History of the CCIO – who, what, why, and where?
The rise of the Chief Clinical Information Officer (‘CCIO’) as a recognised role within the NHS has been the most influential change in how technology is applied to healthcare in the last 20 years.
As recently as the early 2010s, it was rare to find practising doctors who also pioneered digital healthcare. Developing and improving the use of technology was often seen as eccentric by NHS colleagues, who viewed the doctors pursuing it as harmless cranks.
However, such doctors were also often seen as “good with computers” and rapidly became familiar with colleagues asking them for advice.
The forerunners of CCIOs
There were formal opportunities in the NHS and some clinicians found it simpler than others. GPs, for example, found it relatively easy to trial new technology because their practices were small and they owned the business.
The major primary care systems, such as EMIS’ Electronic Patient Record (EPR), were all coded by pioneering GPs. Doctors working in secondary care with similar skills, however, didn’t have the same opportunities.
‘Computerisation’ in hospitals often consisted of putting large mainframe computers in the basement to process administrative data. Although some trusts succeeded in this wasn’t recognised at the regional or national level.
Nonetheless, these pioneering individuals were the forerunners of the modern ‘CCIO’.
The National Programme
The digital maturity gap between primary and secondary care worried the Blair Labour government who, in 2002, launched the National Programme for IT (NPfIT). This was, at the time, the largest public sector IT programme ever attempted in the UK, and had the aim to bring NHS information technology into the 21st century.
Much has been written about how local innovation largely halted in the face of such a large-scale national programme. A few heroic figures tried to avert disaster but, in retrospect, too much emphasis was placed on big technology companies, and the role of clinical experts was overlooked.
As the NPfIT drew to a close, most health care providers had made little progress, and the idea of digital transformation was largely discredited.
The CCIO role emerges
However, at grassroots level, change was brewing. People who disappointed by the National Programme nonetheless felt it was a missed opportunity, not a bad idea, and were keen to take the good ideas forward.
They latched onto a small, but vocal, website known as ‘e-Health Insider’ (now Digital Health), who had begun to socialise the US concept of a ‘Chief Medical Information Officer’ (CMIO). This was a senior doctor responsible for overseeing the design and operation of clinical technology.
The term ‘Chief Clinical Information Officer’ was soon coined and the EHI CCIO Campaign to lobby for “every NHS provider organisation to appoint a CCIO to provide clinical leadership on IM&T projects.” Unlike CMIOs, who were senior medical staff, the CCIO was intended as a role anyone with a clinical background could fulfil.
The rise of the CCIO
The campaign proved successful. People began to turn away from the NPfIT’s failures to look ahead. The promise of CCIOs was to bring clinical leadership to the fore and, through doing so, ensure every aspect of technology applied to clinical work was driven by those with a clear understanding of need.
Moreover, the CCIO could use their clinical understanding to engage staff at large. And, thus, improve engagement compared to the NPfIT.
While an interest in technical matters was clearly desirable to the new CCIO role, it wasn’t essential. The most important skills were in communication and managing change. Some described the CCIO as akin to a translator, responsible for explaining clinical requirements to IT staff, and articulating IT concepts back to clinicians.
The CCIO Network forms
This new group of CCIOs began to naturally join networks, which were nurtured by eHI. An active discussion group sprang up on Google Groups which, over time, matured into a mature web forum.
These communities were further bolstered by conferences and day events, with the first Summer Schools held in 2012. These have continued to the present day.
eHI also mounted a formal campaign for every NHS Trust to appoint a CCIO and, as part of this, the Secretary of State for Health formally launched the CCIO Network in March 2012. As interest grew, more NHS organisations launched large implementation projects and appointed clinical staff into leadership roles.
The Wachter Report
An important milestone was the 2016 publication of ‘Making IT Work’, popularly known as The Wachter Report. Bob Wachter, an American physician and internationally-recognised expert in digital healthcare, was invited by the Secretary of State to review NHS IT and make recommendations for further change.
Three of his recommendations relate directly to the workforce, recommending a national CCIO be appointed, as well as developing a workforce of clinician-informaticians, and investing in digital literacy among the broader workforce.
A national CCIO was appointed, and there followed a rapid series of reorganisations, including the brief existence of NHSX as a central organisation leading digital transformation. The national CCIO role continues to exist, but is currently vacant.
Education and Training
Wachter’s recommendation to develop a digital workforce has been pursued more unevenly, although the NHS Digital Academy was established and offers a few training places on a Digital Health Leadership programme.
Other schemes, such as the Topol Fellowship, also offer a training programme but, again, places are limited. The main requirement for working in digital health remains enthusiasm for the subject, with informal help and support available through the Digital Health networks for those at all stages of their careers.
The CCIO role today
The role of CCIO has become increasingly well established. While not every organisation has a formal CCIO position, it is now increasingly rare to find NHS Trusts without clinical leadership of systems and technology in some form.
For those with a passion for digital healthcare, now is a time of opportunity for developing a career, as the CCIO develops into one of the most important clinical leadership roles.