At Royal Brompton and Harefield NHS Foundation Trust, CIO Joanna Smith has continued to use digital and tech solutions to enhance clinical outcomes. Not always new for large global enterprises, in the NHS Smith is pushing a relentless and exhilarating pace of change and creating significant opportunity. In the past 12 months her team introduced an app for doctors to dictate patient letters from their mobile phones. She has replaced physical bleepers with an app that also keeps an audit trail to show when alerts are received, and provides more information with the alert so the recipient can take immediate action. An expanded e-requesting service has cut the time taken to request and report diagnostic tests. An ageing PBX switchboard has been replaced by cloud-based VoIP and UC, giving greater mobility and driving productivity. And the Trust's migration to Office 365 and introduction of Yammer, Sharepoint and Teams is in the last stages of completion, with significant productivity, collaboration and communication gains expected. Smith team has been rolling out Skype for Business internally and for remote consultations with patients and other healthcare providers. On the back of that has come an initiative to develop a home monitoring service for cystic fibrosis patients to reduce the number of their visits to the hospital and give them greater control over their condition. 2017 also saw her develop robotic process automation pilots in a number of areas of the hospital and trial wearable monitors to generate immediate indicators of a patient's vital signs and alerts to changes. [Read next: Royal Brompton & Harefield NHS Foundation Trust CIO Joanna Smith describes the organisation's cloud-first transformation]