HTN caught up with Daniel Ray, CTO at Birmingham Women’s and Children’s (BWC) NHS Foundation Trust, to learn more about what went into the development of the trust’s new digital strategy, covering key points, ambitions, and hopes for the future.
“I’ve been in the NHS around 28 years,” Daniel told us, “and in that time I was national director of digital for NHS Digital, I worked in commissioning, in primary care, with a regulator, I was CIO at a very large university hospital for ten years, and I’ve been at BWC for the last six years. I’m also doing a lot of research, and have been a professor at UCL for 11 years, as well as doing quite a lot of work internationally in places like Australia, Saudi Arabia, the US, and Italy.”
More recently, his main focus areas have included data governance, EPR implementation, and informatics, Daniel continued. “BWC went live with Epic in May of last year, which was an unbelievable feat that was three or four years in the planning and a huge team effort, but it has been a massive leap forward in our digital and data setup,” he said. “The last five years has been about doing the groundwork and improving our infrastructure, and the strategy is going to help us with where to go from here.”
Preparation work on infrastructure and data
As part of this wider preparation work, Daniel and his team have been moving the trust’s mental health service away from its previous system supplier, and building on Epic’s implementation with the switching off of a “very long list” of legacy systems. “Moving forward, we’ve got this fantastic EPR in place, and we’re looking at what that now means – we’ve still got a couple of high risk legacy systems remaining that we need to remove, and some large-scale infrastructural changes to make.” That includes moving systems from Windows 2016 once it reaches end of life in January 2027, and strengthening the trust’s current cybersecurity position, “which will never end”, he added.
It’s not just the systems that have been a focus for BWC, according to Daniel. “We’ve done a lot to strengthen the people engagement side of things, including a lot of bespoke training. We’ve now got to also maximise the use of our EPR for seeing more patients, improving experience and outcomes, because we invested a huge amount of money in it. In the first seven months, 20,000 people signed up for MyChart, which is a game changer in helping patients have more information and control over their care.”
Data has been another area undergoing improvement work, Daniel explained, “and we’re now storing millions of records digitally since going live that we never did before”. That has meant that many practices across the trust have changed – “all of a sudden, drug prescriptions are digital, and the vast majority of observations have moved from paper to bedside screens”. A very recent meeting with the head of informatics on the BWC data strategy led to discussions on the need to automate the production of routine data and upskill teams, he continued, “because the skillset and mindset of people at the trust needs to change to think differently about how we use data”.
Digital strategy development and key themes
Daniel shared with us that the strategy’s presentation to the board prompted “really good discussion” and a lot of initial feedback. “There were probably four or five key things that they wanted to be uplifted a bit more, so we worked on that, and then presented a further version for their review and approval.” The strategy itself is the culmination of national policy and identified local needs, along with input from patients, clinicians, the board, and colleagues across the trust, he shared.
A key theme in BWC’s new strategy is engaging with emerging technologies such as Ambient Voice Technology (AVT), Daniel said. “We’re reviewing a business case to enable additional AI features within the EPR. I think we’re taking a really interesting approach to AI – we’ve identified specific roles from executive level to administrator, and given them some advanced accounts in AI, given them some training, and let them run with it.”
A couple of weeks later, a follow-up meeting asked participants what gains they had been able to make in their roles, forming the basis for building a framework and structure to be rolled out at BWC, Daniel told us. “We’re going to package it up, and set an expectation to use Copilot when producing certain outputs to support our productivity and efficiency programme. That’s rather than expecting them to just run with it, and ending up with this massive inequity in use of AI, where some people are just flying with it, and others might not even really understand what it is.”
The trust needs to get better at linking data to allow the tracking of patients longitudinally, Daniel said, “which goes back to making improvements for patients – we need to look at what happened after a patient was discharged, whether they came back, whether they were able to return to work or school, and what they are able to do post-treatment that they weren’t before”.
Challenges
Although there are plenty of areas of “real excitement” offered in the strategy, there remain major risks and challenges, according to Daniel. Those include some legacy systems that need updating as soon as possible. “In the strategy, we created some design principles, where we tried to tackle some of those challenges, and they’re the classic things you would expect: changing culture and mindsets, resources in terms of both finance and people, then skills, and timing.”
When looking at AI and AI business cases specifically, there can be challenges with demonstrating the return on investment, or the “route to cash”, Daniel shared, making it difficult to secure funding. “Another area that’s going to be particularly challenging is that some staff, particularly in the clinical space, are going to end up leapfrogging others,” he went on, “like with Ambient Voice Technology – early adopters could quickly overtake people who may be struggling with the more routine ways of recording care and processing orders.”
In terms of final thoughts, Daniel offered: “We’ve still got some major legacy risks to work out, but at the other end of the spectrum, there’s real excitement about the gains that are being achieved as a result of using all this new tech that has been rolled out. We’re hopeful that our recent CQC visit will report positively on how things like our new EPR are enabling safer, more effective care to be delivered.”
We’d like to thank Daniel for taking the time to share these insights with us.
