Richard Corbridge's drive towards an e-health service in Ireland has been so successful that the media has embraced the concept and sees it as a transformative function of the health service. He has brought in clinicians to guide technology delivery across health from a user-based perspective. And he has turned a geographically dispersed technology function into a single organisation-wide department, and moved it away from being the 'internet police' to a technology access facilitator.
Name and job title
Richard Corbridge, Chief Information Officer, Health Service Executive.
How are you influencing the products, experience and services your organisation offers to its customers?
As CIO within the health service in Ireland I am responsible for all technology deployed into the whole health family nationwide. We have created an understanding within the health system that information is an intervention in wellness care, a step away from making people better and a move towards keeping people well.
The influence over products deployed is very much an advisory role. The ownership of product-based decisions is facilitated through the Office of the CIO to ensure that new products and innovations are led by the business and are part of benefit-based decisions. A design authority is in place to ensure that these decisions are made against a strategic backdrop of integration and national standards. The design authority and service management functions within my office impact upon the experience of the organisation and its customers through clearly defined ownership and business engagement.
At a personal level as CIO I have led a cultural change in the organisation, which now sees healthcare professionals more willing to try new technology to understand the benefit that can be gained. This has been achieved through open and transparent engagement with all areas of the business: clinicians, patients and public.
The process to access technology has been made more simple. The IT element of the organisation has actively stepped away from being the 'internet police' to a role facilitating access to new technology. Social media access has been enabled. Mobile devices have been updated through a refreshed mobile strategy. Population health analytics and a business intelligence programme of work has been identified and implementation started. In addition the use of cloud technology has been enabled to improve working practices and the sharing of information throughout the organisation.
How as CIO have you driven cultural and behaviour change in your organisation, and to what extent?
The key cultural change I brought to the organisation in 2015 is openness/transparency. I led the team through a significant transformation programme, moving from five geographic teams to a single national function that relates to the capability and structure of care delivery. This has been driven forward as One eHealth Ireland and done against a need to 'not break anything' along the way.
The team have embraced the need to move from concepts of 'users' to one of 'fans' of technology, enabling and facilitating access to technology, innovation and solutions that bring benefits to the delivery of care to patients. Placing the patient at the centre of all projects has become a culture embraced by all projects; innovation can only be brought to decision-makers if the benefit to the patient can be described. This enhances a team culture of understanding the impact technology brings to the patient journey, and while this can be more difficult with large infrastructural projects it is still possible to do.
Openness and transparency have been embraced as a health service-wide vision statement into 2016. The Office of the CIO has led the way taking to social media to open debate and conversation with major special interest groups, including privacy-aware, open health data, mental health inclusion teams and clinical research. A diverse array of considerations need to be balanced in health to achieve the business change technology can bring.
Define the key business outcomes that you have delivered over the last 12 months and their impact on your organisation's performance
2015 was the first year that Ireland had a CIO leading health technology. In the first year we have created an organisation-wide technology function rather than a geographically dispersed function. I have created an operating model and five-year delivery plan that has been approved by all areas of public sector and government.
In 2015 a business leadership group was created (the Council of Clinical Information Officers). This is a group of over 140 clinicians who come together to guide and lead the technology delivery across health from a user-based perspective. Tangible system deliverables in 2015 included the implementation of an individual health identifier for every person in Ireland. The capability for all acute hospitals in Ireland to receive a referral digitally from primary care has also been implemented. A pilot of electronic prescribing has been launched in several parts of the county. The completion of clinical validation and testing for the first national maternity and newborn IT system and a national lab system has been completed. Both of these systems are first-in-class national systems, a new capability for Ireland to deliver care as a national service is facilitated by these solutions.
Infrastructure projects were a major delivery in 2015: over 47,000 upgraded desktop machines were deployed to resolve a Microsoft compliance and legacy system issue across the health service. Some 7,000 applications were audited, tested and where possible upgraded to new platforms. A large central Oracle infrastructure was added to enable the creation of the health identifier service with the implementation of Oracle's OHMPI solution. An open data strategy has been set that will see health data in Ireland, where appropriate, made available to an innovative data community. The vision is for new exciting information solutions to be developed for patients and clinicians alike.
The impact on the organisation has been transformational. The organisation now looks to the Office of the CIO to lead business change considerations and conversations. The media has embraced the concept of e-health and sees it as a transformative function of the health service, which adds to an improving view of the healthcare organisation itself. The patient journey is perhaps most impacted by the digital referral process: a patient now knows before they leave their GP's surgery that their referral has arrived at the hospital of their choice and is no longer asked to post a letter (often to multiple addresses) to ensure that the referral has been received.
Describe how you have used organisational and third-party information to provide insight that has benefited your organisation, its customers and products or services
The ability to deliver analytics within health systems globally has become part of the 'hype cycle' for healthcare technology. The health system in Ireland collects a huge amount of data, but until recently it did not create information with this very easily. In 2015 a business intelligence programme was created to consider how the silos of data that have been created can be brought together to enable safety and efficiency to be built up from information.
A first example of this is the creation of the individual health identifier and demographics service for every person in Ireland. By linking the information within the Department of Social Protection to information within the primary care reimbursement service (part of the health system), a 95% match rate was achieved for the creation of a unique identifier for Ireland (4.2 million records).
An identifier as an information set is intrinsic to enabling information services in the future, hence the prioritisation given to it. As the identifier has come into being it is being used – for example, on the creation of a consented data set within the study of epilepsy and the genomic sequencing now possible in this area in Ireland. This ability is transformative, delivering insight that saves €5m of drug waste in epilepsy alone and an estimated 90 lives per year from earlier diagnosis
Describe how you organise and operate IT and how this aligns effectively with business strategy and operations
In 2015 a programme director role was created for each of the five business verticals within the health system of Ireland. This has aligned the delivery of technology to how care is delivered across all settings across the whole country.
In addition three key governance functions were created to facilitate close links to the business. The first was the eHealth Ireland Committee, a connected health thinktank with global representation, acting as adviser and lobby group for the delivery of health technology to Ireland. The second was the Council of Clinical Information Officers, which is an award-winning group built from the ground up to include 140 clinicians coming together regularly to act as project and programme advisers. The third was patient group collaboration: the Irish Platform for Patients Organisations, Science and Industry is now working closely with eHealth Ireland to ensure access to patient opinion on elements of the connected patient.
The chief information officer also sits on the organisation-wide shared business services board to ensure linkages to key strategic decisions about estates, human resources, financial modelling and provisioning. As well as the programme delivery function, the Office of the CIO has created national functions that enable an Ireland-wide approach to the delivery of infrastructure, service management, business change and design authority elements. This second mode of function is responsible for the delivery of programmes beyond inception and running of live services, and has aligned geographically through centres of excellence for each area being created.
Describe your role in the development of digital strategy in your organisation
The creation of a truly digital strategy is a new concept for health in Ireland. In 2015, the knowledge and information plan was created, approved by the minister for health, and published. The title of this plan was carefully considered to be neither a digital plan nor an IT strategy. The knowledge and information plan describes in business language how access to information and technology can reform healthcare, putting patients at the centre of all that is done.
In 2015, the organisation recruited a head of digital within the communications division. The Office of the CIO has been able to collaborate strongly with this role, building up the social media presence of the organisation and the key delivery areas of the health service, increasing the number of interactions ten-fold with digital platforms and being a significant part of the redesign and build of web technology for the engagement of patients and the public.
The concept of digital first is now being applied to services requiring detailed interactions with patients remotely. We have launched several mobile digital pilots with patients as a focus; they include epilepsy (40,000 patients), haemophilia (15,000 patients) and bipolar disorder (10,000 patients).
In 2016, the health service will define and publish a digital strategy. This is to be developed as a collaboration between the Office of the CIO, HR, shared business services and communications. The Office of the CIO has led the collaboration for this, to ensure the digital strategy is truly representative of what is needed by the clinician and patient.
Describe how you use and promote technology to redesign the processes, services and structures of your organisation to enable it to become more efficient and customer-focused
The changed operating model for the organisation implemented in 2015 moved the national team from local focus to care setting and a delivery focus. We removed the geographic duplication of elements like infrastructure support and service management, creating single national functions for these areas. This also enabled us to create business-focused verticals that focused on care pathways in the system, placing Office of the CIO staff into the national acute, primary care, community and mental health teams.
The Office of the CIO has created a vision for the future that patients and clinicians can understand. It has used digital media capacity to enable public evaluation and comment to be made on elements as diverse as the creation of the identifier, the concept of an electronic health record and the content of what an e-pharmacy programme should have.
eHealth Ireland created an Eco-System group in 2015 that enables an open and public forum to come together each quarter and provide input and steerage to key national programmes. This Eco-System is chaired by external bodies and is able to hold the eHealth Ireland team to account for decisions and advice it provides.
How do you engage regularly with your organisation about your team and the role of technology in the organisation, and what impact is this having?
As a CIO I believe one of my key functions is ambassadorial, providing a focal point for an understanding of what eHealth Ireland can deliver and why it should be considered a transformational function. eHealth Ireland launched a new website in 2015 with organisation-wide content and a programme of regular information updates.
The Office of the CIO has embraced the use of social media across the team, creating two environments for engagement. One, #eHealth4All, is a place where innovation and conversation can take place about all things related to e-health. The other, #ONEeHI, is focused primarily on the internal transformation. In the final quarter of 2015 the team ran two Twitter chats, the second of which achieved over 4.9 million Twitter impressions across the globe.
As CIO I write a blog that includes items about IT leadership, business change and technology. I have encouraged members of the senior team to write guest blogs here, which has been well received. In quarter one of 2016 the Council of Clinical Information Officers is to begin its own blog site, inspired by the success of the guest blogs on eHealth Ireland.
In March 2015 the technology team of health in Ireland came together for the first time in 10 years. The exercise is now repeated twice a year, with huge success. As CIO I have embraced other types of engagement including podcasts with the senior management team and webex videos. I also write an editorial piece quarterly for an Irish medical journal and have put in place the ability for the team to do 'back to the floor' sessions, spending time in the patient-facing health service to ensure reality is kept in mind at all times about what eHealth is here to do.
How do you use social networks to engage in conversations across the industry about the opportunities and challenges technology is creating?
eHealth Ireland has created a social media presence for all of its major delivery projects, using Twitter, Linkedin and Facebook as routes to engage clinicians and patients in the delivery and benefits assurance of projects. While the digital engagement of stakeholders is hugely important to eHealth Ireland, the face-to-face network has not been overlooked, and clinicians are now part of the senior management team and lead some of the social network get-togethers directly.
The most important example of the office of the CIO using social networks, though, has been in the creation of the clinical information officers' council. This group has over 140 members and uses social networks, in particular Twitter and an internal collaboration and chat forum, to work together to influence technology delivery and benefits delivery. The first Twitter chat in health in Ireland was on the subject of the work programme and gathered around 150 interactions. The second was on the subject of an electronic health record for Ireland and created over 4.9 million impressions in a one-hour engagement.
During eHealth Ireland-wide meetings we encourage all the team to tweet questions, thoughts and impressions about the internal elements of the team, making them transparent and viewable by all. This is done against a specific hashtag that has become the name of the transformation programme itself.
I have also created a strategic partnership with a new organisation in Ireland, Think Visual, which is providing assistance in considering new social network functions like Showbox and Blah, as well as ensuring that the visual impact of social media can be investigated.
How do you bring the organisation together to explore and discuss technology and its challenges and to develop stronger alignment of the technology function with the full business?
Alignment of technology functions and business in health is perhaps the most important aspect of what needs to be done right to avoid mistakes made over the past two decades. We have gone to great lengths to encourage clinical leadership and ownership of technology. The appointment of the clinical information officer to the Office of the CIO senior management team has provided a true clinical voice at the most senior decision-making function for technology. Each major programme has a senior responsible owner who is a clinician. They ensure that clinical validation is in place at each major project gate.
In addition, whenever large parts of the team come together as part of the transformation programme there is always a clinical or patient involvement to ensure clear and continued understanding of the business need. Empowering a patient voice at events has brought significant impact to technology decisions on a number of items, in particular the creation of the individual health identifier in 2015.
The wider organisation has information services as a standing agenda item as part of the board. In addition, the health service strategic reform group, a leadership function of health in Ireland, provides significant impact and steering to the delivery needs for technology.
Describe how you keep up to date with developments in technology and IT management
As a country Ireland places itself at the centre of a digital evolution. The ability for me as a CIO to take part in innovation accelerator programmes run by two angel investor organisations has allowed me to continue to learn and understand the art of the possible. Additionally we have enabled the major suppliers of health technology to provide briefings to staff at the all-staff meeting, ensuring that the organisation as a whole continues to learn.
The health sector can learn hugely from other areas and therefore we have set up cross-sectoral briefings on advances and structures in the Irish financial district and Irish facilities marketplace. As a CIO I continue to write for several technology web sites, which enables me to stay in touch still further with commentators on the how as well as the what.
Provide an example of how you have developed the diversity and improved the culture of your team
The senior management team of eHealth Ireland had had the same structure and function although by a different name for around 10 years when I took over. Design capacity, business intelligence, clinical ownership and integration services were not covered by the senior management team. By including these groups onto the senior management team we have improved the width of knowledge and diversity significantly. In particular, bringing a clinician to the management team has ensured that the technology part of the delivery is grounded in clinical need.
In addition, the culture of eHealth Ireland has focused on being open and transparent. Simple elements such as using my name and not my title for my email have made a difference to where the CIO sits in the culture of the organisation and ensures that staff become part of an approachable team. The eHealth Ireland function has committed to openness and transparency with the public and media. We have published plans, business case drafts and analysis to the eHealth Ireland website, and provided briefings on subjects as diverse as an electronic health record for Ireland and the privacy impact of identity.
Describe how you collaborate and influence the organisation and its leadership team
The CIO role in Ireland has a seat on the board and reports to the director general of the health service. The role of the CIO is rightly expected to be part of the healthcare management team, being part of the decision-making processes that are integral to the reform of the health system. As a CIO in health I am part of the decision-making process relating to the physical infrastructure of the organisation, ensuring that technology can facilitate and often even act as a catalyst for a health care reform programme.
Two key areas of significant success are held up as examples of collaboration. The building of Ireland's first digital hospital is moving through planning permission and business case stages. The technology element of this has worked in a collaborative manner with the acute division and business services (estates) division to ensure that wherever possible consideration of future technology is captured in all planning.
The second clear example is with the digital team of the health service. As CIO I have worked with this team to ensure tools already available for engagement with population can be used by clinicians and managers across the system. Simple mobile refresh programmes, social media awareness training and enablement, and access to cloud-based web technology have all been achieved in this space.
Tell us how you have developed your own management, leadership and personal skills
I strongly believe that my own personal skills need to constantly be challenged, reviewed and built on. I have set aside a day a month as a study day, and leverage agreements in place with Gartner and other suppliers to continue this process. In 2015 I also put in place two 'back to the floor' sessions where I went to care settings across Ireland and worked alongside clinicians for three days each time. This truly enables me as CIO to see where the gaps in technology are and how they need to be fulfilled.
I have also begun delivering elements of a health informatics module at three of the universities in Ireland with strong links to health delivery. This enables me to test my own knowledge in preparing it and to hear new ideas coming from the brightest of students in the country. At the end of 2015 I was also able to put my own first year in post through a 360-degree review, which truly enables continuous improvement of my position and capability to be considered.
What new technologies are you investigating, tracking or experimenting with?
Machine learning/artificial intelligence, data analytics, wearable technology, enterprise apps, the internet of things, the sharing economy, genomic sequencing and inclusion in health records, patient end supply chain management, telemedicine, home-based inclusion monitoring – all are in consideration in some form.
How do you decide where to apply the best technological approach?
Decisions on the best approach to technology are taken at a programme and design authority level. We are putting in place a cloud-first policy that will ensure this is considered first not last from a hosting point of view. Currently cloud would often be only considered for DR and DBT. The need to have in-house development in some cases is still clear, particularly in the development of tools for business intelligence.
The decision on which is the best approach is always taken in conjunction with the design authority and a maturing enterprise architecture blueprint as well as a council of clinical information officers that represent the clinical input. Information governance also plays a large part in these decisions in health and as CIO I have responsibility for this, so it plays well into this decision-making process.
Do you give yourself and your team time each month to assess or learn about technology vendors outside of the established providers?
Yes, the senior management team has access to a study day policy whereby each month one day can be taken for the development of knowledge and networks. The expected outcome from this is for the team to develop ways of onward communication of this learning through blog articles, presentations, field demonstrations and awareness sessions.
A small technology fund has also been set aside in 2016 to allow technology to be piloted in specific settings to allow learning in the 'live' environment to take place. For example, taking the new surface hub and deploying that into larger team areas to enable a collaborative platform to be in place grew from this policy.
In 2016 this group will also create a physical innovation centre, a space in an acute hospital in Ireland where new solutions can be deployed to demonstrate integration and clinical fit. In 2015 the Office of the CIO took part in a pre-accelerator programme run by the minister for communications, natural resources and energy known as Future Health. In 2016 the group will be part of this again, ensuring that new and innovative ideas can be taken from the initial thought to solutions that bring disruption to how e-health is delivered.
Describe your sourcing strategy and your strategic suppliers
The sourcing strategy for the health service in Ireland is a very processed pathway following detailed regulations and rules. Innovation in sourcing solutions is passed to pre-procurement delivery and relationship building so that clear intent and ideas are understood by the market place and the panacea of all technology contracting can be reached, a true partnership. The transparency and openness agenda permeates this area significantly, with the organisation publishing its draft business case for an electronic health record and signalling to the market in detail what it expects.
The organisation has chosen its strategic suppliers as much based on their diversity and will to deliver as on the content. At the start of 2016 KPMG is a significant partner, aiding in the delivery of a number of key solutions and platforms. A new organisation called Think Visual has provided small bodies of hugely valuable product for the engagement of staff, clinicians, patients and public throughout the system. Traditional suppliers (Microsoft and Oracle both have a large influential estate within the organisation) also now provide not just traditional product but deliver in a model far more akin to a strategic partnership.
The health system, though, is still reliant on over 100 different system providers due to its legacy. There is a strategic intent to reduce this number, but to maintain relationships with new innovators just as much as the large multinationals.
Describe the technology innovations that you have introduced in the last year and what they have enabled
Two very different examples are worth calling out here. The delivery of e-referrals to the whole nation in one year has been done partly as collaboration with GP system providers across Ireland and partly as an internal build and support solution. The internal team built the messaging infrastructure for Ireland some years ago. At the end of 2014 a realisation of its capability as a digital platform was reached; over 2015 this was utilised to full effect, meaning that every hospital in the country can now receive e-referrals.
The second example is the build of the individual health identifier, an international service enabling every person in Ireland to have a unique identifier that can traverse the EU health systems, identifying them uniquely and enabling the consent of the patient to share clinical records to be captured once in a national system.
What strategic technology deals have been struck and with whom? What uniquely do they bring?
New strategic deals put in place include a contract with Oracle to deliver the Oracle Healthcare Management Person Index and its associated solutions for Ireland and the integration this offers to the many diverse systems across health in Ireland. Framework contracts have been favoured for a plethora of healthcare-focused solutions, allowing local sites to make decisions that fit their business model against national frameworks put in place. These cover electronic document management, emergency department systems, and e-rostering solutions to list just a few.
In addition Cerner has agreed contracts and begun delivery on a national maternity system and a national lab system, and CSC has agreed a contract extension to migrate two significant areas of Ireland to a more modern patient administration system. Learning from the NHS Ireland has also put in place a central framework with GP system suppliers to ensure the cost of technology innovation in GP practice does not have to be solely borne by the GP.
Rank in order of importance your sources for innovative technology suppliers
1 CIO peers. 2 Analyst houses. 3 Media. 4 Consultants. 5 Industry body.
Has your organisation detected a cyber intrusion in the last 12 months?
Is cyber-security led and discussed by senior management?
When did you start your current role?
What is your reporting line?
Are you a member of the board of directors?
What is the annual IT budget?
How much of your IT budget is capital and how much revenue?
€102m revenue, €55m capital.
What is your budget's operational/development split?
75% keeping the lights on, 25% on new innovation and programmes.
How many users does your department supply services to?
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?
Does your IT organisation operate an apprenticeship scheme?
Being developed for 2016/17.
How many employees are there in your IT team?
Are you increasing your headcount to bring skills and the ability to react to needs in-house?
What is the split between in-house/outsourced staff?