When Dr Zafar Chaudry joined Cambridge, it was put into special measures (due to financial problems) and rated as ‘inadequate’ by the Care Quality Commission. An electronic patient record (EPR) implementation project was cited as the source of many of the problems. Within 12 months, he has fixed the project, leading to the hospital exiting special measures and being rated as ‘good’. The EPR gives 4,000 clinicians concurrent access to real-time, point-of-care patient data – on their own devices as well as 650 computers on wheels.
Chief information officer
Cambridge University Hospitals NHS
How are you influencing the products, customer experience and services your organisation offers to its customers?
I lead by example, and never give my staff any task that I couldn’t do myself. I’ve restructured my department to be more patient-centric and focused on our internal customers – ie the clinicians. Being a medical doctor myself helps me to understand the needs of my clinicians and deliver solutions at the point of care. My department’s hierarchy has been flattened and I empower all my staff to make decisions without any approval from myself. I am heavily embedded in the business and am part of all the committees that are clinically focused.
I don’t believe I’m in the business of IT – I believe I’m in the patient business, and as such spend most of my time with end-users and clinicians on wards. With our new focus on patients and clinicians and our digital strategy, we’re the only hospital to have deployed patient access to its medical records on Apple and Android apps that are part of a fully integrated single-system electronic patient record.
I help to set the right goals for the organisation, interact with vendors to bring in the right technology at the right time, and then ensure each department has the tools they need for ongoing success. I have built a reputation as the technology adviser, enabling the executive board to make decisions based on real-time insight and digital capabilities; as the IT service provider – ie accountability for guaranteeing highly reliable IT services; as a business partner, to help design thinking and agile approaches to work hand in hand with the service lines to achieve shared business goals; and as the security chief, to ensure my organisation is protected against cyber threats.
Define the key business outcomes that you have delivered over the last 12 months and their impact on your organisation’s performance
The Healthcare Information and Management Systems Society (HIMSS) is an American not-for-profit organisation dedicated to improving healthcare quality, safety, cost-effectiveness and access, through the best use of information technology and management systems. HIMSS measures a hospital’s ability on a scale of 1 to 7 (7 is the highest) to achieve a paperless hospital environment and implement a full electronic patient record (EPR). Over the last 12 months, I’ve delivered a full EPR (Epic) across two hospitals and 13,000 users, and we have been graded by HIMSS as a stage 6 hospital (the highest in the UK) making Cambridge University Hospitals one of the safest in the UK and the most digitally advanced. Stage 6 institutions have set clear goals for improving safety, minimising errors and prioritising IT implementations.
An independent study conducted by the Department of Health and led by Professor Bob Wachter from University of California, San Francisco, has confirmed that Cambridge University Hospitals has the most integrated and digitally advanced EPR and is the most digitised hospital in the UK. This was a £200m project that was delivered to budget. The new system has received over 80% satisfaction ratings. Our Epic EPR is a Gartner level 3 system (the highest), and provides my clinicians with electronic prescribing, order entry, clinical workflow, interoperability between systems at other hospitals, order management, clinical decision support, dashboards, and clinical documentation – all in a single database system.
The Department of Health has selected Cambridge as a digital exemplar site to lead and teach the rest of the UK. We now have the UK’s largest single research database of patient data (1.2 million patients’ worth: 470,000 diagnoses, 345 million lab results, 4.3 million medication records, 9.9 million medications administered).
Some of the benefits delivered include:
- pharmacy – preparing discharge medication reduced from 90 to 45 minutes
- antibiotic prescribing – 100% recording of indication for prescribing
- paediatrics – zero ICU sedation-related drug errors since go-live
- barcode medication administration in general paediatrics
- allergies – approximately 51,000 alerts, with approximately 8,500 leading to a change in prescription, which otherwise could have caused patient harm
- medical records – no more paper records
- virtual fracture – £200,000 per year savings
- hip fracture – achievement of best-practice care, rising from 66% to 82%.
I’ve also delivered a new adaptive digital strategy for IT linked into our business strategy for the next five years. When I joined Cambridge, it was put into special measures (due to financial problems) and the Care Quality Commission (CQC) rated it as ‘inadequate’. Many of the problems were cited as being with the EPR implementation project. Within 12 months, I’ve fixed the problems with the EPR implementation project and as of last month we were taken out of special measures by the Department of Health and CQC rated us as ‘good’.
What has been your involvement with innovation at your organisation – in particular, with products, business model and technology – over the last 12 months?
I’ve recovered and delivered the full EPR project. This gives 4,000 clinicians concurrent access to real-time, point-of-care patient data. Some 500 nurses have Apple iPod devices for clinical documentation at the point of care (the world’s largest deployment in healthcare). Clinicians have access to the EPR anywhere, any time, through the deployment of 650 computers on wheels. All clinicians have access to fully integrated apps on Apple and Android for the EPR on their own devices. I provide my clinicians with electronic prescribing, order entry, clinical workflow, interoperability between systems at other hospitals, order management, clinical decision support, dashboards and clinical documentation – all in a single database system – anywhere, any time, even from home.
With our new focus on patients and clinicians and our digital strategy, we’re the only hospital to have deployed patient access to medical records on Apple and Android apps that are part of a fully integrated single-system electronic patient record.
We provide full telestroke services to our region. Our EPR is fully integrated with Apple Healthkit for remote patient monitoring. All our systems (1,500) run in a full private cloud.
How have you delivered cultural and behavioural change as a CIO within the IT department and/or more broadly across the organisation?
I believe that as IT becomes more integrated with the organisation, IT will empower innovation by providing a clear understanding of the business value of diverse digital trends. On the basis of this, I’ve designed a new digital strategy for the organisation. I encourage the adoption of new systems. I am very active in managing stakeholder engagement and support. I help in establishing and maintaining strategic and operational governance, and try to create a culture of enterprise risk management. IT leaders are unique in working with people across the enterprise; they are prime candidates for being agents of cultural change.
I had handled change by clearly communicating the new cultural framework to my staff. I’ve set new rules of engagement for people, teams and stakeholders. I’ve used the concept of personal branding – and tried to develop my own personal brand within my organisation, as well as help my people develop and express their own brand. I lead by example and show leadership, personal involvement and commitment.
How have you worked with your CEO and/or board to communicate whatever ‘digital’ and IT means to your organisation/sector and improve digital literacy at the highest levels of the organisation?
I am a member of the most senior management boards in my organisation. We run informational sessions and workshops, and I personally engage with key clinical stakeholders on a regular basis to communicate our digital strategy at all levels. We actively undertake quarterly staff satisfaction surveys using an independent external agency to gauge our progress.
I regularly meet with my board to articulate in non-technical terms what our digital plans are. I actively engage with the wider community, patients and governors too.
How have you worked with the technology and IT vendor market to achieve your business goals? How have you been able to influence IT suppliers and successfully manage your partnerships/relationships with large IT companies, SMEs and startups?
I interact on a regular basis with all our key vendors. I maintain relationships to the CEO level. I actively speak on behalf of our vendors at conferences. I typically use five principles in vendor relationship management:
- Articulate a clear understanding of my organisation’s priorities to the vendor.
- Work hard to develop a relationship with vendor executives who are farther up the company’s chain of command.
- Be diligent in understanding the vendor’s motivation. I try to use a scorecard methodology to further performance and incorporate feedback.
- Communicate effectively – make it a point for both parties to subscribe to open and honest communication about needs and expectations. Be frank and transparent in the relationship.
- Have a clear understanding of any contracts.
How have you tried to develop the diversity of your team?
My plans have centred around: helping to customise my department’s diversity vision, definition and rationale, ensuring that the message that diversity matters comes from the top. We also focus on impact and metrics. We audit diversity. There is an NHS focus on recruiting and selection practices and we provide training for unbiased interviewing and selection processes, and establish strategic partnerships that connect the organisation with diverse talent pipelines such as local universities.
We invest in leadership development to retain high performers, and provide a range of formal and informal professional development tools, such as mentoring, coaching and education opportunities. We also regularly engage in open, honest and multidirectional dialogue at different levels, and work on developing a shared understanding that achieving diversity takes commitment and hard work from every member of the team.
Describe how you organise and operate IT and how this aligns effectively with business strategy and operations
I lead by example, and never give my staff any task that I couldn’t do myself. I’ve restructured my department to be more-patient centric and focused on our internal customers – ie the clinicians. Being a medical doctor myself helps me to understand the needs of my clinicians and deliver solutions at the point of care. My department’s hierarchy has been flattened and I empower all my staff to make the decisions without any approval from myself. I am heavily embedded in the business and am part of all the committees that are clinically focused. I don’t believe I’m in the business of IT – I believe I’m in the patient business, and as such spend most of my time with end-users and clinicians on wards. All heads of service act as relationship managers aligned to each clinical division of our business; all engage on a regular basis at every level of the organisation.
What strategic technology deals have you made in the last year and who are your main suppliers and IT partners?
We have a £140m commodity IT outsource deal with HP. We have a £40m EPR deal with Epic. I’m currently undertaking a new seven-year £140m outsourcing tender.
What are your key strategic aims for next year?
To achieve HIMSS Stage 7 (first in the UK). Complete a £140m commodity IT outsource tender and deliver circa £30m in cost savings in IT over the next five years.
How are you preparing for any impacts Brexit might have on your organisation?
We’re rewriting our IT business case and cost model for the next 10 years, factoring in any currency fluctuations and Brexit impacts.
When did you start your current role?
1 September 2015
What is your reporting line?
To the chief medical officer
Are you a member of the executive leadership?
Are you a member of the board of directors?
What other emerging roles does your organisation have and what is their relationship to you?
None. I’m serving as CISO and am responsible for the IT innovation agenda.
How often do you meet with your organisation’s CEO or equivalent?
How many people at your organisation does your function supply services to?
What is your annual IT budget, or your spend as a proportion of the organisation’s revenue?
£40m or 5% of annual revenue.
What percentage of your budget is operational spend (ie keeping the lights on) and how much new development (ie innovation, R&D, exploratory IT)?
97.5% operational, 2.5 % innovation.
Rank the following sources of advice/information in order of importance:
- Industry bodies
- CIO peers
- Analyst houses
Has your organisation detected a cyber intrusion in the last 12 months?
Are you expecting an increase in budget specific to security in order to tackle the cyber threat?
Does your organisation have a designated security professional – CISO or otherwise – and what is their relationship to you?
No, I’m the CISO.
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?
How many employees are there in your IT team?
Are you increasing your headcount or planning to bring skills and the ability to react to needs in-house?
Which technologies or areas are you expecting to be investing in over the next year?
- data analytics/business intelligence
- enterprise applications
- machine learning/artificial intelligence
Which technologies or areas are you expecting to be investing in over the next one to three years?
- data analytics/business intelligence
- enterprise applications
- machine learning/artificial intelligence
What emerging technologies are you investigating or expect to have a big impact on your sector or organisation?
Remote patient monitoring, NLP.
Does your organisation do a significant amount of trade with the EU?
Does your department include technology staff from the EU?
Are you or have you been looking to the EU to recruit key skills?