In conversation with… Lisa Emery, CIO at The Royal Marsden NHS Foundation Trust
Lisa Emery has been CIO at The Royal Marsden NHS Foundation Trust since 2018, , overseeing a comprehensive programme of digital transformation. Prior to that, she was CIO at West Herts NHS Foundation Trust for four years, and spent a number of years in healthcare IT including on the National Programme for IT in London.
Lisa started her career as a Biomedical Scientist, which she did for four years. In this piece, we spoke to Lisa about her “bonkers” journey to CIO, why the NHS’s paperless vision is unrealistic, and the one thing the NHS can do to make digital a reality.
Lisa was interviewed in June 2020 - this piece was originally published as subscriber-exclusive content.
What does your role entail and how did you get there?
“My job is to look after all the digital requirements for The Royal Marsden NHS Foundation Trust. So that runs all the way through from basic infrastructure, like the support desks and all the kit that goes with this, all the way to delivering clinical systems, integration, and applications right across the spectrum and supporting research teams with digital innovation. It’s a very broad ranging and transformative role. I look at what the business needs are and work on translating those into the technology that is needed to deliver those goals and services. That's the ‘what’, and the ‘how’ is a bit bonkers because nobody gets to a CIO post the same way I think it's fair to say!
“The ‘how’ is a bit bonkers because nobody gets to a CIO post the same way I think it's fair to say!”
“I actually started out in medical microbiology and was working as a biomedical scientist for about 12 years. I got interested in IT whilst I was doing that and slowly moved through programme management roles. At one of the trusts that I was delivering IT solutions for, the IT director was retiring so I took on that role alongside the other role and then when that organisation created a CIO post I went for it. That’s a potted history of how I got into it, but it really came from expressing an interest in IT early on in my career, which then grew.”
How has your role in the trust adapted in the face of the COVID-19 pandemic?
“It's certainly has had a really significant impact. In terms of changes to my role specifically, we were very fortunate to have had a big investment in technology and a whole set of plans already in place to deliver new devices, and tools like Office 365. We were part way through these projects at the start of the pandemic and we were lucky to be able to just accelerate them. We rolled out MS Teams at scale. We helped with supporting the migration to virtual appointments, which allowed people flexibilities like working off-site.
“I think what was really interesting is that we managed to deliver those services whilst working remotely and using our own toolset to best effect. It was challenging and it was difficult, but having the opportunity and a way to do it actually enthused the team, and we were all much more connected to the pandemic response as a result. I think what we've seen as an outcome is that all clinical and operational engagement has continued to prosper, and that’s been quite a unifying thing in a lot of ways.
“It's a side effect of a very unfortunate time, but it really accelerated some of our digital transformation.”
“We made a conscious choice not to introduce a whole load of change with new systems, which sort of stabilised what we already had in place. Now we are pretty much through the provisioning of those kinds of tools and we're trying to get our attention back to some of the more strategic projects we had that we wanted to start working on before the pandemic. It’s been incredibly busy and difficult for absolutely everybody, but it has accelerated a lot of what we wanted to do.”
What is the biggest barrier you face in your role as CIO when implementing new technologies?
“The main barrier is often fear of change. Interestingly, the initial COVID-19 response has helped with that.”
“Where there might have been some resistance to training on new systems or tools, now everyone has to. The cultural shift that you make when you change ways of working is undoubtably the biggest factor. Because some of that was forced upon us, people have realised that some of those changes aren't quite as terrifying or nerve wracking as they might be. And that's partly necessity that makes you adapt.
“It’s not necessarily the way I'd recommend doing large scale change, but it has demonstrated to people that we can adapt quickly and we can change our ways of working without having a negative impact on on the care that we give to patients or the way that we interact with staff. For example, MS Teams meant that our staff were sometimes catching up and checking in with each other more often. These are things that I didn't necessarily expect to be byproducts, but they've been positive.”
In your experience at other trusts, how do the barriers to change differ?
“I think it can differ. If you look at somewhere like the Royal Marsden, there's always this excitement to change and become more cutting edge. But to cut down barriers, quite often it's about taking time to demonstrate reasons to change and understanding why we're doing what we're doing, rather than a lack of desire to want to do something.
The Royal Marsden, for example, has got a reputation for absolutely outstanding patient care.
“So, there are sometimes barriers in terms of thinking about… ‘why would we want to change things we are already doing fantastically well?’ So then the narrative is more about what more you can do, and how much more you can offer.”
“For example, what more can we do around supporting researchers or increasing our capacity to see patients? The dialogue is different across organisations and the drivers are different, but that cultural change and the reasons why you're doing something is always quite challenging.
“With the pandemic, one of the positives we saw was around procurement and the length of time it takes to get systems in place. We got help to accelerate that but we were particularly cautious that was not to just take a change for change’s sake, and not accept what felt like potentially free software or something like that without really thinking through the implications. We didn't just jump to decision making because we're so careful about what we're doing, thinking about patient safety and security.
“Every CIO you talk to will say this, but there's now an element of work for us all just to make sure that we go back around the decisions that we've made and make sure that they are the right ones.
What do you think about the goal of a paperless NHS?
“It's been a goal for quite a few years now but the reality is you're never going to have a scenario where there's no paper in the NHS, are you?”
“To me it's more about striving to reduce that administrative workload, as much as we possibly can, and digitising in areas where there will be massive benefits such as having proper integrated digital records in one place with high quality data standards. So if that means we end up with a paperless organisation, we will be delighted, but to me that's more of a driver than achieving a target for the sake of achieving a target.
“Particularly working in a research heavy organisation, data is king and what we do with our data, it changes lives.”
For me, that is as big a goal - high quality data integrated and available to clinicians absolutely everywhere it's needed, and supporting patient care and research.”
Which of your digital projects do you see as the highest priority and why?
“We had a really ambitious five year strategy, which we are fair amount of way through. We're just closing out on some really important projects which are probably less visible to the clinical teams and are around becoming future proof for all the great work we want to do.
“It's getting that done and having a really good state of the art infrastructure to support the trust. Data warehousing within the research environment, for example, we have a lot of work going on to make sure we've got the technology for our research and our new electronic patient record with a view to getting running and starting in this calendar year as well.
“We have some other pieces around some of the more innovative work. So, again, supporting clinicians and researchers, summarising and moving to a very high quality infrastructure to now starting to exploit that infrastructure with new technology. The final area is making sure that we're really working in the organisation. So we're getting good at using Teams but we're not really exploiting all of the functionality that it has to offer.
“I really don't think COVID-19 has changed our overall strategy. It's probably given us a little bit more leverage and acceleration in some areas and maybe made us think slightly differently about how we best support the organisation.”
But I think fundamentally that the strategy that we have is the right one and continuing to follow it. think we're broadly probably on track with where we thought we would be.”
If the NHS could do one thing tomorrow to make digital a reality, what do you think it should be?
“I'm in a really lucky position because I've got really great support to deliver for this organisation, but I'd like to see that sort of equality of digital maturity and spend right across the NHS.”
“When you start talking about interoperability and sharing the verticals, it is more of a reality because everybody's starting from the same sort of level playing field - and that's what I’d like to see. There is quite a difference between organisations in what is deemed possible. If you're looking at system wide record sharing and strategies, everybody needs to be a good base level to be able to do that.
