Consultant Clinical Oncologist

The implementation of electronic health records in hospitals is an exciting but also a daunting experience for most clinicians. The prospect of a new system which contains all the information about patients in one place, fills every clinician with a feeling of hope and security, as it promises to reduce administration time, duplication of work and the fear of patient misinformation. At the same time, the radical change from a system of handwritten notes which can be kept and retrieved from file rooms years after they were first written, to digitally archived notes kept in ‘clouds’ can lead to anxiety for many clinicians, especially the ones who are less tech savvy.

A similar divide probably exists amongst patients who are also the end users of their own health files. Electronic health records enable patients to see pretty much what the clinicians can see in the hospital, through the use of patient portals.Information such as booking appointments and test results as well as medical reports can now be visible to patients from the comfort of their own home. Some patients will find readily accessible digital information helpful for them to manage their own health. Others may struggle to navigate the digital tools or may find their detailed information distressing,unless explained by their doctor.

The clinician’s involvement in digital transformation and e-health record implementation can vary according to the organisational culture and power dynamics: from an early and continuous clinician involvement throughout the digital process, with clinicians implementing and owning the digital change, to a bystander clinician relationship with digital transformation.

Scenario 1 –Digital transformation as a Clinician Affair

Early clinician engagement and involvement in the design and strategic direction of hospital digital programmes can create a sense of ownership and belonginess amongst clinicians, which can spread across all levels of the organisation.

• Clinical leaders and champions of digital programmesoften play the role of middle-level managersand ‘bridges’ between the executive team and the front-line adopters of digital innovations, ensuring that communication about the vision and benefits of digital transformation programmes is consistent and unified.

• The clinical leader and digital champion involvement in the technical design and implementation of new technologies as well as in the training of peers within the organisation, can be instrumental in catalysing technological adoption across all organisational levels and ensuring that data is managed in an organised and safe manner.

• Clinicians are best placed to drive patient engagement in an attempt to co-design aspects of the new technologies such as patient portals, ensuring that clinician-patient communication is optimised and data flows are safe and meaningful through the useof such digital tools.

The digitisation of health records can be considered as a ClinicianAffair in this scenario as it is shaped and driven by clinicianswho are championing digital innovations, with the intention of changing how clinicians work for the better.Through the broader adoption of such technologies by clinicians, improvements in process and cost efficiencies, patient safety, as well as end userexperience can more easily materialise. Clinicians are more likely to gain confidence in the organisational innovation capabilities and continue to innovate and generate research from data analytics in all service areas.

Scenario 2 –The Clinician as Bystander in Digital Transformation

The opposite scenario of the clinician as a bystander throughout the digital transformation process, can lead to different implementation outcomes, based on the organisational and clinician attitude to innovation.

"Early clinician engagement and involvement in the design and strategic direction of hospital digital programmes can create a sense of ownership and belonginess amongst clinicians, which can spread across all levels of the organisation"

The combination of an entrepreneurial organisational culture and a critical mass of clinician- innovators and early adopters, can lead to the successful implementation of digital technologies without much effort from clinicians. The opposite is true for organisations without innovation and commercial capabilities and whose clinicians are late adopters of innovations. If clinicians are alsodisengaged throughout thedigital transformation process, then the risks are multiple and include:

• Delays in the delivery of the digital programme;

• Implementation of digital technologies which don’t serve the purpose of the service they are intended for (project failure);

• Increasing costs from last minute systems additions and reconfigurations;

• The failure of patient pathways to serve their purpose, potentially introducing patient harm risk (programme failure).

If clinicians are not engaged early in the digital transformation process in this scenario, they are likely to lose trust in the organisation leadership capabilities and also lose their opportunity for their practice and their patients to benefit from digital technology. Late adopters and laggards are more likely to display disbelief in the digital programme benefits which is why early engagement is key for such clinicians. Clinician autonomy and enablement through targeted education and training in change management, digital strategy and implementation skills can go a long way in ensuring that organisations deliver a safe and effective collection of digital technologies. The role of external providers and delivery partners with experience in change management and the delivery of complex programmes could be invaluable in this scenario.

If we are debating whether electronic health record digitisation is a Clinical Affair or a Clinical Bystander, the answer is rootedin the organisational culture and values.

The safest route to success in digital transformation is undoubtedly, in our opinion, through clinician ownership and bottom-up methods, rather than having clinicians as passive observers in digital transformation.