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CIO interview: Christine Walters, director of informatics, St Helens & Knowsley NHS Trust

St Helens and Knowsley Teaching Hospitals NHS Trust’s director of informatics, Christine Walters, talks about running a health informatics service, the importance of understanding how people on the front line work and managing expectations

Christine Walters has a passionate desire to use technology to improve the day-to-day operations of her healthcare organisation and the patients it serves. As director of informatics at St Helens & Knowsley Teaching Hospitals NHS Trust, Walters reports to the chief executive and manages the IT budget for a number of bodies.

“I can honestly say that I don’t know what each day is going to bring,” says Walters. “The position has its challenges but it’s an honour to be in this role because you have the opportunity to make a difference. I’m not here to deliver boxes, wires and technology. I’m here to help doctors and nurses provide the care that our patients deserve.”  

In her role, Walters manages a shared informatics service that provides technology to a range of organisations, including two hospitals, a mental health trust, GP practices and local councils.

She was appointed to her board-level role at the end of September 2015. After starting her career in the private sector, Walters, who originally trained as a computer programmer, moved to the NHS and most recently spent several years in IT leadership roles at Pennine Acute Hospitals NHS Trust before moving on to St Helens & Knowsley.  

Her overall responsibility is to lead and develop an effective health informatics service, which supports 14,000 users across 155 sites. “It is a very unusual role in terms of the NHS,” says Walters, referring to her role as a healthcare IT leader and her position in the trust.  

“Running a shared service and being on the board is not a position that many of my peers hold. It gives me an opportunity to understand the priorities of the business and the rationale of why decisions are made. It helps me do my job much more effectively because I understand how to align technology with the wider aims of the organisation.” 

Walters’ ability to interact with the wider trust is not just restricted to her role in the boardroom. In her job, Walters regularly visits hospital wards with a non-executive colleague and meets clinical staff. She is also an executive on-call and can be asked to help in high-pressure healthcare situations. 

“It keeps your feet on the ground and allows you to develop an understanding of staff priorities,” she says. “It’s very easy when you run technology to get disconnected from day-to-day realities. Taking part in the activities of the hospital really helps me to understand my job better.” 

“Running a shared service and being on the board is not a position that many of my peers hold”

Christine Walters, St Helens & Knowsley NHS Trust

After two years in charge, Walters says her key achievement is introducing technology that helps clinical staff spend more time on patient care. To deliver IT effectively as a shared service to multiple organisations, she puts significant emphasis on the importance of customer service among her team, and the strategy is paying dividends. 

“We are here to support our partner organisations to deliver clinical care,” says Walters. “We are getting feedback from our partners and customers to say they have noticed a marked improvement in the last couple of years in how the team responds.” 

Positive feedback is not restricted to staff. Walters says she occasionally receives email and post from patients praising the IT team for providing doctors and nurses with up-to-date information. She also points to improvements in cyber security, emphasising that data defence is a big priority in the NHS, particularly in the context of the WannaCry ransomware incident. 

“We have developed a cyber security response plan, we put that into action and I got a huge amount of satisfaction from the fact that we were one of the first trusts to come back online,” she says. “We weren’t infected in any way and the IT team responded well. Making sure the service is robust and fit for purpose has really helped.” 

Managing expectations

Walters says the creation of an effective shared service is not just about business benefits – close integration creates plus points for patients, too. “It’s very easy for clinicians to share information about individuals, whether that’s in the community or in the hospital,” she says.

“This means that when patients move between different healthcare organisations, they are not necessarily aware this transition is taking place. 

“We provide the same front-end services for patients to use and we can direct messages, so we can send targeted information to people across the various organisations that make up the health economy. It allows everyone in the service to do things they couldn’t do if they were part of separate organisations.” 

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Walters gives the example of an ongoing smart apps project. She is currently creating a business case for funding to set up a team to help develop clinical software for smartphones and tablets. She says this type of innovative thinking is possible because many organisations – rather than an individual hospital, for example – are working together across the trust. 

The partnership approach of a share service provides a means to source funding in a constrained economic climate, she points out. 

“There are lot of potential benefits from collaboration,” says Walters, adding that Microsoft has selected the trust as one of 12 NHS organisations it will work with closely on an ongoing basis.   

But although the partnership approach works well, there can be challenges. It can sometimes be difficult to establish a broad consensus across the trust’s range of individuals and organisations. In these instances, effective leadership is more essential than ever – and Walters continues to hone her technique. 

“I manage IT budgets across the trust, but everyone wants to know that they are getting value for money and are getting a fair share based on their contribution,” she says. “It is an unusual role for a CIO, but in terms of personal development, I have learnt an awful lot since taking up the position.” 

Digitising patient records 

Walters has continued to make rapid progress in terms of digital transformation during her two years in-situ. She says the strategic aim of the shared service is to create a customer-focused approach to informatics that provides agile, innovative systems to improve organisational efficiency and support the delivery of first-class patient care. 

One of the key technologies supporting this strategy is an electronic document management system (EDMS). The trust first implemented a customised version of CCube Solutions’ EDMS in 2010, becoming the first NHS organisation to stop using paper records in operational practice.  

The system supported the digitisation of medical records, which could then be served electronically to clinical staff. About 130,000 medical records were digitised at the time, producing £1.4m in annual savings for the trust following an initial investment of £1.2m. 

Walters has recently overseen an update to the latest version of CCube Solutions’ EDMS. The re-architected system introduces support for mobile and tablet devices, includes additional workflow methods and enables closer integration with the trust’s other IT systems. These platforms include a new Medway patient administration system (PAS) from System C, for which the trust signed a 10-year contract in July,  and an electronic observation system.  

“Technology really makes a difference,” says Walters. “Having a system that is fit for purpose is about making sure the clinicians want to use the technology and making sure it meets their needs. If the technology doesn’t help a doctor or a nurse, they won’t use the systems you provide. What I can say is that everyone here uses EDMS and they’re very happy with it.” 

Pushing further change 

In terms of ongoing projects, Walters and her shared services team are currently running a telehealth and unified communications initiative. The project, which provides video conferencing for outpatients, is being backed by funding from the Innovation Agency. The trust is running two pilots, one for stroke patients and one for burns treatments. 

The technology set-up will mean patients can receive consultancy without having to leave their homes. The trust is using Cisco teleconferencing technology to run outpatient clinics. Patients can use their own devices and an application, such as Skype, to communicate with healthcare staff.

“People are looking at this initiative with great interest,” says Walters. “It provides a way to formalise how patients and doctors interact through advanced technology. We are holding proper clinics, so people will book in using this technology, they will be able to see and talk to a receptionist, and then they can speak with the doctor.” 

Walters also points to other key achievements. The trust has already introduced an electronic prescribing system, from specialist supplier JAC, and an electronic modified early warning system, which alerts clinical staff to patients that require priority treatment. Walters is also leading the introduction of a new electronic order communication system, through which clinicians request investigations, such as radiology images or blood tests. 

“There has been a massive amount of change since I arrived,” she says. “We have also had to modernise the service and provide a much sharper focus on customer service. The good news is that we’re managing that level of change successfully because we have such strong clinical engagement.” 

Embracing the future

Walters continues to ensure that key systems, such as the new patient administration system, are bedding down successfully. During the next 12 to 18 months, she expects to turn to clinical systems and is keen to establish a shared care record, which will allow healthcare professionals in the trust to share information securely with local authority bodies, such as social care groups, housing authorities and voluntary organisations. 

“We want to go a lot further and introduce systems that help support the way citizens and patients are looked after in St Helens,” she says. “We want to help create a one-stop shop for all the services our citizens require. And that’s where things start to get exciting – we’re talking about true transformation. 

“I want everyone to have access to the right information about a patient at the time they need it. And I want our customers and partners to say the technology delivered has really made a difference to patient care.”

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