The University College London Hospitals (UCLH) is one of the most complex healthcare organisations in London as both a major incident response hospital, a leading treatment hospital for a wide range of care from heart to cancer and wards for maternity and A&E.
Deciding on the very top members of the CIO 100 is always hard for the entire panel, but all agreed Director of ICT James Thomas shows what a CIO can do for an organisation in terms of sourcing strategy and management, process improvement and being a board level leader that enables an organisation to think openly and differently about how it creates something like the Macmillan centre with technology playing a key role. As the NHS faces a new dawn, public sector finances are slashed and the population ages, Thomas shows transformation is the way forward.
Richard Sykes said: "He is a very worth successor on the CIO100 to Trevor Didcock at easyJey."
Director of ICT James Thomas ensures the systems that support the hospital are up to the job. Like the rest of the NHS, the hospital is highly regulated and scrutinised in terms of quality of care and expenditure.
UCLH and James Thomas are an example of what the NHS can be in the 21st Century. The ability to think differently and put technology as a process improvement in place marks UCLH out from the experience too many of us sadly receive from the mendacious administration of the NHS.
Following a typically relaxed interview in Thomas’ office surrounded by pictures of his original Mini Thomas takes CIO UK to the new UCLH Macmillan Cancer Centre.
Stepping into this building could not be more starkly different to entering a typical hospital. The centre of the building is a vast shaft of light, decorated by sculptures and topped with a glass roof. Even on the winters day of the CIO visit the building floods with life giving light. Spanish architect Gaudi famously used these methods in the private homes he created in Barcelona. Modern furnishings, a reception desk that would look at home at a leading international hotel and brushed metal plinths housing the beginning of the technology journey patients will take greet you. Tackling cancer has often been described as a journey by those who have or do suffer from it and the experts around the world that fight and treat it. Entering the Macmillan Cancer Centre has more in common with an airport lounge and has none of the institutionalism typically associated with hospitals.
Opened in April 2012 the Macmillan ward was a £100 million development between both the UCLH and as the name suggests the Macmillan cancer care charity.
In a recent family experience of the NHS I counted 12 administration staff and mountains of paperwork, but only a couple of clinicians. On my tour of the Macmillan centre I saw just a couple of admins, all equipped with iPads and roaming the building while clinicians were as plentiful as patients.
The building includes a hotel for patients and their partners, a third floor ward devoted to teenagers that has social areas, pool tables and computer games booths and there is a roof garden.
All of this has been made possible because UCLH is collaborative, Macmillan is not the only charity to commit to this centre, CLIC Sargent and the Teenage Cancer Trust have invested in the partnership. UCLH and Thomas bring to the centre a management ethos that is bold and prepared to embrace technology to improve the lives and processes of all involved, whether patient or carer.
“Patients receive a bar coded letter for their appointments,” Thomas explains, “they present the bar code to the plinth computers on entering the centre, this is connected directly to the hospital administration system and the scheduling software is connected to the core patient records. When a doctor requests a patient’s records this triggers the information screens in the building which alert patients that their appointment is due and where.” Again the airport analogy serves well as patients can sit in comfort in the atrium area of the centre and then go to their appointment, not be tied to a ward’s waiting room. Thomas explains that the system also provides information of how to get to the room of your appointment. This is recognition of technology having a role in helping patients during a very stressful part of their lives.
Patients can opt to be informed by text message as well as the screens.
UCLH is collecting information throughout the processes too, so time stamps allow the analysis of how long doctors and patients need together, which Thomas says will improve the scheduling and management of the centre.
“How people consumer information is a real issue and the creation of the atrium helps them relax. A patient portal means patients can raise a question with a consultant see their diagnostic results and their records. A huge amount of learning on how people engage with information has gone into this,” Thomas says.
Thomas has been treating the entire UCLH institution to a dose of digitisation. All four intensive care units are going fully digital without a single sheet of paper in them. The administering of drugs is being digitised rather using the latest sensor based infusion pumps, which again create and log information that is used in the treatment process. Thomas agrees this machine-to-machine strategy could sound imposing to some, but offers real benefits to speed up the “care journey”.
“The provision of real time clinical information is an area of real challenge,” the CIO says of the instant access to records and blood test results for example, but he foresees this will be an increasing demand from patients in the future.
“The way we are trying to transform the organisation also is to pick the standard processes and expose them and rectify them through automation and for all processes to be the same whether at a heart hospital or here,” he says of the campus of hospitals UCLH operates.
Thomas and UCLH have prescribed their own tonic for technology with managed service telecommunications through a deal with Azzuri and an outsourcing agreement with Logica to operate its GE patient administration systems. Thomas has in the past told this title how these relationships are partnerships and not vendor and client.
“Using outsourcing is very deliberate,” he says. But in the last year the relationships have been tested as Canada’s CGI acquired Logica.
“Logica being bought by CGI has been interesting as CGI is smaller and very US centric, so we have had to go through a transition with them.
“We have lost all the tiers of people that we knew and that is risky as we have been working with them to re-engage on a level of the importance of us to them and them to us,” he says. But Thomas is positive about the new crew at CGI: “I’m hoping there will be a net gain and it may become more flexible”.
Azzuri too has had a change of CEO and board members and again Thomas says he has had to do a lot of re-engagement.
“The issue is when the management come in and view us as a typical NHS contract. It is all time and effort that is not taking you forwards,” he says.
In the judging of the 2013 CIO 100 Richard Sykes led a chorus of support from the panel that applauded Thomas’ attitude and influence on the vendor community and readiness to challenge, discuss and innovate with the suppliers.
The outsourcing strategy means that Thomas’ IT staff consists of just 20, yet as I look from his office I see a busy and full office, that Thomas says consists of 100 outsourced heads.
Greater flexibility is exactly what Thomas seeks for UCLH moving forwards as he continues to focus on innovations like the Macmillan centre.
“We have over 270 applications in the data centre, which is a difficult place to be. The primary application is the legacy GE patient administration system and a clinical administration system jointly developed by UCLH, Logica and CDR.”
To keep a legacy system healthy Thomas has a user group that constantly challenge the functionality of the clinical administration system, while Logica/CGI operate a three times a year release cycle to “constantly evolve” the platform.
“When the clinical administration system journey was started there was nothing available on the market that would take the trust forwards and at that time it was the world of the NHS National Programme for IT,” he says of being a hospital trust that doesn’t fit the one size fits all suites vendors and the NHS programme were designed for.
Thomas has begun the journey towards a new clinical administration system again and is typically doing things the UCLH way.
“We are looking around the world at other healthcare providers based on their outcomes and as healthcare providers they must have a synergy to us, so we are looking at a major cancer hospital for example.
“We are working with the UCL (University of Central London) to work out a benchmark of how to do the assessment and we are taking ideas from Gartner’s pace layered application strategy model, which normally requires you to place your applications on to and then do the assessment from that. We are turning it on its head and putting our requirements in.
“Gartner are keen to work with us on this as they know they are too US centric in their healthcare technology information, so we are able to help them,” he says.
One of the reasons for the need for a new clinical administration system is to continue Thomas’s strategy of embracing new working methods at UCLH and in particular mobility and consumer devices. UCLH issues over 7000 log in accounts to clinicians, nurses, administration staff, consultants and support staff. As a research and academic hospital UCLH also issues access to the many students that pass through its doors.
“We have got more into BYOD, the issue is not about devices, it is about content and to resolve that we have gone through an exercise in clustering our user base. We are trying to transform the way we work. But care is more complex now that doctors and consultants are delivering care at other hospitals as part of the changes to the NHS, and they want access to our data when off site,” he explains.
Thomas has integrated Mobile Iron mobile device management and describes it as liberating for the information UCLH has for its community.
Thomas has been Director of ICT at UCLH for seven years now and has seen the organisation grow to be worth $1 billion in turn over. UCLH splits itself into three medical boards: Cancer and Surgery; Medicine, Acute and Emergency; Heart, ENT and Dental; each have their own P&L responsibilities. Thomas sits on all three medical boards. There is also an ICT strategy board with membership from board members of each of the three operating boards. Thomas is clear, every board organisation at UCLH is clinically focused.
Thomas reports to the Deputy Chief Executive, which he says is a good compromise as they are not part of the financial area of the organisation.
“We are challenged because the reporting line is not to the medical areas,” he says.
IT leader: James Thomas, Director of ICT.
In role since: Seven years.
Reporting line: Deputy Chief Executive, which is a good compromise, it is not in the financial area, they challenge us and they are not tied into any one of the medical areas and this reporting line has existed for five years.
Board level seat: Yes, seat on three medical boards. These boards are: Cancer & Surgery, Medicine – acute & emergency, Specialist hospitals – Heart, ENT, Dental and these three are effectively brands themselves.
IT budget: Core ICT is 1.3-1.4% of turnover.
IT estate and or number of log on accounts under the control of the IT leader: 7000+ employees with full log in access.
IT staff currently employed: UCLH is mostly outsourced, the IT staff consists of a Programme & Projects team of 20, Apps management and Contract management teams of 25.
Split between in-house/outsourced staff: 100 outsourced heads.
IT management team and reporting structure: A senior management team of 5 consisting of ICT Programmes Director, Head of Business Solutions, Head of Service Delivery, Programme Manager for Electronic Health Records, Head of ICT & Records.
Primary technology platforms at the organisation: The primary application is the legacy GE patient admin system.
Primary technology suppliers: Logica and Azzuri.
Major technology or transformation project recently completed and how did it transform operations, customer experience or the organisation:
The Macmillan ward opened in April 2012. It is an evolution and it is really innovative. How people consume information is a real issue, so we created a big atrium to make them relax.
Macmillan UCLH Cancer Centre is a £100 million build that is built to work with the technology to flow people through the building. It has a large atrium rather than waiting rooms and airport style screens detailing where a patient needs to be having checked in using a touch screen plinth.
Business transformation programme – beyond technology – that the CIO owns or is a major contributor to: The way we are trying to transform the organisation is to pick the standard processes and expose them and rectify them through automation and for the processes to be the same, whether a heart hospital or a standard hospital.
UCLH has four intensive care units that are being digitised – health records – so that there is no paper in the units and even administration of drugs is digitised with sensors in infusion pumps, so we are using information to speed up the care journey.
Strategic aim of the CIO and IT operation for the next financial year: Commissioning Support Groups are replacing the PCTs under the present government and they have a hunger for information, so over the next two years there will be a focus on how we share information and that is having an impact on us already.
Strategy in the use by employees of their own technology, use of mobiles and how social networking is impacting operations, customer experiences or the organisation: We have got more into BYOD as it is not about devices it’s about content, so we went through an exercise of clustering our user base.
We are trying to transform the way we work. Care is more complex now that our doctors and consultants are delivering care at other hospitals, but they want access to our data, but using Mobile Iron which is really liberating for freeing up information.
Transformational inspiration sources: I seek inspiration from the hospital and looking around the global health information community and the five UK health research centres.