Richard Corbridge, CIO for the Health Service Executive (HSE) in Ireland, recognises that he likes to be tested. As well as being IT leader for the organisation, Corbridge is chief executive of eHealth Ireland, which was set up to help deliver innovative technology to help improve healthcare.
“I like a challenge – that’s why I work in healthcare IT,” he says with a smile, recognising that technology transformation projects in the sector have an extremely mixed record of success. Yet the low level of attainment is not discouraging Corbridge (pictured). In fact, he is embracing the need for change.
“We’re trying to change perceptions about healthcare IT,” he says, talking about his plans for digital enablement in Ireland. While driving change in a huge organisation – Ireland’s equivalent of the NHS – is extremely difficult, Corbridge believes the smaller scale of the country’s population, of about five million people, means total transformation is an achievable aim. His enthusiasm for the project comes across loud and clear.
“It’s a great role,” says Corbridge. “I’m busy; very busy. Ireland has not really invested heavily in its IT healthcare systems until now. For that reason, there’s an awful lot to do. But it’s a wonderful opportunity. And what we’re discovering is that the smallest changes can make the biggest differences.”
Grabbing the opportunity to lead a transformation project
Corbridge started his dual role in December 2014. He joined after a three-year stint as CIO of the NHS’s National Institute for Health Research Clinical Research Network. He held organisation-wide responsibility for information systems and technology, implementing new strategies, delivering bespoke capabilities and innovating wherever possible.
During his tenure with the organisation, the average time for a clinical trial was cut from 200 days to 20. “I’d been there for four years. I’d achieved a lot in terms of IT strategy and helped start some key programmes, such as the open data platform and the use of business intelligence,” says Corbridge.
Richard CorbridgeHealth Service Executive
He looked back on his achievements and realised he had a choice – to stay and lead more change, or to move on and try something new. When the opportunity arrived in late 2014, Corbridge grabbed the chance to lead the Health Service Executive (HSE) with both hands. “The opportunity to lead a country’s health strategy was too much,” he says.
Corbridge says he inherited an initiative that had already made progress. The eHealth Ireland Strategy was published in late 2013, which created a long-term vision for the health system, supported by a digital infrastructure. Corbridge and his colleagues started working on implementing the strategy after his appointment in December 2014.
The resulting Knowledge and Information Plan provides a defined structure to deliver results, a roadmap for the expected benefits to be released and governance to ensure delivery is managed effectively. Corbridge received clinical input on the plan in early 2015. Movement through the various staging posts of the roadmap is now being made.
“You’re talking about a series of long-term programmes, but all the key initiatives are now off the ground,” he says. “The platform for delivery has been identified. We now know what we’re going to be working on for the next five years. What we’re talking about is the complete restructuring of the organisation.”
Taking the best of local developments to the national level
Corbridge says progress on planning and strategy has been accompanied by interesting, small-scale initiatives. He points to changes that had already been pushed at the local level prior to his appointment. He says the lack of a national IT strategy in Ireland means individual areas have often taken the lead, creating small centres of excellence, citing the electronic general GP referrals pilot in Cork and Kerry as a great example.
In comparison to the previous manually intensive process, the e-referrals system creates integrated information flows and provides reliable analytical data. Corbridge visited Cork early in his tenure and noted the achievements of the small project team, especially when compared to the 100-plus staff working on the NHS England e-referral project.
Success in Cork and Kerry means the pilot is now being rolled out on a national basis. The countrywide e-referral project is set to complete within the next 12 months. It is a model for development that Corbridge intends to replicate. “What you should do is take the best from established centres of excellence and to roll out the benefits elsewhere,” he says.
Yet while Corbridge is keen to make the most of great initiatives at the local level, his long-term aim is to create an integrated, cross-nation approach. While small-scale pilot initiatives can provide benefits to a select community, the aim of his IT strategy is to create benefits for the entire population.
“We must stop doing so much stuff locally,” he says. “The aim must be to do something once, to do it well, and to then replicate that successful approach everywhere.” To this end, Corbridge and his team currently are working across a series of strategic programmes.
Putting the foundations in place for digital delivery
One of the key elements so far has been workplace re-organisation. To support the creation of a national approach to digital healthcare, Corbridge is creating central pools of talented IT professionals. Key developments include a unified helpdesk, a single project management office and a core service management centre.
“It’s helping us to get a better grip over our human resources,” he says. “Rather than being based around local delivery, we’re creating national capability and delivery models. We’re putting the building blocks in place to create digitally enabled change.”
Corbridge says the aim is for the population of Ireland to benefit from access to a digital healthcare system by 2020. “Without technology and innovation, you can’t provide great services to patients,” he says. “What we’re determined to demonstrate is that the digital transformation taking place in modern enterprises can also be applied in the healthcare sector.”
Overcoming the resourcing and funding challenges
Corbridge recognises that reaching such an impressive target will be no easy task. Healthcare IT is often viewed as a bit of a problem child when compared to technology transformation projects in other sectors, particularly in the public arena. The NHS Programme for IT, for example, was notoriously problematic and received a great deal of media attention.
Such high-profile projects can make it difficult for executives to successfully argue the case for change. Corbridge says two key barriers become apparent immediately. “It’s all about resourcing and funding,” he says, acknowledging the fact that project sponsors want to see value from what can be an expensive process, both in terms of cash and time.
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The plans will take at least five years to implement and require significant investment, totalling hundreds of millions of euros. Research suggests Ireland has historically spent just 0.85% of its health budget on IT, compared with a European Union norm of 2-3% per year.
“What we’re trying to push is a hugely significant alteration in approach,” says Corbridge, adding that the healthcare system in Ireland is going through a broad transformation, of which technology plays just one crucial element. “We’re trying to build change on top of change, which is never going to be easy. But time is of the essence – and we must convince people of the power of transformation.”
Benefiting from enthusiastic clinician support
Corbridge is receiving great support in important areas. Clinical engagement, for example, is extremely high. While IT professionals have sometimes struggled to find buy-in from on-the-ground healthcare providers, Corbridge and his colleagues have been overwhelmed by the strength of support.
The Council of Clinical Information Officers has been established to provide governance and guidance. Since starting in May 2014, more than 75 volunteer clinicians have signed up to the initiative. Corbridge says their diverse experiences and perspectives represent a crucial support.
“It’s really important to get strong clinician input because it helps you make sure the technical aims of the project are grounded in reality,” he says. Corbridge suggests possible explanations for the high participation of clinicians, especially compared to some of the projects he has previously witnessed in the UK, are regional variability and senior support.
“Clinicians are empowered to try things locally in their centres of excellence in Ireland,” he says. “That leads to enthusiasm and a belief that, if they are successful, their efforts might lead to a national initiative. People get to see the benefits of IT quickly.”
Searching for the right level of third-party support
The preparedness to embrace innovation is also manifest at a national level. Corbridge says Ireland is now a “very tech-savvy” country. Major technology firms, such as Amazon, Google, Apple and Facebook, have established European bases in the country. “Having an awareness of the importance of IT to the economy really helps,” he says.
Corbridge is tapping into the wealth of technical knowledge as he starts to deliver his plan for change. The HSE is working with a range of IT industry partners to help deliver healthcare services. Infrastructure support in various flavours, for example, comes from EMC, IBM and Microsoft. When it comes to healthcare systems, the HSE is using a series of specialists, including McKesson, CSC and Oracle.
“Rather than simply relying on one company, we’re working with best-in-class providers across a broad range of areas and then doing a lot of the integration work ourselves,” says Corbridge. “People are engaged in the project and we’re learning lessons from transformation projects in other countries and sectors. Our approach has been phenomenally successful so far.”