University Hospital Leicester CIO John Clarke discusses the NHS digitisation journey

John Clarke is CIO at University Hospital Leicester, one of the biggest hospitals in the UK as well as a research centre with links to three universities. Though not one of the most technologically advanced hospitals, in recent years, it has undergone a period of digital transformation, with a £48 million project to renovate the emergency department beginning in 2014, and a number of technological initiatives being introduced in partnership with Japanese Systems Integration company, NTT Data, aimed at improving patient care.

Clarke explained that these initiatives were introduced in response to feedback from the hospital’s staff.

“We spent time listening to them and listening to their pain points,” he said. “Listening to their sense of priority so that we could start to make a meaningful impact. It’s very easy for IT teams and their partners to deliver technology; it’s much more difficult for us to deliver change – especially at patient level.”

Technological advances at UHL

Working with NTT Data, the project involved upgrading network services, applications and data across different devices for the new Emergency Department. Opened in 2017, it is now the largest of its kind.

Some of the specific technological initiatives introduced include ‘follow-me’ desktops, allowing staff to tap into any nearby PC with a smart card and pick up what they were working on and patient facing screens meaning that receptions can easily share information with patients to increase speed and accuracy.

Another major feature of the project was improving mobility, following feedback from the workforce. “So what came back to us was, we hate computers,” said Clarke, laughing. “They’re a bind, trying to find one, trying to use one, it’s a problem. So we developed our new strategy around being a mobile first organisation. In terms of our main electronic patient record – it’s a mobile first solution.”

What does this mean in practice? Clarke said the system is delivered via iOS throughout the organisation, and that they began at the level of nurses, in response to general reports finding nurses are often forgotten in the introduction of IT initiatives.

“That’s where we started, we started our journey in that place,” Clarke said. “It started from very simple things such as capturing all the observations electronically on a little iOS device. And using that to calculate the early warning scores which are relevant to treating patients and getting the right treatment at the right time to patients.”

This is more revolutionary given that across the world, these calculations have typically been carried out manually, rather than electronically, meaning that it is a method prone to error. “If you don’t notice a patient is getting sicker, it has direct consequences,” Clarke said. “We went very quickly from having none of this to having this across the whole of our organisation.”

And this is particularly useful for certain types of illness, such as noticing if a patient is suffering from sepsis, a condition where the patient’s body responds to infection by damaging its own tissues. If symptoms are not correctly recognised and monitored, this condition can quickly escalate in seriousness and soon become life-threatening. The new electronic way of carrying out patient checks includes automated sepsis alerting, meaning that the data collected will search for patterns indicating potential sepsis and send an immediate warning to hospital staff.

Further automation is an ongoing aim for the hospital. “The next level for us is, how do we make those machines automatically talking to the system so we no longer even have to capture the data, the machines are actually capturing the data for us and passing it through,” he said.

NHS on a digitisation drive

Digitisation is undoubtedly the pathway to more efficient, holistic care. “Clinicians wandering around have always got the information to hand that they need,” Clarke said. “The impact is not having to constantly change bits of paper and all of that and is a matter of improvement in how we treat patients.”

Clarke points out the disparity between patient understanding of the NHS and how it works in practice.

“If we speak to patients, they’re just surprised the information is not shared across the NHS and that it’s difficult,” he said. “They think that the NHS is a single organisation and putting things into one log system means that everybody will be able to see that. We’re away from making that a reality.”

But these new initiatives have sometimes caused confusion for patients. “Some of the issues that we’ve found when we move IT heavily into areas, that patients were going, ‘Why are doctors and nurses playing on their mobile phones?’ Well, they’re not, they’re looking at your medical record and things,” Clarke explained.

However, patients are growing to expect increased levels of digital fluency in every realm of daily life. “That consumerisation drive we can’t ignore it; what patients expect is based on best of breed technology that they now have access to in banking and insurance. The NHS still have racks of paper as part of its process.”

NTT partnership

However, the NHS is advancing in their drive for digitisation. Clarke discussed the hospital’s partnership with NTT Data. The company’s global reach and experience in a medical setting – running hospitals in Japan – were both factors in selecting them to work with.

“What comes out of Japan in terms of research at times is pretty astounding. Through working with them we’re looking at wearables, we’re looking at AI – within a clinical setting with practicable outcomes,” Clarke said. “So we’re not talking about research based purposes, we’re talking about things that have a real impact on our patients.”

The company was attractive for an NHS partnership due to a matching of values and their respect for the fact that in the realm of healthcare, patients – rather than profits – are the bottom line. Clarke pointed out that sometimes health bodies must go beyond budgets or deadlines to deliver the best level of care.

And despite being an advocate for the introduction of various new technologies, Clarke said that it was important not to forget the heart of the NHS.

“Healthcare is a human business,” he said, “and what I want is technology to give my doctors and nurses more time to concentrate on those human efforts and to build those positive relationships with their patients.”