yvonne goff and richard corbridge

Three hundred and sixty five days, a big number in any role. When taking up the role of CIO in Ireland Richard Corbridge was reminded by a commentator on CIO UK that the average tenure of a CIO in 2015 was just over three years; now more than a year into the role, in early January 2016 we held a showcase of all that has been delivered in those 12 months in Ireland. What is fascinating though is making that showcase 'real' for ministers and health leaders means that some of the more important back-office items, the really challenging items for a CIO in a new post was barely touched upon.

Corbridge was the first CIO for health in Ireland, the first time the health service had enabled the concepts of technology in health to have a seat at the board of executives, to truly impact upon the direction of a reformed health service.

The republic of Ireland has a population of around 4.9 million people, the health service is around 109,000 and the newly formed office of the CIO has a very lean 288 staff. The Irish health system has learnt the hard way, like many others, the wrong way, how not to implement technology into health. A significant IT project had publicly been seen to fail in the late 90s burning public and political will to invest in public sector health and in particular health IT.

After 10 years of this restricted investment it has decided to create a whole public sector vehicle to ensure that a reformed health service can be supported, maybe even be the catalyst for, the reform of the way in which health is delivered through technology and innovation.

The vehicle is eHealth Ireland, and Corbridge has been named Chief Executive Officer of this new function, he describes this as a, 'natural progression'. In the first year in existence the eHealth Ireland team have created a list of deliverables that clearly show how, with focus and clinical leadership, technology in health can truly make a difference. The organisation has been able to take the paper referral process from GP to hospital and make it digital, removing the need for the referral letter to go through 18 (I kid you not) pairs of hands from GP to Consultant.

The team have been able to create what is known as the Individual Health Identifier for every person in Ireland, a building block for the sharing of information across care settings safely, securely and efficiently.

And these are just two of the programmes worthy of being called out, what is more impressive though is the way in which eHealth Ireland and the Office of the CIO have been created. In January 2015 there were five geographically based health board IT teams, and yet the concept of a geographic health board in Ireland had not existed for nine years, Corbridge jokes, "someone forgot to tell IT!"

He goes on to say that when he took on the role the creation of the national health care system in Ireland was described as, "happening a little like a road traffic accident, on Friday someone said the Health Service Executive will exist, on Monday morning it did". And yet for the next nine years technology was provided piece by piece with significant governance and financial control but without a single vision or destination in mind. During this time Ireland invested around 0.8% of the 13 billion euro health budget on technology, the average across Europe is said to be around 3% compared to the financial market rule of thumb, 7%.

Coming into post in December 2014 the first thing Corbridge did was define the six strategic programmes for 2015 and what they would deliver, he also added to every programme charter, in bold red, don't break anything on the way!

The organisation knew it had to change its form and function to achieve the new strategic programmes and ensure the bold red statement at the bottom of every programme charter was met.

Having viewed the Gartner 'Bimodal' approach Corbridge could see how this could help, a dual function organisation that had capability to 'keep the lights on' and facilitate delivery, his biggest concern though was sheer capacity, and that was going to take time to put right, therefore the significant piece of work was going to be to create the enthusiasm for the model. Part one as far as he was concerned was staff engagement. Corbridge had always tried hard to embrace the opportunity that openness and transparency with staff offers and used these principles to set about ensuring staff could embrace a new operating model that introduced a national service management function of over 120 staff, a single Programme Management Office, a design authority and Technology Office that would be based out of Cork.

Having therefore created a new operating model for the team he need a defiend and specific plan that would allow the wider organisation to see what could be delivered with the resources that were in place. Back in his days at the National Institute for Health Research Corbridge had been trying to build an understanding in his clinical colleagues that IT was something to be a fan of and not a user of, learning from this he started to try to do the same.

The creation of a Council of Clinical Information Officers was a concept borrowed from the UK and USA. In March the council came together for the first time, a group of volunteers willing to place some commitment in to eHealth Ireland to ensure it delivered clinical benefits and not shiny new but useless technology. In November the council met for the fourth time and had grown to a group of 145 members and had been awarded significant recognition in Ireland as a driving force for change led by clinicians or in Corbridge's words, 'clinical fans.'

Just over a year in to the existence of eHealth Ireland and the nations ambition to leap frog others in its adoption of a digital fabric to drive health care reform appears to be on track, there is some significant distance to be got to but so far, learning from the mistakes and success of others Ireland really does seem to be on track to deliver against its ambition.

Yvonne Goff (top image with Richard Corbridge) is eHealth Ireland Chief Clinical Information Officer, leading the delivery of eHealth projects throughout Ireland from a clinical point of view