal Brompton and Harefield completing the integration of an Electronic Prescribing and Medicines Administration System (EPMA). The Trust won £3 million in government funding to ensure its medical records are digitised and that it uses electronic prescribing, though it also had to provide £3 million. The Department for Health aims to have full digital care records across the NHS by 2018. Smith and her team have been integrating scanning bureaus at both the Royal Brompton and Harefield sites, which handle 250,000 patient records.

Cloud and Bimodal

"EPMA is well liked. These projects form part of a comprehensive overhaul of the Trust's information systems, which are vital in enabling it to remain a world leader in research, diagnosis and treatment of heart and lung disease.

"I hate the term bimodal, but the concept of two speeds is really visible in this world," Smith reflects. The CIO would like to see great adoption of cloud and mobile technologies in the NHS, as she believes they offer incredible opportunities to improve healthcare and operational efficiency.

"I think wearables is really exciting. That data can feed into the systems and take mitigating actions," she says, "Wearables are not on my radar yet though, as we have to get the basics right.

"The cloud to me is the opportunity to make a big difference to the NHS and save money." Smith asks why individual trusts are solving their datacentre and application challenges themselves when there are nationwide organisations within the NHS that could operate an NHS cloud. She cites the soon to be launched NHS Mail 2, which Accenture won the contract to operate, ahead of BT and CSC, in 2015. Accenture will provide a Microsoft and Avanade cloud-based email service to a reported 700,000 users.

As CIO, Smith doesn't sit on the board, but does sit in on most board meetings. She explains that as a member of the chief executive's team she and her peers attend the board meetings as observers. "The board is there for ratification and I cannot see any downside to not being on the board. Coming from a world where the CEO was the top of the pyramid, we are more a group of people with areas of expertise that are trying to do good things," she says of the leadership team.

"I love problem-solving and I love a flowchart of how to problem solve," Smith says of her continued enthusiasm for business technology leadership. Behind on the wall sit a series of detailed flow diagrams. "There's so much more to do, we cannot get complacent," she adds of her role at Royal Brompton and Harefield.

Away from the major changes she is implementing, Smith relaxes with her family and an Italian greyhound, and affords herself two nice holidays a year to recharge from the role.