Interview Series: Graham Walsh, Consultant and CCIO at Calderdale and Huddersfield FT

Calderdale and Huddersfield NHS Foundation Trust (CHFT) is widely regarded as digitally mature and well known for embracing the latest tech and innovation.

To find out what they’re up to at the moment, and why digital works for them, HTN arranged a chat with Mr Graham Walsh, CHFT’s Chief Clinical Information Officer (CCIO) and a consultant in knee surgery.

When he spoke to us, Graham had already had an interesting day, having been mistaken for a television presenter: “Obviously because of COVID we’ve been ringing a lot more patients than we used to – so I just rang one patient up and she said, ‘Love is in the Air’. She thought I was [from] This Morning, doing a competition.”

His voice for TV aside, here Mr Walsh tells us all about what keeps CHFT at the forefront of digital innovation, and their latest projects, as well as how he became interested in the digital side of medicine.

How did you become a CCIO? What drew you to digital?

“When I saw the job advertised, the first thing I had to do was Google what a CCIO is, because it wasn’t clear to me. I was probably an unusual choice because at Calder and Huddersfield, I think we’re quite digitally advanced.

“We went ‘big bang’ with our electronic digital record about three years ago or even four years ago now. When it was live, I remember the CIO was in clinic with me and it wasn’t going so great…back then I was a surgeon [in my main role] and I was saying ‘this is a real big mistake’. I was quite…not anti…but I wasn’t really accepting of it.

“That led to a conversation with the chief executive and, actually, I gave it a real go and very quickly I realised that the electronic record was a really good thing for patients and clinicians. And I became a real advocate for it.

“When the job arose, I just thought it worked for me and I’d seen the benefits. Part of my day job within knee surgery was looking at efficiencies and improving outcomes and I could see how using technology can help to do that.

“The reason I took the CCIO is to kind of embed some of that thinking, get rid of some of those naysayers…and put them on the same journey I went on to realise that technology is beneficial to us as clinicians, but more importantly, to patients as well.

“It’s been really interesting to see two sides to healthcare…particularly with COVID…one of the few benefits we’ve seen is this digital expansion, accelerated learning and adoption. To have been part of that is really important…it’s been really enjoyable in a weird way.”

What do you think makes Calderdale and Huddersfield digitally advanced when compared to some larger trusts?

“I think big teaching hospitals…always have a reputation of excellence. [But] it’s very difficult to get adoption very quickly, to change processes.

“Whereas places like Huddersfield and Calderdale, we can be much more agile. We went with one of the big players in EPR [electronic patient records], Cerner, and what that meant is we went ‘big bang’.

“We went with Bradford [Teaching Hospitals NHS Foundation Trust] and had a joint venture with them – we shared domains, so we shared the build. Not only does that reduce costs but it means you’ve got a bigger team that can make changes.

“It’s not without its challenges – governance has to be matched between two organisations which are very different, but I think being a smaller organisation allows you to be more agile and you can introduce things. You tend to get a much better staff buy-in…adoption is much easier in a smaller organisation.

“We’ve also been very lucky in that our chief executive is very digitally mature. It’s all well and good bringing in an EPR and digitising processes but the board, the senior management level, have to be there with you.

“That’s allowed us to progress and we’re now a Digital Aspirant trust [a programme intended to accelerate the procurement, deployment and uptake of technology].

“What we recognise is that there’s an importance not only in progressing the digital process, but [in] being one of the leaders, so we can blueprint for others. We can show what improvements can be made to both clinical and patient care and the way we work.

“We’re a trust that companies come to when they have new tech they want to try, we have a transformation team that are constantly trying to evolve…reputation isn’t thrust upon us, we’ve got to build our own.”

You told us previously about your ‘virtual visiting service’ – how’s that going?

“We started very early in the COVID pandemic. We realised that we needed a solution quickly, to allow patients to see their relatives. We used the Microsoft Bookings app, because we’re one of the partners of Microsoft and we’re in the development sphere, so we get things very early.

“We teamed that with Teams on the device, so we were able to have a central system where patients could book an appointment and we could then have a team going out.

“We’ve since had 8,000 virtual visits and we’re doing 150 a week. So, it’s something there certainly was a real value [in]. And some of the feedback, although sad, has been great…for relatives to have that opportunity to say goodbye.

“Challenges were that there were issues with infection control; we couldn’t be giving devices out to all patients – they had to be cleaned, we had to have a reliable system and a process in place for bookings.

“We looked, first of all, for devices that we could use and we found the Zebra device… [which is] multi-functional but it can be cleaned. It was COVID-secure, if you like – once a patient had a consultation you could clean it between [patients] so you weren’t risking transmission.

“It’s a small device, which in itself can be a problem for older patients when they’re seeing family members on a small screen. We’re currently looking at much larger devices now from Zebra, to allow us to do that.

“I was doing a ward round and saw an older lady on an iPad and she clearly couldn’t see the text – so rather than doing what we would do and get her fingers and swipe it, she was there with a magnifying glass. It summed it up for me how older people are embracing technology, but they aren’t quite there yet.”

What’s the latest on the digital knee rehabilitation pathway and app?

“The UK average is that patients stay for one to three days in hospital, following a knee replacement. We put a pathway in place that would allow patients to go home on the same day. We used wearable technology as a way of monitoring patients in the post-operative phase.

“Going into COVID, we’d finished the first phase of the pilot and realised how it brought in massive cost savings, it reduced the amount of therapy input we needed and also had a real improvement to patient satisfaction and outcomes, because as a patient in pain at home it’s very difficult to know how you’re doing. But this set goals for patients.

“What we’re finding now [is] any pathway needs to reduce the amount of contact points with healthcare. Using an app and a wearable means [that] physiotherapists can get much richer data.

“In the post-COVID phase, we’ve now gone from about 30 per cent as day cases to about 90 per cent of patients, so we’ve had a real increase. Patients have changed as well, patients don’t want to be in hospital. They’re embracing technology in a way to allow them to get home.

“I want to get to a truly digital knee pathway – from the beginning to the end. Some of the original consultations where patients come into a joint school, that can be done virtually, or through video tutorials. Using augmented reality they could have a physio in a room with them.

“I want to get to a point where patients can be managed remotely but feel as though you’re part of their care. What we found is this technology made the patient feel closer to the team. Even though they were going home early, they felt part of that team because we were in touch with them digitally.

“I often say, technology is not a cold thing; technology can be used to make people feel as though you’re monitoring them, you’re close to them.”

And what about your work with voice recognition?

“Voice recognition is not like some tech, where you’re replacing something you already have with something new…voice recognition is to try enhance something you already have, to stop people using their fingers, in a way.

“That’s really hard because, although voice recognition when fully adopted offers massive benefits to staff [by] reducing time seeing patients, getting staff adoption has been difficult. It’s been slow progress and we’re still working through that. As we adopt voice recognition, we’re looking at ambient technology as well, with listening, which may supersede that.

“For some of the projects we’ve done, voice recognition has been tricky; the technology is good, the integration is good but getting adoption in the pandemic phase, particularly with social distancing where we can’t be hands-on with staff, that’s been one of the tricky ones. But beyond that, the benefits are huge.”

Is there anything else you’re working on at the moment?

 “Something else we’re keen on is our video consultations. We use Microsoft Teams… [it’s not a great] experience for patients. They’ve had to download the app themselves.

“What we’ve been lucky enough to do is, we’ve teamed up with one of Microsoft’s partners, a company called Andor from the [United] States. We think we’re one of their first UK partners.

“Their bot, in a way, is an interface between our EPR and Microsoft, so it could be piloting a much more agile video consultation, which works with our past system so the clinician can initiate the consultation from the clinic list we already have in our EPR.

“It’s a web-based browser so the patient doesn’t need the app…it has a virtual waiting room, which I think Microsoft really lacks. So, this bot sits there and gets rid of the issues we’ve faced in the early stages with our video consultations.

“The Andor [bot] is a really exciting moment for us. It really will enhance the patients’ and the clinicians’ experience and massively reduce some of the administrative time spent booking appointments and setting them up, because it will automatically do that.

“One of the few bits of paper we have left at our trust is consent. We’re going through an e-consent process; not just an electronic consent, a virtual consent. That can only enhance some of the virtual consultations we’re doing.

“We’ve [also] done a big bit of work using an Mpage within our electronic record, where clinicians can now identify the priority level of a patient and we’re now putting in automated processes so the patient can get the appointment at the right time. It’s a requirement from the NHS, but I think we’re one of the few trusts that have an electronic solution to clinical prioritisation of our patients.”

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