How Can Hospitals Advance Their Digital Transformation With HIMSS Maturity Models?

[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology with me, Tjasa Zajc.

[00:00:17] Hospital digital transformation is an incredibly difficult endeavor and when hospitals try to change something, they need to think about processes, equipment, change management, training of staff and much, much more.

[00:00:33] HIMSS, the Healthcare Information and Management Systems Society, is an American non-profit organization dedicated to improving healthcare in quality, safety, cost-effectiveness and access.

[00:00:47] One of the things that HIMSS does is helps hospitals advance in their digitalization effort with the help of maturity models.

[00:00:56] These are assessment questioners that position hospitals on a level from 1 to 7 on a maturity scale and they can help hospitals benchmark their current digital position and help them plan better which steps to take next to advance on their digital transformation journey.

[00:01:15] So far, HIMSS designed six maturity models.

[00:01:20] The most known to the public is MRAM for the assessment of the maturity of electronic health records.

[00:01:27] There's INFRAM for the infrastructure, MM for analytics, GM for medical imaging, CECOM for community care outcomes and CCMM for continuity of care.

[00:01:41] I spoke with John Reiner, Senior Director of Analytics for EMEA Region at HIMSS, who talked about the different maturity models, how hospitals use them, what to be mindful of in digital transformation of healthcare and much, much more.

[00:02:26] Enjoy the show.

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[00:02:30] You can find it at FODH.substack.com.

[00:02:34] That's FODH.substack.com.

[00:02:37] Now let's dive in.

[00:02:54] John, hi, and thank you so much for joining me here on Faces of Digital Health to talk a little bit more about approaches that hospitals and governments can take when they're trying to invest in the digital transformation in healthcare.

[00:03:10] You're the Senior Director for Analytics for the EMEA Region at HIMSS.

[00:03:16] And one of the main things that you do is basically work with hospitals on assessing their digital maturity.

[00:03:25] HIMSS has six maturity models, and I'm hoping that we can explain them a little bit more in this discussion.

[00:03:31] So let's start at the beginning.

[00:03:35] HIMSS, as such, is 60 years old.

[00:03:38] What's the history of maturity models?

[00:03:40] How did they begin?

[00:03:41] How do they get developed?

[00:03:44] Because you're also adding new ones.

[00:03:46] Yeah, thank you.

[00:03:47] Thank you very much.

[00:03:48] And it's great to join you here this afternoon.

[00:03:52] So HIMSS is a 60-year-old history.

[00:03:55] We're not always called HIMSS.

[00:03:57] We've had a couple of other names.

[00:03:59] But we've been using maturity models for 20 years.

[00:04:03] And in itself, that's quite an important point.

[00:04:08] Because whenever you use a maturity model, it's always important that you have a model that has a history, which allows you to look back and understand how the model's developed.

[00:04:20] But also look back at others that have gone before.

[00:04:24] So you could always find a hospital who has a similar start point to yourself, using the same system, doing the same things, and that creates a reference point.

[00:04:37] And one of the great things about the HIMSS network is that these networks and reference points are established all over the world.

[00:04:44] So it's very easy for us to connect you up with somebody who's doing the same thing as you are doing.

[00:04:52] But the other most important thing is that maturity models have a future.

[00:04:59] Because at some point, you will need to remeasure.

[00:05:02] And you will need to remeasure using the same set of metrics that you used for the initial baseline assessment.

[00:05:10] And all too often, certainly where I come from, these maturity models seem to come and go.

[00:05:16] And model's here today and he's gone tomorrow.

[00:05:19] And that's not very helpful when you are looking for the same process to measure continuous improvement.

[00:05:27] So the NRAM, for example, has been reviewed every three years in the last 20 years or so.

[00:05:33] It was last reviewed in 2022, making it fit for purpose in 2024.

[00:05:42] If I just stop you there for a bit, can we just go a step back and explain what a maturity model actually is?

[00:05:50] Is it like a questionnaire for hospitals?

[00:05:53] What kind of process is this?

[00:05:56] Yeah, so we've seen maturity models all over the world.

[00:06:00] And I rather suspect that if you were to look at any country, you would see an example of a maturity model.

[00:06:08] And often it is a survey, it is a self-assessment survey that allows the care provider to complete a series of questions that when analysed will give you an indication of where you are against a digital maturity scale.

[00:06:29] So the maturity models that HIMS has, they are all 1 to 7.

[00:06:37] And as you increase the number, you tend to increase the level of digital maturity.

[00:06:44] Do hospitals ever get downgraded?

[00:06:48] If, you know, when the models are updated, how do you manage that?

[00:06:53] Yeah, so that is possible.

[00:06:55] When we review and update a model, it inevitably becomes slightly more challenging.

[00:07:03] And as such, it is quite possible for a hospital that was previously at stage 6 to score at stage 5 against the new model.

[00:07:14] And I think people are very accepting of that because they wouldn't want a model to be updated to actually make it easier.

[00:07:23] This is about raising the bar and about having models that are fit for purpose and models that actually keep up with the rate of change in healthcare technology.

[00:07:36] You previously mentioned MRAM, which is the maturity model for EHRs.

[00:07:41] It's probably one of the models that is also most known among the public in the digital health space.

[00:07:49] I think 3,500 hospitals have been assessed so far.

[00:07:53] So can you talk a little bit more about that?

[00:07:55] How are these hospitals chosen?

[00:07:58] Do they come to you?

[00:07:59] Do you go to them?

[00:08:00] Do you track how they're doing today?

[00:08:02] So the MRAM, Electronic Medical Record Adoption Model, is the flagship model.

[00:08:12] We've used it in the best part of 53 countries across the world.

[00:08:18] The number that you reach, 3,500, is probably the number of assessments that we've done in Europe.

[00:08:25] Certainly the worldwide assessment runs into the thousands.

[00:08:29] And every country is associated with a number of stage 6 hospitals.

[00:08:36] Those are hospitals where a member of the HIMSS team has actually carried out a physical on-site assessment.

[00:08:45] So the process of self-assessment runs between stages 1 to 5.

[00:08:51] And anybody triggering stage 6 will require a HIMSS assessor to be on-site for a whole day.

[00:08:59] And that will mean that a very comprehensive assessment is carried out before the hospital can be promoted and declared,

[00:09:12] validated against the stage 6 standards.

[00:09:14] Is it quite clear how hospitals can progress from one stage to the other?

[00:09:22] Like, how do your recommendations or opinions look like?

[00:09:27] And to which extent, for example, do hospitals also compare each other?

[00:09:30] In some countries, especially in private systems, there's a lot more competition between hospitals for the patients.

[00:09:38] So I imagine that they might potentially be even more interested to position themselves as more developed, more advanced, more technologically driven.

[00:09:48] What are your experiences in that regard?

[00:09:51] So the start point all over the world is very similar.

[00:09:56] A hospital will have access to the HIMSS survey platform and will complete a self-assessment survey.

[00:10:04] Once the survey has been returned, it goes through a quality assurance process.

[00:10:13] And we then present the hospital with a maturity model score, as well as a very detailed report,

[00:10:22] which contains the gap assessment between where the hospital currently are and stage 7.

[00:10:32] On top of that, we also have a list of things that the hospital might need to do in order to close that gap.

[00:10:42] So it all becomes very logical that the recommendations within the report can be adopted into the digital strategy of the care provider,

[00:10:53] if, of course, they wish to adopt those standards.

[00:10:56] And that is a way then that the hospital starts to make progress against the model.

[00:11:02] The model is very logical.

[00:11:05] It follows the way hospitals typically increase their EMR level of maturity,

[00:11:17] but it could relate to infrastructure and analytics, digital imaging, depending on which model was being used.

[00:11:25] But the idea and the most important point is that at some point in the future, a hospital will measure again.

[00:11:34] And it's through that process that they can demonstrate to their sponsors, their stakeholders,

[00:11:41] that the money is being spent on the right thing and the desired effect is then being measured.

[00:11:49] Given that you mentioned other models as well.

[00:11:52] So there's DIAM for imaging, there's INFRAM for infrastructure,

[00:11:58] there's one model for community care and another one for community care.

[00:12:02] Can you explain a little bit how these models were developed?

[00:12:07] What do they entail and who usually decides for them?

[00:12:11] So why do hospitals do several models?

[00:12:16] What's the mindset usually behind that?

[00:12:20] I think the development of anything new in the maturity model space comes as a result of market event.

[00:12:30] So we listen very carefully to what the market is telling us.

[00:12:36] And if we believe there's a gap and a potential to close that gap,

[00:12:41] then we will go through a business planning process in order to develop a new model.

[00:12:48] So that's really how all the models started.

[00:12:52] In the development phase, we work with our key stakeholders in stage six and stage seven hospitals.

[00:13:00] They're often senior technologists or senior clinicians.

[00:13:05] But we also work with the academic sector and, perhaps most importantly, our industry supplier colleagues.

[00:13:15] Because we want to make sure that to some extent, whilst we are vendor agnostic,

[00:13:22] we do need to align with the way the market is taking these various products.

[00:13:29] There will be little point to us developing standards that were not applicable to the markets in which we operate.

[00:13:37] So to which degree do you work with standards bodies for healthcare standards?

[00:13:44] Because I can imagine that it would be helpful to create some sort of unification in the healthcare industry

[00:13:52] if the maturity models also include the recommendation of various standards.

[00:13:58] You advance in the digital maturity, which means that you're ready for larger interoperability projects,

[00:14:06] such as EHDS, for example.

[00:14:08] So to which extent are these projects interlinked?

[00:14:11] So we are acutely aware that there are standards for electronic messaging.

[00:14:19] There are standards for coding.

[00:14:22] There are multiple standards for security, confidentiality, resilience, etc.

[00:14:30] And where there's a definite international standard that is used by everybody,

[00:14:39] the model would make reference to that.

[00:14:42] Because we are checking how compliant the organisation is against that international standard.

[00:14:50] What we try and avoid is referring to standards that are only relevant in one particular country.

[00:15:00] Because the biggest challenge that we have is to find a way of making the models locally sensitive but globally applicable.

[00:15:12] And that is a challenge.

[00:15:13] So if we are aware of local standards, we will probably talk about compliance with local standards without actually naming them.

[00:15:25] And the HIMSS assessor would have normally done a bit of homework to understand what the local standards are in that particular country.

[00:15:34] One of the big challenges in healthcare is that, in fact, every hospital has its own ways of doing things.

[00:15:41] Even if you have national guidelines, they adapt them to local needs.

[00:15:46] So it's very interesting to hear that basically you're also adapting to local specifications a little bit.

[00:15:52] So can you talk a little bit more about that?

[00:15:54] So to a degree, when you see that a hospital is MRAM stage 6 or 7,

[00:16:00] you imagine the same level of digital maturity in the UK or in Taiwan.

[00:16:06] So where are the differences and how do hospitals look at these differences?

[00:16:12] Do you ever get complaints around the assessments or something?

[00:16:18] That's a great question.

[00:16:19] And over the last 10 years, I've been in hundreds and hundreds of hospitals.

[00:16:25] I'm not sure whether I've tipped 1,000 yet, but I've been in hundreds.

[00:16:30] And concluded that once you've been in one hospital, you've been in one hospital.

[00:16:36] And what that means is that whilst several hospitals will all be able to achieve the same standard,

[00:16:46] they often get to that place in a multitude of ways.

[00:16:50] And that's great because we want the models to be flexible enough to account for different workflows,

[00:16:59] different customs, different practices, different workforce initiatives.

[00:17:04] And that's the vibrancy of Europe.

[00:17:08] And everybody's doing this in a slightly different way at a slightly different speed.

[00:17:14] And that is to be encouraged.

[00:17:16] But if you imagine we need to overlay a set of standards that are consistent with what happens in Europe,

[00:17:27] Asia-Pac and North America, equally, that is very important.

[00:17:34] And the skill of the HMS assessor is not to understand the standard.

[00:17:39] The skill is to understand the context.

[00:17:42] Because the context will change every single hospital that you want.

[00:17:48] And the challenge is to look at the context, look at that particular workflow, look at that outcome,

[00:17:58] and be sure that the spirit of the standard is being met.

[00:18:03] And only with experience do you have the knowledge to make that judgment call.

[00:18:11] Who can become a HMS assessor?

[00:18:15] And the reason I'm asking that is because I know that you also do national assessment.

[00:18:21] It was done in Italy.

[00:18:23] It was done in Germany before Germany did their whole digital health strategy.

[00:18:27] So with those kinds of projects, you're in a position of assessing hundreds of hospitals at the same time.

[00:18:36] So what does that mean for the workforce that you have that's capable of doing those assessments?

[00:18:43] It's very common for us to work with partners.

[00:18:47] We have a digital health transformation partnership scheme that runs globally.

[00:18:55] And that is a way of extending our workforce through a partnership scheme.

[00:19:04] And all the DHTPs have been trained to work with the models, to understand the standards,

[00:19:11] to allow them to work with hospitals in order to move from one stage to the next.

[00:19:19] And to some extent, they are going through a process of continuous assessments.

[00:19:24] As they potentially start at stage two, take the client all the way through to stage six,

[00:19:33] when the HMS assessor would come along and actually carry out the validation.

[00:19:38] When we do stage seven assessments, we take people with us.

[00:19:43] And it's normally a team of four.

[00:19:45] And we would have a chief information officer,

[00:19:49] chief clinical information officer as part of the assessment team.

[00:19:55] And to some extent, they serve as external assessors.

[00:20:00] But they are very knowledgeable.

[00:20:02] They're very helpful.

[00:20:03] They don't make the decision for us,

[00:20:05] but they often help in collecting data to allow the correct decision to be made on the day.

[00:20:12] So to answer your question, really anybody can be an assessor, providing, of course,

[00:20:19] you have the appropriate knowledge, experience, training,

[00:20:24] not only to understand standards, but to apply them in context.

[00:20:29] I imagine that this is like a test day, an exam for hospitals,

[00:20:35] because you come in as an assessor.

[00:20:37] And at the end of the day, you say you get this badge or you don't get this badge.

[00:20:42] How often does it happen that a hospital, for example,

[00:20:46] would expect to get a stage seven say, but they don't?

[00:20:50] And what happens then?

[00:20:52] Are you also under a lot of pressure that maybe your assessment isn't fair?

[00:20:58] Yeah, once again, a good question.

[00:21:00] If we get on site and we've been there for two days

[00:21:04] and we can't reach a positive decision, which would be successful validation,

[00:21:11] then we actually see that as failing on the part of the client

[00:21:18] to failing on our part as well.

[00:21:21] Because we have a process in place whereby we screen hospitals,

[00:21:26] prior to the visit, we go through the questionnaire,

[00:21:30] we go through the report.

[00:21:31] And if we actually arrive on site and there are things missing,

[00:21:37] that is a potential failing in our process.

[00:21:41] So whilst it occasionally does happen,

[00:21:44] it doesn't happen very often, fortunately.

[00:21:47] At the end of the day, we have four decisions.

[00:21:50] We cannot validate a hospital, which, as I've previously mentioned,

[00:21:55] happens rarely.

[00:21:57] We can validate a hospital with recommendations,

[00:22:01] which is by far the most common outcome,

[00:22:05] because we can always find something that the hospital can improve.

[00:22:10] We rarely validate a hospital without validations,

[00:22:14] without recommendations, which is the third outcome.

[00:22:19] The fourth outcome is we validate with a condition.

[00:22:26] And what that means is that we're absolutely satisfied with the results,

[00:22:32] but we found maybe one or perhaps two things that just aren't right.

[00:22:38] That if there were many, then the outcome wouldn't be positive.

[00:22:44] But if it is a couple of things that we think the hospital can put right

[00:22:49] in order to really strengthen that validation,

[00:22:52] then we might give them three to four months in order to corrective action.

[00:22:59] And the reason we do that is because the maturity models

[00:23:03] have this incredible link to patient safety.

[00:23:07] And we would rather the hospital put something right,

[00:23:12] because we know that's going to improve patient safety,

[00:23:17] than run the risk of not validating them

[00:23:20] and the hospital never taking corrective action.

[00:23:25] What do you see as the biggest challenge in digital maturity?

[00:23:29] Because we currently really focused on the hospitals as individual institutions,

[00:23:37] which to a degree is an easy part.

[00:23:40] In healthcare, we expect interoperability.

[00:23:43] We expect a holistic care.

[00:23:47] So that's how I imagine that also the coordinated patient care model was developed.

[00:23:54] So that to me sounds much more difficult,

[00:23:59] because suddenly you have to work with several institutions

[00:24:03] and come to an agreement that they're going to connect,

[00:24:07] build integrated care plans,

[00:24:09] multiple care pathways and protocols for chronic conditions.

[00:24:13] So can you talk a little bit more about that?

[00:24:16] And maybe what's an example of a region

[00:24:20] that would have the CCMM model achieved?

[00:24:25] Yeah, you're absolutely spot on.

[00:24:28] Healthcare is not linear.

[00:24:30] We rarely travel in a straight line.

[00:24:34] We move between different care settings

[00:24:37] and different care providers

[00:24:39] that have been built upon geographical boundaries,

[00:24:44] political boundaries,

[00:24:46] managerial boundaries,

[00:24:48] policy boundaries.

[00:24:49] But typically, you know,

[00:24:51] these boundaries are the way patients move through the system.

[00:24:57] And a good example would be a process

[00:25:01] that took account of how patients move from primary care

[00:25:06] into secondary care,

[00:25:08] into community care,

[00:25:10] maybe a bit of home care

[00:25:12] before returning to the care of the family doctor

[00:25:16] or the GP.

[00:25:17] That would not be an untypical patient flow.

[00:25:22] And every time the patient moves

[00:25:25] between care settings,

[00:25:27] which we call transfers of care,

[00:25:29] the level of vulnerability increases.

[00:25:33] Because we need information to follow the patients,

[00:25:38] clinical responsibility to follow the patients,

[00:25:41] and sometimes the ball gets dropped.

[00:25:43] And all those things occasionally do happen.

[00:25:47] And the patient leaves hospital without medication,

[00:25:51] without a discharge letter,

[00:25:53] and they get home without any follow-up physiotherapy.

[00:25:57] And those are all things that affect recovery.

[00:26:02] So being able to carry out a digital maturity assessment

[00:26:08] on the whole system,

[00:26:11] rather than a single organisation,

[00:26:13] is the main feature of CCMM.

[00:26:18] You asked about challenges.

[00:26:19] the biggest challenge that we have is to educate,

[00:26:23] not just individuals,

[00:26:25] but organisations, regions,

[00:26:28] health ministries,

[00:26:29] that this is not about single organisations.

[00:26:33] But unfortunately,

[00:26:35] whilst we continue to fund single organisations,

[00:26:41] commission care for single organisations,

[00:26:45] and regulate single organisations,

[00:26:48] we will continue to conduct

[00:26:51] digital maturity assessments

[00:26:53] of single organisations.

[00:26:55] So if you were to change the commissioning,

[00:26:58] the regulatory,

[00:27:01] the financial regime,

[00:27:02] you would automatically switch

[00:27:05] the assessment regime,

[00:27:08] single organisations,

[00:27:10] to entire economies of care,

[00:27:14] whole systems,

[00:27:15] if you will,

[00:27:16] or ecosystems,

[00:27:17] as we sometimes describe them.

[00:27:19] So that's the nirvana,

[00:27:21] to being able to conduct

[00:27:23] an assessment on the entire system,

[00:27:26] because that's the most important thing.

[00:27:28] Hospitals are simply

[00:27:30] a secondary care provision.

[00:27:32] We spend most of our care,

[00:27:34] most of our time,

[00:27:36] receiving care in the community

[00:27:38] and the care from our general practitioner.

[00:27:41] Where do you see the biggest challenges

[00:27:44] in easing the connectivity

[00:27:46] between institutions,

[00:27:48] alongside all the changes

[00:27:50] that we see in healthcare,

[00:27:52] the move towards virtual wards,

[00:27:54] at-home care,

[00:27:56] drive to daycare,

[00:27:58] and day visits in the hospital,

[00:28:00] so patients spend more time at home.

[00:28:03] I imagine that,

[00:28:04] to a degree,

[00:28:05] this brings a new plethora

[00:28:07] of challenges

[00:28:07] when suddenly you potentially

[00:28:09] have new vendors

[00:28:10] that are trying to capture information

[00:28:12] in the home settings,

[00:28:14] but they use different standards

[00:28:15] that data structures

[00:28:17] or software in hospitals.

[00:28:19] So again,

[00:28:21] you're creating new frictions.

[00:28:23] What are the recommendations there?

[00:28:25] And maybe there's a good use case

[00:28:27] that you saw

[00:28:28] in terms of how to bridge that.

[00:28:30] Is it policy?

[00:28:31] Is it mandating standards?

[00:28:33] What is the best way forward?

[00:28:36] First of all,

[00:28:37] we need a process of levelling up.

[00:28:40] When we look across a community,

[00:28:44] a region,

[00:28:45] or even an entire country,

[00:28:48] we still see examples

[00:28:50] of organisations

[00:28:51] that still operate on paper

[00:28:54] alongside organisations

[00:28:57] that are paperless.

[00:29:00] And whenever we have that scenario,

[00:29:03] the thing that I've just been talking about,

[00:29:06] the whole system working as one,

[00:29:08] just doesn't happen.

[00:29:10] And when we're looking for examples

[00:29:13] of interoperability

[00:29:15] of health information exchange,

[00:29:16] that is only going to occur

[00:29:18] if the whole system

[00:29:20] is digital mature.

[00:29:22] And that makes us think

[00:29:26] about how the money is distributed,

[00:29:28] where the money is spent.

[00:29:30] And many communities,

[00:29:32] certainly in the United Kingdom

[00:29:34] and indeed elsewhere in Europe

[00:29:36] and in the Middle East,

[00:29:39] have recognised

[00:29:40] that we've got to move away

[00:29:42] from individual planning

[00:29:45] to whole system planning.

[00:29:46] The clusters

[00:29:47] in the Kingdom

[00:29:48] of Saudi Arabia

[00:29:50] are great examples

[00:29:51] of this.

[00:29:52] The integrated care boards

[00:29:54] in the United Kingdom

[00:29:55] are another example.

[00:29:57] And what these new

[00:29:59] mechanisms

[00:30:00] are trying to do

[00:30:01] is to switch

[00:30:03] from organisational thinking

[00:30:05] and organisational leadership

[00:30:08] towards

[00:30:09] whole system thinking.

[00:30:11] Because it's only

[00:30:12] when the whole system

[00:30:13] works well

[00:30:15] do we see

[00:30:16] all these great things

[00:30:18] around integrated care,

[00:30:20] home care,

[00:30:21] care out of hospital

[00:30:22] at home

[00:30:23] actually working well.

[00:30:25] If there's no connectivity

[00:30:26] between our homes

[00:30:28] and hospital

[00:30:29] and primary care,

[00:30:30] each thing simply no.

[00:30:33] What is the difference

[00:30:34] between

[00:30:35] the

[00:30:37] CCMM model,

[00:30:39] so

[00:30:39] the

[00:30:40] continuity of care model,

[00:30:42] and the

[00:30:43] community care

[00:30:44] outcomes

[00:30:45] model.

[00:30:46] Generally speaking,

[00:30:47] there's more

[00:30:49] and more emphasis

[00:30:49] in healthcare

[00:30:50] on patient-reported

[00:30:51] outcomes.

[00:30:52] The

[00:30:53] Denmark,

[00:30:54] I think,

[00:30:54] already integrated

[00:30:55] patient-reported

[00:30:56] outcomes

[00:30:56] in their

[00:30:57] national patient

[00:30:58] portal.

[00:30:59] In the UK,

[00:31:01] one London

[00:31:01] is doing

[00:31:02] urgent care planning

[00:31:03] and patients

[00:31:04] can already

[00:31:04] input

[00:31:05] basic feedback

[00:31:06] on urgent care plans

[00:31:07] through the NHS app.

[00:31:09] So we wanted

[00:31:10] that feedback

[00:31:11] information

[00:31:11] and we want

[00:31:12] healthcare to

[00:31:13] move towards

[00:31:14] value-based care

[00:31:15] and focus on

[00:31:16] outcomes.

[00:31:17] So what does

[00:31:17] community care

[00:31:18] outcomes maturity

[00:31:19] model actually

[00:31:20] measure and

[00:31:21] who usually

[00:31:22] uses it?

[00:31:24] CCOM,

[00:31:25] which is the

[00:31:25] model you

[00:31:26] referred to,

[00:31:27] the community

[00:31:28] of care

[00:31:29] outcomes

[00:31:29] maturity

[00:31:30] model,

[00:31:31] will often

[00:31:32] focus on

[00:31:33] a single

[00:31:34] organisation.

[00:31:36] That single

[00:31:36] organisation

[00:31:37] may have

[00:31:39] responsibility

[00:31:40] for several

[00:31:42] care

[00:31:42] providers.

[00:31:43] Those

[00:31:44] care

[00:31:44] providers

[00:31:45] are

[00:31:45] non-acute

[00:31:46] community-based

[00:31:48] ambulatory

[00:31:49] providers.

[00:31:51] So they

[00:31:52] are not

[00:31:52] hospitals,

[00:31:54] they are

[00:31:55] community

[00:31:56] centres,

[00:31:57] community

[00:31:57] clinics

[00:31:58] that

[00:31:59] provide

[00:32:00] a full

[00:32:01] range of

[00:32:02] ambulatory

[00:32:03] services

[00:32:03] to people

[00:32:05] in an

[00:32:06] outpatient

[00:32:07] setting

[00:32:07] or in

[00:32:08] a day

[00:32:09] care

[00:32:10] sense.

[00:32:12] CCNM,

[00:32:13] the

[00:32:13] continuity

[00:32:15] of care

[00:32:16] maturity

[00:32:16] model,

[00:32:17] looks at

[00:32:18] the whole

[00:32:18] system.

[00:32:19] And the

[00:32:20] whole system

[00:32:21] for most

[00:32:21] people would

[00:32:22] be primary

[00:32:23] care,

[00:32:24] secondary

[00:32:24] care,

[00:32:25] mental

[00:32:26] health

[00:32:26] care,

[00:32:26] community

[00:32:27] care,

[00:32:28] home

[00:32:28] care,

[00:32:29] social

[00:32:29] care,

[00:32:30] and perhaps

[00:32:31] the ambulance

[00:32:32] service or

[00:32:33] some

[00:32:34] other

[00:32:37] care

[00:32:37] provider

[00:32:38] that

[00:32:38] operates

[00:32:39] over a

[00:32:39] large

[00:32:40] geographical

[00:32:41] region.

[00:32:42] So those

[00:32:43] are the

[00:32:43] fundamental

[00:32:44] differences.

[00:32:45] CCOM,

[00:32:46] single

[00:32:46] organisation,

[00:32:48] CCN,

[00:32:49] whole

[00:32:50] system.

[00:32:50] You're

[00:32:51] absolutely

[00:32:51] right that

[00:32:52] there are

[00:32:52] some great

[00:32:52] examples.

[00:32:53] I was

[00:32:54] in a

[00:32:55] London

[00:32:55] hospital

[00:32:55] only a

[00:32:56] couple of

[00:32:57] weeks

[00:32:57] ago and

[00:32:58] we saw

[00:32:58] some

[00:32:58] fantastic

[00:32:59] examples

[00:33:00] of

[00:33:01] hospital

[00:33:01] at

[00:33:01] home and

[00:33:03] technology

[00:33:04] was

[00:33:05] monitoring

[00:33:06] and managing

[00:33:07] a number

[00:33:08] of clinical

[00:33:09] parameters

[00:33:09] including

[00:33:11] vital signs,

[00:33:13] daily

[00:33:13] weight,

[00:33:14] spirometry,

[00:33:15] saturation,

[00:33:16] in order

[00:33:17] to keep

[00:33:18] that individual

[00:33:19] out of

[00:33:20] hospital.

[00:33:21] And we

[00:33:21] had a

[00:33:22] great

[00:33:22] conversation

[00:33:24] looking at

[00:33:25] the benefits,

[00:33:26] value,

[00:33:27] we see

[00:33:28] other

[00:33:28] examples

[00:33:29] of patients

[00:33:30] being able

[00:33:30] to report

[00:33:31] outcomes

[00:33:32] through

[00:33:33] extended

[00:33:34] care

[00:33:34] plans,

[00:33:35] through

[00:33:37] images,

[00:33:38] photographs

[00:33:39] that the

[00:33:40] patient might

[00:33:40] submit to

[00:33:42] a wound

[00:33:42] care specialist.

[00:33:43] So there's

[00:33:44] some fantastic

[00:33:45] ideas,

[00:33:46] some fantastic

[00:33:48] examples

[00:33:48] of innovation

[00:33:50] happening

[00:33:50] all over the

[00:33:52] place.

[00:33:52] Personally,

[00:33:53] I think the

[00:33:53] interesting

[00:33:54] conversation

[00:33:55] is about

[00:33:56] the economics

[00:33:57] effects,

[00:33:58] because to

[00:33:59] look after

[00:34:00] somebody

[00:34:00] in their

[00:34:01] own home

[00:34:03] means that

[00:34:04] there's been

[00:34:04] an investment

[00:34:05] and the

[00:34:06] spending

[00:34:07] is potentially

[00:34:08] much less

[00:34:09] than having

[00:34:10] somebody in

[00:34:10] hospital.

[00:34:11] That's a

[00:34:12] great thing.

[00:34:13] Is there

[00:34:14] a saving?

[00:34:15] Usually not,

[00:34:16] because the

[00:34:17] demand on

[00:34:18] hospitals is

[00:34:19] such that

[00:34:20] any spare

[00:34:21] capacity in

[00:34:22] the hospital

[00:34:23] is immediately

[00:34:24] consumed by

[00:34:26] the next

[00:34:27] patient.

[00:34:29] Yeah,

[00:34:31] that's

[00:34:31] absolutely

[00:34:32] true.

[00:34:34] So healthcare

[00:34:35] is super

[00:34:36] busy.

[00:34:36] If I stay

[00:34:38] with the

[00:34:38] outcomes

[00:34:39] model for

[00:34:40] just another

[00:34:41] moment,

[00:34:42] can you

[00:34:43] share what

[00:34:44] are the

[00:34:44] criteria to

[00:34:45] have a

[00:34:46] stage 7

[00:34:47] CECOM

[00:34:48] validation?

[00:34:50] So what

[00:34:50] does

[00:34:50] organization

[00:34:51] need to

[00:34:51] provide to

[00:34:52] patients

[00:34:53] patients?

[00:34:53] Because I

[00:34:54] don't know,

[00:34:54] if I

[00:34:55] think of

[00:34:56] patient

[00:34:56] outcomes,

[00:34:58] my immediate

[00:34:59] reference point

[00:35:00] or association

[00:35:01] is with the

[00:35:02] quality of

[00:35:03] care that

[00:35:03] an individual

[00:35:04] provides.

[00:35:05] So how

[00:35:05] does digital

[00:35:06] fit into

[00:35:07] that?

[00:35:08] So I

[00:35:09] think with

[00:35:10] many of

[00:35:10] the models,

[00:35:11] CECOM

[00:35:12] really isn't

[00:35:12] that much

[00:35:13] different.

[00:35:14] It is

[00:35:15] directed

[00:35:15] to a

[00:35:17] different

[00:35:17] care

[00:35:17] setting.

[00:35:18] But many

[00:35:19] of our

[00:35:20] models have

[00:35:20] this golden

[00:35:21] thread that

[00:35:22] runs

[00:35:23] throughout

[00:35:23] them.

[00:35:24] So at

[00:35:25] a very

[00:35:26] basic level

[00:35:27] to get

[00:35:27] a foundation

[00:35:28] in place,

[00:35:29] we would

[00:35:30] expect

[00:35:30] clinicians

[00:35:31] to be

[00:35:32] documented

[00:35:32] electronically

[00:35:33] rather than

[00:35:34] documenting

[00:35:35] on paper

[00:35:36] to benefit

[00:35:37] from

[00:35:37] clinical

[00:35:38] electronic

[00:35:39] alerts

[00:35:40] and warnings,

[00:35:41] some

[00:35:42] evidence of

[00:35:44] clinical

[00:35:44] decision

[00:35:45] support

[00:35:46] that might

[00:35:47] offer an

[00:35:48] order set

[00:35:48] or help

[00:35:50] with

[00:35:50] prescribing,

[00:35:51] ensuring

[00:35:52] that the

[00:35:53] prescriber

[00:35:54] gets the

[00:35:55] dose

[00:35:55] right or

[00:35:56] recognises

[00:35:57] the laboratory

[00:35:58] value,

[00:35:59] the weight

[00:36:00] of the

[00:36:00] patient or

[00:36:01] the allergy

[00:36:01] status,

[00:36:02] for example.

[00:36:03] So all

[00:36:04] those things

[00:36:05] are part

[00:36:06] of the

[00:36:06] foundation.

[00:36:07] With CECOM

[00:36:08] in particular,

[00:36:09] we're also

[00:36:10] looking for a

[00:36:11] high degree

[00:36:12] of interoperability.

[00:36:14] Ambulatory

[00:36:14] patients move

[00:36:16] a lot by

[00:36:17] definition.

[00:36:17] We've got to

[00:36:18] make sure

[00:36:19] community

[00:36:20] providers are

[00:36:21] capable of

[00:36:23] exchanging

[00:36:23] healthcare

[00:36:24] information

[00:36:25] with others

[00:36:26] in that

[00:36:27] local

[00:36:27] community.

[00:36:28] That might

[00:36:29] be primary

[00:36:30] care to

[00:36:31] secondary

[00:36:31] care,

[00:36:32] patient to

[00:36:33] primary care

[00:36:34] to patient,

[00:36:34] or primary

[00:36:35] care to

[00:36:36] primary

[00:36:36] care.

[00:36:37] So the

[00:36:38] degree to

[00:36:39] which we

[00:36:40] see evidence

[00:36:41] of electronic

[00:36:42] messaging

[00:36:43] between

[00:36:44] patients and

[00:36:45] clinicians or

[00:36:46] clinicians and

[00:36:47] clinicians is

[00:36:48] often good

[00:36:49] evidence.

[00:36:50] There's been

[00:36:51] some investments

[00:36:52] and that

[00:36:53] investment is

[00:36:54] starting to

[00:36:55] have the

[00:36:56] design effect.

[00:36:57] As we move

[00:36:57] away from

[00:36:58] the foundations

[00:36:59] and go a

[00:37:00] little bit

[00:37:00] further up

[00:37:01] building,

[00:37:02] we're looking

[00:37:03] at how the

[00:37:03] organisation

[00:37:04] is using

[00:37:05] analytics,

[00:37:06] how the

[00:37:07] organisation

[00:37:07] is using

[00:37:08] data,

[00:37:09] perhaps

[00:37:09] artificial

[00:37:10] intelligence,

[00:37:11] to not only

[00:37:12] look back

[00:37:13] at what's

[00:37:13] happened

[00:37:14] before and

[00:37:15] to provide

[00:37:15] an explanation,

[00:37:16] but to

[00:37:17] actually look

[00:37:18] to the

[00:37:18] future using

[00:37:20] prediction and

[00:37:21] prescription.

[00:37:22] Typically,

[00:37:24] predictive analytics

[00:37:26] will describe a

[00:37:27] future event.

[00:37:28] It could be a

[00:37:30] busy clinic or

[00:37:31] some kind of a

[00:37:33] seasonal event

[00:37:34] that happens in

[00:37:35] the summer or

[00:37:35] happens in the

[00:37:36] winter.

[00:37:36] but the

[00:37:37] criticality is

[00:37:38] the prescription

[00:37:40] helps the

[00:37:41] organisation.

[00:37:44] So not only

[00:37:45] do we

[00:37:45] forecast the

[00:37:47] event,

[00:37:47] but we

[00:37:48] actually give

[00:37:48] some ideas

[00:37:49] of what the

[00:37:50] organisation

[00:37:51] might do

[00:37:52] in order to

[00:37:53] manage that

[00:37:53] event in

[00:37:54] the future.

[00:37:55] And how

[00:37:57] do hospitals

[00:37:59] basically decide

[00:38:01] that they

[00:38:02] want to

[00:38:02] undergo an

[00:38:03] assessment?

[00:38:04] So what's

[00:38:05] in it for

[00:38:05] them?

[00:38:06] Like,

[00:38:06] why would

[00:38:06] the hospital

[00:38:07] want to

[00:38:08] have an

[00:38:09] assessment on

[00:38:10] MRAM or

[00:38:11] on their

[00:38:12] analytics or

[00:38:13] on their

[00:38:14] imaging status?

[00:38:17] So what's

[00:38:18] the biggest

[00:38:18] benefits that

[00:38:19] they get

[00:38:19] out of that?

[00:38:20] I imagine

[00:38:21] that some

[00:38:22] leaders might

[00:38:23] see that as

[00:38:23] unnecessary and

[00:38:24] would perceive

[00:38:25] themselves as

[00:38:26] being very

[00:38:27] digitally

[00:38:27] mature.

[00:38:27] So what are

[00:38:28] your experiences

[00:38:29] in that regard,

[00:38:30] in terms of

[00:38:31] the mindset or

[00:38:32] the feedback that

[00:38:32] you see on

[00:38:33] the market

[00:38:33] from various

[00:38:34] leaders?

[00:38:36] People do

[00:38:37] these things

[00:38:39] for a whole

[00:38:40] variety of

[00:38:41] reasons.

[00:38:42] If you think

[00:38:43] about a typical

[00:38:43] improvement cycle,

[00:38:45] which is

[00:38:46] baseline assessment,

[00:38:47] plan, act,

[00:38:49] and remeasure,

[00:38:50] that is a

[00:38:50] typical cycle

[00:38:51] that a

[00:38:53] hospital or

[00:38:53] a primary care

[00:38:54] provider will

[00:38:55] be thinking

[00:38:56] about.

[00:38:56] Let me

[00:38:57] understand where

[00:38:57] I am today,

[00:38:59] what I need

[00:39:00] to do to

[00:39:00] move forward,

[00:39:01] actually move

[00:39:02] forward,

[00:39:03] and then

[00:39:04] remeasure.

[00:39:05] So many

[00:39:05] people will

[00:39:06] use any

[00:39:07] of the

[00:39:08] models for

[00:39:09] that simple

[00:39:10] reason,

[00:39:11] because they

[00:39:11] want to

[00:39:12] know where

[00:39:12] they are.

[00:39:13] Not just

[00:39:14] where they

[00:39:15] are when

[00:39:16] compared to

[00:39:16] their peers,

[00:39:17] but where

[00:39:18] they are in

[00:39:20] accordance with

[00:39:20] global standards.

[00:39:22] That's the

[00:39:22] first thing.

[00:39:24] Other people

[00:39:25] are looking

[00:39:26] at a

[00:39:27] procurement

[00:39:27] process,

[00:39:28] they're looking

[00:39:29] to buy

[00:39:30] something.

[00:39:31] So the

[00:39:32] output from

[00:39:33] the maturity

[00:39:34] model can

[00:39:35] often give

[00:39:36] them an

[00:39:37] idea of

[00:39:38] what to

[00:39:38] put into

[00:39:39] the

[00:39:39] specification,

[00:39:40] because they

[00:39:42] want to

[00:39:43] be compliant

[00:39:44] with the

[00:39:45] MRAM or

[00:39:46] INFRAM or

[00:39:47] DIAM standards

[00:39:48] at some

[00:39:49] point in the

[00:39:49] future.

[00:39:50] So to

[00:39:51] miss those

[00:39:51] standards from

[00:39:53] the specification

[00:39:54] that has been

[00:39:55] put together to

[00:39:56] buy a system

[00:39:57] may mean

[00:39:58] that they

[00:39:59] actually miss

[00:40:00] the opportunity

[00:40:01] to validate

[00:40:02] at some

[00:40:03] later date.

[00:40:04] Other people

[00:40:05] will use a

[00:40:07] maturity model

[00:40:08] to help them

[00:40:09] with a

[00:40:09] deployment plan

[00:40:10] because they

[00:40:11] want to

[00:40:11] deploy in

[00:40:12] a logical

[00:40:13] way.

[00:40:14] Maturity

[00:40:14] models are

[00:40:15] logical,

[00:40:15] and that

[00:40:16] allows them

[00:40:17] to layer

[00:40:17] their functionality

[00:40:18] in a very

[00:40:21] intelligent and

[00:40:22] scientific

[00:40:22] method.

[00:40:23] Some people

[00:40:25] just want

[00:40:25] the batch.

[00:40:25] some people

[00:40:26] just want

[00:40:27] the trophy

[00:40:28] of the

[00:40:28] stage 6

[00:40:29] or stage 7,

[00:40:30] and some

[00:40:31] people will

[00:40:32] do that

[00:40:32] multiple times.

[00:40:33] So we

[00:40:34] have a

[00:40:34] number of

[00:40:35] hospitals who

[00:40:36] are multiple

[00:40:37] stage 7

[00:40:39] award holders

[00:40:40] across four

[00:40:41] or five

[00:40:42] different

[00:40:43] models,

[00:40:44] and once

[00:40:44] again,

[00:40:45] that is

[00:40:45] done for

[00:40:46] great reasons.

[00:40:48] Occasionally,

[00:40:49] they're so

[00:40:50] good for

[00:40:51] his bread.

[00:40:51] Yeah,

[00:40:52] I'm just

[00:40:53] thinking that

[00:40:53] even if you

[00:40:54] just do it

[00:40:54] for the

[00:40:54] badge,

[00:40:55] it still

[00:40:55] shows that

[00:40:56] you're still

[00:40:56] quite digitally

[00:40:58] advanced,

[00:40:58] because if

[00:40:59] you get

[00:40:59] like an

[00:41:00] additional

[00:41:00] basically

[00:41:01] confirmation

[00:41:02] that you're

[00:41:02] still doing

[00:41:03] great,

[00:41:04] that's still

[00:41:04] good.

[00:41:05] I think

[00:41:05] it's,

[00:41:06] yeah,

[00:41:06] I'm just

[00:41:07] thinking,

[00:41:07] because one

[00:41:08] thing that

[00:41:08] I wanted to

[00:41:09] really tap

[00:41:10] your brains

[00:41:11] about is

[00:41:12] when hospitals

[00:41:13] are buying

[00:41:14] new things,

[00:41:14] they really

[00:41:15] need to know

[00:41:16] what they

[00:41:17] need,

[00:41:17] and that

[00:41:18] can be

[00:41:18] really

[00:41:18] difficult

[00:41:19] because

[00:41:19] technology

[00:41:19] is

[00:41:20] advancing

[00:41:20] so fast,

[00:41:21] and it's

[00:41:24] how do

[00:41:25] you actually

[00:41:27] validate

[00:41:27] vendor claims

[00:41:28] in the

[00:41:29] responses that

[00:41:30] you get.

[00:41:30] So what

[00:41:31] are your

[00:41:31] experiences

[00:41:32] from working

[00:41:33] in the

[00:41:34] field,

[00:41:34] in terms

[00:41:35] of what

[00:41:36] hospitals tell

[00:41:37] you that

[00:41:38] they wanted

[00:41:38] to achieve,

[00:41:39] but actually

[00:41:40] in the end

[00:41:41] couldn't,

[00:41:41] or were

[00:41:42] disappointed

[00:41:42] by technology,

[00:41:44] where do

[00:41:44] you see

[00:41:45] the biggest

[00:41:46] challenges

[00:41:46] in the

[00:41:47] procurement,

[00:41:47] and the

[00:41:49] difference

[00:41:50] between the

[00:41:52] theoretical

[00:41:53] promise

[00:41:54] of

[00:41:55] technology

[00:41:56] and all

[00:41:57] the edge

[00:41:58] cases

[00:41:59] and the

[00:42:00] challenges

[00:42:00] that show

[00:42:01] up hardly

[00:42:02] when you

[00:42:02] implement

[00:42:02] technology?

[00:42:04] I'm sure

[00:42:04] you have

[00:42:04] many stories

[00:42:05] from hospitals.

[00:42:06] Yeah,

[00:42:07] we work

[00:42:07] with industry

[00:42:08] and clinical

[00:42:10] systems,

[00:42:11] flyers and

[00:42:11] EMR vendors

[00:42:12] very closely,

[00:42:15] but we

[00:42:15] don't validate

[00:42:16] products.

[00:42:18] We validate

[00:42:19] hospitals and

[00:42:21] or validate

[00:42:22] healthcare

[00:42:22] providers.

[00:42:23] We have

[00:42:23] many examples

[00:42:24] of where

[00:42:26] the same

[00:42:27] system has

[00:42:28] been deployed

[00:42:29] in two

[00:42:30] separate and

[00:42:31] different

[00:42:32] organisations

[00:42:33] and the

[00:42:35] amount of

[00:42:36] variation

[00:42:36] and the

[00:42:37] outcome is

[00:42:38] very different.

[00:42:39] One goes

[00:42:40] well,

[00:42:41] one doesn't

[00:42:42] go well.

[00:42:43] And the

[00:42:44] functionality

[00:42:44] of the

[00:42:45] software is

[00:42:46] exactly the

[00:42:47] same.

[00:42:47] And when

[00:42:49] we look

[00:42:49] at the

[00:42:50] reason why

[00:42:51] one has

[00:42:52] gone less

[00:42:53] well,

[00:42:54] there are

[00:42:54] a number

[00:42:55] of core

[00:42:56] themes.

[00:42:57] First and

[00:42:58] foremost is

[00:43:00] all around

[00:43:00] culture and

[00:43:02] leadership.

[00:43:03] It's culture

[00:43:04] and leadership

[00:43:04] that constitute

[00:43:06] a success.

[00:43:07] And in

[00:43:09] third place,

[00:43:10] following very

[00:43:11] closely,

[00:43:12] is clinical

[00:43:12] engagements.

[00:43:13] if you

[00:43:14] don't have

[00:43:15] an engaged

[00:43:15] clinical

[00:43:16] workforce,

[00:43:18] this thing

[00:43:18] is going

[00:43:19] to be

[00:43:19] difficult.

[00:43:20] And I

[00:43:20] think the

[00:43:21] fourth

[00:43:21] thing is

[00:43:23] the ability

[00:43:24] to spend

[00:43:24] money on

[00:43:25] the right

[00:43:25] thing.

[00:43:26] Once again,

[00:43:27] many examples

[00:43:28] of where

[00:43:29] technology

[00:43:30] has been

[00:43:32] purchased

[00:43:33] tactically

[00:43:33] rather than

[00:43:34] strategically.

[00:43:35] and the

[00:43:36] hospital

[00:43:37] have simply

[00:43:38] bought the

[00:43:38] next

[00:43:39] sharing thing.

[00:43:40] And there's

[00:43:41] no context.

[00:43:43] It's almost a

[00:43:44] solution looking

[00:43:44] for the

[00:43:45] problem.

[00:43:45] and it's

[00:43:47] been employed

[00:43:48] in complete

[00:43:49] isolation.

[00:43:50] So I

[00:43:51] always think

[00:43:51] there's

[00:43:52] something about

[00:43:52] building the

[00:43:53] foundation and

[00:43:55] the maturity

[00:43:55] model standards

[00:43:56] allow you to

[00:43:58] build the

[00:43:58] foundation.

[00:43:59] And stage

[00:44:00] seven is by

[00:44:01] far the

[00:44:02] end point.

[00:44:03] It's probably

[00:44:04] the start

[00:44:04] point.

[00:44:05] That's what

[00:44:06] stage seven

[00:44:06] tells you

[00:44:07] is that

[00:44:08] your foundation

[00:44:09] is sound

[00:44:10] and it's

[00:44:11] firm.

[00:44:12] And then

[00:44:13] it's upon

[00:44:13] that foundation

[00:44:14] that you

[00:44:15] can start

[00:44:16] and build

[00:44:16] and start

[00:44:17] to do

[00:44:17] some more

[00:44:18] interesting

[00:44:18] things.

[00:44:19] So you

[00:44:20] can become

[00:44:20] tactical

[00:44:21] once you

[00:44:22] have your

[00:44:23] foundation.

[00:44:24] So does

[00:44:25] that mean

[00:44:26] that for

[00:44:26] example

[00:44:27] you start

[00:44:28] with

[00:44:29] MRAM

[00:44:29] and get

[00:44:30] your

[00:44:30] EHR in

[00:44:31] order so

[00:44:32] you know

[00:44:32] that the

[00:44:32] data capture

[00:44:33] is sound

[00:44:34] and then

[00:44:35] you can start

[00:44:35] thinking what

[00:44:36] you can do

[00:44:36] with that

[00:44:37] data and

[00:44:38] also look

[00:44:38] at what

[00:44:39] you can

[00:44:40] learn from

[00:44:40] the

[00:44:40] analytics

[00:44:41] model and

[00:44:42] build up

[00:44:42] on that.

[00:44:44] Yeah so

[00:44:45] that's pretty

[00:44:46] typical for

[00:44:46] hospitals to

[00:44:47] use more

[00:44:47] than one

[00:44:48] model.

[00:44:48] In some

[00:44:49] scenarios

[00:44:50] INFRAM

[00:44:51] is used

[00:44:52] first to

[00:44:53] help people

[00:44:54] understand

[00:44:54] their

[00:44:55] capabilities

[00:44:56] of

[00:44:56] infrastructure

[00:44:57] and their

[00:44:58] ability to

[00:44:59] support it

[00:44:59] and they

[00:45:00] do that

[00:45:01] because

[00:45:01] infrastructure

[00:45:02] is often

[00:45:03] a point

[00:45:04] of failure.

[00:45:05] It's like

[00:45:06] trying to

[00:45:07] drive a

[00:45:08] Lamborghini

[00:45:09] on a

[00:45:10] country lane.

[00:45:11] It doesn't

[00:45:12] work.

[00:45:13] Having

[00:45:13] a

[00:45:14] motorway

[00:45:15] network

[00:45:15] in place

[00:45:16] is often

[00:45:18] very important

[00:45:19] before you

[00:45:20] buy the

[00:45:20] Lamborghini.

[00:45:21] The Lamborghini

[00:45:22] being the

[00:45:23] electronic

[00:45:23] patient record

[00:45:24] system.

[00:45:25] So making

[00:45:26] sure that

[00:45:26] the servers,

[00:45:27] the wires,

[00:45:28] the cabinets,

[00:45:28] the network,

[00:45:29] the infrastructure,

[00:45:30] the points of

[00:45:31] access,

[00:45:32] the access

[00:45:33] devices,

[00:45:34] end user

[00:45:35] adoption,

[00:45:35] all those

[00:45:36] things have

[00:45:37] been taken

[00:45:38] care of

[00:45:39] before

[00:45:40] deploying

[00:45:41] electronic

[00:45:42] patient

[00:45:42] records

[00:45:43] is a

[00:45:43] very

[00:45:44] sensible

[00:45:44] move.

[00:45:45] The two

[00:45:46] models we've

[00:45:46] covered in

[00:45:47] that scenario

[00:45:48] would be

[00:45:49] Infram and

[00:45:50] EMRAM

[00:45:51] or

[00:45:52] Infram and

[00:45:54] CECOM.

[00:45:55] When the

[00:45:56] electronic

[00:45:57] patient record

[00:45:58] environment

[00:45:58] becomes mature,

[00:46:00] it's often

[00:46:01] time to start

[00:46:03] on the look

[00:46:03] at the

[00:46:03] information,

[00:46:04] the data,

[00:46:05] and the

[00:46:05] benefit of

[00:46:06] advanced

[00:46:07] analytics.

[00:46:08] That's why

[00:46:09] you've done

[00:46:09] it.

[00:46:09] You've

[00:46:10] done it

[00:46:10] to produce

[00:46:11] data in

[00:46:12] order to

[00:46:12] improve

[00:46:13] patient

[00:46:13] safety and

[00:46:14] increase the

[00:46:15] overall quality

[00:46:16] of clinic.

[00:46:17] So that's

[00:46:18] the point

[00:46:18] in which

[00:46:19] you might

[00:46:20] use AMA

[00:46:21] to ensure

[00:46:22] that you

[00:46:22] are getting

[00:46:23] the best

[00:46:24] use out

[00:46:24] of the

[00:46:25] data that

[00:46:26] you spend

[00:46:26] so much

[00:46:27] money

[00:46:27] actually

[00:46:28] providing.

[00:46:29] Yeah,

[00:46:30] yeah,

[00:46:30] yeah.

[00:46:30] I wonder,

[00:46:31] is it

[00:46:32] possible

[00:46:32] that,

[00:46:33] for example,

[00:46:34] a hospital

[00:46:35] achieves

[00:46:36] high

[00:46:36] maturity

[00:46:37] on one

[00:46:38] model

[00:46:38] and say

[00:46:40] EMRAM,

[00:46:40] but they

[00:46:41] actually

[00:46:42] don't,

[00:46:43] they are

[00:46:43] very low

[00:46:44] on the

[00:46:44] in-from

[00:46:46] kind of

[00:46:46] scale,

[00:46:47] is that

[00:46:48] even

[00:46:48] possible?

[00:46:49] Because I

[00:46:49] imagine that,

[00:46:50] for example,

[00:46:50] if you have

[00:46:51] something that's

[00:46:52] highly digitized,

[00:46:52] but then your

[00:46:53] infrastructure is

[00:46:54] not in order

[00:46:55] and say you're

[00:46:55] a badge

[00:46:56] collector and

[00:46:56] really want

[00:46:57] the in-from

[00:46:57] badge as

[00:46:58] well,

[00:46:59] then you

[00:46:59] would basically

[00:47:00] have to

[00:47:00] potentially

[00:47:01] throw the

[00:47:01] whole thing

[00:47:03] that you

[00:47:03] have for

[00:47:03] EMRAM

[00:47:04] away in

[00:47:05] order to

[00:47:05] really

[00:47:06] advance

[00:47:07] in the

[00:47:08] in-from

[00:47:08] stage.

[00:47:08] I'm

[00:47:09] wondering

[00:47:09] if that's

[00:47:09] even

[00:47:10] possible

[00:47:10] because

[00:47:11] I'm

[00:47:11] going to

[00:47:12] put a

[00:47:13] very

[00:47:13] plastic

[00:47:13] example

[00:47:14] out there.

[00:47:15] So I

[00:47:16] recently

[00:47:16] visited a

[00:47:17] doctor who

[00:47:17] wanted to

[00:47:18] show me

[00:47:18] an IT

[00:47:19] program

[00:47:20] that he

[00:47:20] was using

[00:47:21] and we

[00:47:22] couldn't

[00:47:22] see it

[00:47:22] because he

[00:47:23] couldn't

[00:47:23] open it

[00:47:24] because the

[00:47:24] computer was

[00:47:25] too old,

[00:47:25] there was

[00:47:26] some

[00:47:26] update

[00:47:26] that was

[00:47:27] required

[00:47:27] by

[00:47:28] JavaScript

[00:47:28] and in

[00:47:29] the end

[00:47:29] we just

[00:47:30] gave up.

[00:47:31] So that's

[00:47:31] why I don't

[00:47:32] know if

[00:47:32] it's

[00:47:32] actually even

[00:47:33] possible to

[00:47:34] be low

[00:47:34] on one

[00:47:35] level and

[00:47:36] be really

[00:47:36] high on

[00:47:37] another.

[00:47:38] So within

[00:47:39] all the

[00:47:40] models there's

[00:47:42] an element

[00:47:42] of overlap

[00:47:44] and there's

[00:47:45] an element

[00:47:46] of connectivity

[00:47:47] between all

[00:47:48] the models.

[00:47:49] So when

[00:47:50] the models

[00:47:51] have similar

[00:47:51] demands,

[00:47:53] those demands

[00:47:53] are on

[00:47:55] same stage

[00:47:56] across all

[00:47:57] the models.

[00:47:58] People

[00:47:58] are, let me

[00:47:59] turn your

[00:48:00] question into

[00:48:01] more of a

[00:48:02] positive.

[00:48:02] people will

[00:48:03] often ask

[00:48:04] what stage

[00:48:06] of

[00:48:06] infram

[00:48:07] do I

[00:48:07] need to

[00:48:08] be at

[00:48:08] to ensure

[00:48:10] that my

[00:48:11] electronic

[00:48:11] patient record

[00:48:12] program is

[00:48:14] going to go

[00:48:14] well?

[00:48:15] And the

[00:48:17] answer is

[00:48:18] not stage

[00:48:18] seven.

[00:48:19] So you

[00:48:20] don't need

[00:48:21] to have

[00:48:22] stage seven

[00:48:23] infrastructure

[00:48:23] to have

[00:48:25] a stage

[00:48:26] seven

[00:48:27] MRAM

[00:48:28] in the

[00:48:29] operational

[00:48:30] sense.

[00:48:31] You just

[00:48:31] don't.

[00:48:32] So anything

[00:48:34] above stage

[00:48:34] four on

[00:48:36] infram will

[00:48:37] ensure a

[00:48:38] successful

[00:48:39] electronic

[00:48:40] patient record

[00:48:41] deployment and

[00:48:42] would facilitate

[00:48:43] an organization

[00:48:45] meeting the

[00:48:47] stage six or

[00:48:48] stage seven

[00:48:48] standards on

[00:48:50] MRAM.

[00:48:51] You

[00:48:51] couldn't

[00:48:52] really score

[00:48:53] high on

[00:48:54] AMAM if

[00:48:55] you were

[00:48:56] scoring low

[00:48:57] on MRAM

[00:48:58] because you

[00:48:59] need electronic

[00:49:00] systems in

[00:49:01] order to

[00:49:02] carry out

[00:49:02] analysis.

[00:49:03] So there

[00:49:04] are some

[00:49:05] critical

[00:49:06] dependencies.

[00:49:07] So it

[00:49:08] doesn't always

[00:49:09] mean if you

[00:49:10] score high

[00:49:11] on one or

[00:49:11] score low

[00:49:12] on one,

[00:49:12] that's going

[00:49:13] to be

[00:49:13] replicated

[00:49:14] into other

[00:49:15] models.

[00:49:21] well,

[00:49:22] on CCMM.

[00:49:24] But CCMM,

[00:49:26] don't forget,

[00:49:27] is about the

[00:49:28] entire community.

[00:49:29] It's not about

[00:49:31] individuals.

[00:49:32] So there are

[00:49:33] some key

[00:49:34] dependencies.

[00:49:35] It would be

[00:49:36] unusual if you

[00:49:38] were to score

[00:49:39] at stage zero

[00:49:40] or stage one

[00:49:41] on one

[00:49:42] particular model

[00:49:43] and seven

[00:49:44] on another.

[00:49:45] That would be

[00:49:46] unusual and

[00:49:47] we'd want to

[00:49:48] understand that

[00:49:49] and look very

[00:49:50] carefully

[00:49:51] what's

[00:49:51] made that

[00:49:52] happen.

[00:49:53] We could

[00:49:54] probably

[00:49:54] create a

[00:49:55] lot of

[00:49:55] puzzles in

[00:49:57] terms of

[00:49:57] what goes

[00:49:58] well with

[00:49:58] another.

[00:49:59] But just

[00:50:00] to wrap up

[00:50:01] this whole

[00:50:01] discussion,

[00:50:02] you basically

[00:50:03] at the

[00:50:04] beginning,

[00:50:04] you said

[00:50:05] that when

[00:50:05] you see

[00:50:05] one hospital

[00:50:06] one hospital,

[00:50:07] I assume

[00:50:08] that every

[00:50:08] time you

[00:50:09] go to

[00:50:09] a new

[00:50:09] place,

[00:50:10] it's a

[00:50:10] bit of

[00:50:11] a surprise

[00:50:12] to see

[00:50:13] what you're

[00:50:13] going to

[00:50:14] see.

[00:50:14] And I

[00:50:15] wonder

[00:50:15] what

[00:50:16] surprised

[00:50:17] you most

[00:50:18] so far

[00:50:18] or what

[00:50:19] kind of

[00:50:19] fascinated

[00:50:20] you most.

[00:50:21] Is there

[00:50:21] an institution,

[00:50:22] a culture,

[00:50:24] a country

[00:50:24] that you

[00:50:25] could pull

[00:50:26] out?

[00:50:26] Is there

[00:50:26] an anecdote

[00:50:27] that pops

[00:50:28] up in

[00:50:28] your head

[00:50:29] when the

[00:50:30] assessment

[00:50:31] was even

[00:50:32] specific?

[00:50:34] Because you

[00:50:34] work across

[00:50:35] cultures,

[00:50:35] you work

[00:50:36] across

[00:50:36] countries,

[00:50:37] do you

[00:50:38] then usually

[00:50:39] take a

[00:50:39] translator

[00:50:40] with you

[00:50:40] if you

[00:50:41] did an

[00:50:41] assessment

[00:50:42] somewhere

[00:50:42] that you

[00:50:43] don't

[00:50:43] understand

[00:50:44] the language

[00:50:44] in?

[00:50:50] Sir,

[00:50:50] I think

[00:50:50] over the

[00:50:51] last 10

[00:50:52] years,

[00:50:53] it's been

[00:50:53] an absolute

[00:50:54] pleasure and

[00:50:55] privilege to

[00:50:56] work across

[00:50:58] Europe and

[00:50:59] the Middle

[00:50:59] East and

[00:51:00] Africa.

[00:51:00] It's the

[00:51:01] most vibrant

[00:51:02] of all the

[00:51:04] regions,

[00:51:05] in my view,

[00:51:07] and interesting

[00:51:08] things every

[00:51:10] single day.

[00:51:11] But maybe if I

[00:51:12] can leave you

[00:51:13] with a few

[00:51:14] closing thoughts,

[00:51:15] thoughts,

[00:51:15] and I'm

[00:51:16] not going

[00:51:16] to be

[00:51:17] drawn into

[00:51:17] naming

[00:51:18] single

[00:51:19] organisations,

[00:51:21] and I'll

[00:51:21] explain why

[00:51:22] not.

[00:51:23] But I will

[00:51:24] give you some

[00:51:25] food to

[00:51:25] throw.

[00:51:26] I think the

[00:51:27] first takeaway

[00:51:28] would be

[00:51:29] that every

[00:51:30] maturity

[00:51:31] model is

[00:51:32] flawed.

[00:51:34] But if

[00:51:35] you're going

[00:51:35] to use

[00:51:36] one, then

[00:51:37] use one

[00:51:37] that's got

[00:51:38] international

[00:51:39] applicability,

[00:51:40] has been

[00:51:40] around for

[00:51:41] a while,

[00:51:42] and has

[00:51:43] got a

[00:51:44] future.

[00:51:44] Because of

[00:51:45] all the

[00:51:45] things that

[00:51:46] I've

[00:51:46] previously

[00:51:47] talked about,

[00:51:48] we tend

[00:51:48] to be

[00:51:49] drawn towards

[00:51:50] the maturity

[00:51:50] models that

[00:51:52] are going

[00:51:52] to treat

[00:51:52] us kindly.

[00:51:55] And often

[00:51:55] you get

[00:51:57] the most

[00:51:58] benefit from

[00:51:59] the maturity

[00:51:59] model that

[00:52:00] initially appears

[00:52:02] a little bit

[00:52:02] challenging.

[00:52:05] Thirdly,

[00:52:06] we see

[00:52:06] good practice

[00:52:08] in places

[00:52:10] that we

[00:52:11] don't expect

[00:52:12] to see it.

[00:52:15] people

[00:52:16] are going

[00:52:17] good at

[00:52:17] everything,

[00:52:18] but somebody

[00:52:20] is always

[00:52:20] good at

[00:52:21] something.

[00:52:22] And that's

[00:52:22] important because

[00:52:23] you cannot

[00:52:25] go to a

[00:52:25] single

[00:52:26] healthcare

[00:52:27] provider

[00:52:27] and be

[00:52:29] wowed by

[00:52:30] everything

[00:52:30] that you

[00:52:31] see.

[00:52:31] You can

[00:52:32] be wowed

[00:52:32] by something.

[00:52:33] So for

[00:52:34] example,

[00:52:35] we can

[00:52:36] visit some

[00:52:36] of the

[00:52:36] Nordic

[00:52:37] countries,

[00:52:37] great

[00:52:38] examples of

[00:52:39] technology,

[00:52:39] but then

[00:52:40] you often

[00:52:41] see a

[00:52:41] doctor still

[00:52:42] documenting

[00:52:43] in a

[00:52:43] paper chart.

[00:52:45] So there

[00:52:45] are those

[00:52:46] extremes.

[00:52:48] And I

[00:52:48] think the

[00:52:49] maturity

[00:52:49] models,

[00:52:50] they come

[00:52:51] and go,

[00:52:52] they will

[00:52:52] always

[00:52:53] measure

[00:52:53] different

[00:52:55] things and

[00:52:55] it's right

[00:52:56] that the

[00:52:57] challenges.

[00:52:58] I personally

[00:52:59] don't think

[00:53:00] it matters

[00:53:01] which maturity

[00:53:02] model you

[00:53:03] choose as

[00:53:03] long as

[00:53:04] has,

[00:53:05] it's got

[00:53:05] a future,

[00:53:06] it's got

[00:53:06] a past,

[00:53:07] it's got

[00:53:08] international

[00:53:09] applicability,

[00:53:11] but the

[00:53:11] most important

[00:53:12] thing is

[00:53:13] you select

[00:53:14] one because

[00:53:15] not using

[00:53:16] one isn't

[00:53:17] really

[00:53:17] acceptable.

[00:53:18] Not

[00:53:19] understanding

[00:53:19] where you

[00:53:20] are,

[00:53:21] where you

[00:53:21] want to

[00:53:21] get to,

[00:53:22] the process

[00:53:23] that you

[00:53:23] can use

[00:53:24] to make

[00:53:25] progress

[00:53:25] isn't

[00:53:26] really going

[00:53:27] to be

[00:53:27] acceptable.

[00:53:28] And you

[00:53:30] wouldn't want

[00:53:30] the chief

[00:53:31] executive

[00:53:31] in any

[00:53:32] country

[00:53:34] presiding

[00:53:34] over a

[00:53:35] hospital

[00:53:35] that was

[00:53:36] still using

[00:53:37] paper when

[00:53:38] everybody else

[00:53:39] had transferred

[00:53:40] to digital

[00:53:41] systems.

[00:53:43] So I think

[00:53:43] that's where

[00:53:44] I would leave

[00:53:45] the conversation.

[00:53:46] If you're

[00:53:47] going to look

[00:53:47] at somewhere

[00:53:48] that you

[00:53:49] perceive to

[00:53:49] be good,

[00:53:50] make sure

[00:53:51] that you

[00:53:52] know what

[00:53:52] you're going

[00:53:53] to look at

[00:53:53] because some

[00:53:54] things will

[00:53:54] be great,

[00:53:55] some things

[00:53:56] will be

[00:53:56] less.

[00:53:57] And that

[00:53:57] means that

[00:53:58] you should

[00:53:59] consider

[00:54:01] benchmarking

[00:54:01] visits.

[00:54:02] rather than

[00:54:04] a single

[00:54:05] reference

[00:54:06] site.

[00:54:06] Because as

[00:54:07] I just

[00:54:08] mentioned,

[00:54:09] everybody

[00:54:10] does

[00:54:10] something

[00:54:11] that is

[00:54:12] good.

[00:54:12] I do

[00:54:13] want to

[00:54:14] ask you

[00:54:15] one more

[00:54:15] thing.

[00:54:16] So,

[00:54:17] you know,

[00:54:17] because you

[00:54:17] mentioned

[00:54:18] paper,

[00:54:19] where do

[00:54:20] you see

[00:54:21] the role

[00:54:22] of paper

[00:54:23] in digital

[00:54:25] maturity?

[00:54:26] Because

[00:54:27] paper still

[00:54:28] plays a

[00:54:29] potentially

[00:54:30] very important

[00:54:30] role in

[00:54:31] business

[00:54:31] continuity.

[00:54:33] So,

[00:54:33] what are

[00:54:34] your thoughts

[00:54:35] about that,

[00:54:36] about this

[00:54:36] whole hope

[00:54:37] that we're

[00:54:38] going to

[00:54:38] have

[00:54:38] paperless

[00:54:39] hospitals

[00:54:39] and

[00:54:40] paperless

[00:54:40] healthcare,

[00:54:41] where in

[00:54:42] fact,

[00:54:42] if you

[00:54:43] ask

[00:54:43] hospitals

[00:54:44] how

[00:54:44] prepared

[00:54:45] are they

[00:54:46] for a

[00:54:46] cybersecurity

[00:54:46] attack,

[00:54:47] they have

[00:54:48] to have

[00:54:48] posters on

[00:54:49] the wards,

[00:54:49] they have

[00:54:49] to have

[00:54:50] printers

[00:54:50] ready,

[00:54:51] they have

[00:54:51] to have

[00:54:52] a lot

[00:54:52] of paper

[00:54:52] ready

[00:54:53] as backup.

[00:54:55] Yeah,

[00:54:57] that's

[00:54:58] fine.

[00:54:58] We're

[00:54:59] an

[00:54:59] organisation

[00:54:59] that

[00:55:00] recognises

[00:55:01] the use

[00:55:02] of

[00:55:02] paper,

[00:55:02] so if

[00:55:03] you still

[00:55:04] have

[00:55:04] paper

[00:55:05] systems

[00:55:06] or you

[00:55:07] still have

[00:55:07] paper in

[00:55:08] the system,

[00:55:09] then tell

[00:55:09] us where

[00:55:10] it is.

[00:55:10] don't let

[00:55:11] us find

[00:55:12] it,

[00:55:12] because we

[00:55:13] will find

[00:55:14] it.

[00:55:14] So trying

[00:55:15] to make

[00:55:15] out that

[00:55:16] you are

[00:55:16] paperless

[00:55:18] and then

[00:55:19] us finding

[00:55:19] paper

[00:55:20] makes us

[00:55:22] suspicious.

[00:55:23] Hospitals

[00:55:24] will,

[00:55:24] because of

[00:55:25] cultural,

[00:55:26] legal and

[00:55:27] policy reasons,

[00:55:29] will often

[00:55:30] be working

[00:55:31] with

[00:55:32] paper

[00:55:33] consent

[00:55:34] forms,

[00:55:35] so that

[00:55:36] is typical.

[00:55:37] People

[00:55:37] will often

[00:55:38] use

[00:55:39] paper

[00:55:40] to

[00:55:40] record

[00:55:41] a rapid

[00:55:42] response

[00:55:43] event,

[00:55:43] such as

[00:55:45] a cardiac

[00:55:45] arrest or

[00:55:46] a resuscitation.

[00:55:48] Doctors

[00:55:48] will

[00:55:49] occasionally

[00:55:50] annotate

[00:55:51] paper,

[00:55:52] so they

[00:55:52] might

[00:55:53] annotate

[00:55:53] a paper

[00:55:54] ECG

[00:55:55] printout.

[00:55:57] Someone

[00:55:57] might come

[00:55:58] into

[00:55:58] hospital

[00:55:58] with a

[00:55:59] paper

[00:56:00] referral

[00:56:00] or a

[00:56:01] sketch

[00:56:02] of

[00:56:02] something

[00:56:02] that has

[00:56:03] been

[00:56:03] provided

[00:56:04] by another

[00:56:04] healthcare

[00:56:05] professional.

[00:56:06] Paper's

[00:56:06] okay.

[00:56:07] The most

[00:56:08] important

[00:56:08] thing is

[00:56:09] we want

[00:56:10] to

[00:56:10] understand

[00:56:11] what

[00:56:11] you

[00:56:11] do

[00:56:11] with

[00:56:11] it.

[00:56:12] So

[00:56:12] the

[00:56:13] paper

[00:56:13] is

[00:56:14] an

[00:56:15] important

[00:56:15] part

[00:56:15] of

[00:56:16] the

[00:56:16] record

[00:56:16] and

[00:56:17] as

[00:56:18] such

[00:56:18] it

[00:56:19] needs

[00:56:19] to

[00:56:19] be

[00:56:20] absorbed

[00:56:21] into

[00:56:21] the

[00:56:21] record

[00:56:22] at some

[00:56:22] point.

[00:56:23] So

[00:56:23] we have

[00:56:24] several

[00:56:25] standards

[00:56:25] around

[00:56:26] scanning

[00:56:27] and

[00:56:38] we

[00:56:39] get it

[00:56:40] into the

[00:56:40] record.

[00:56:41] You can

[00:56:42] manually

[00:56:42] key it

[00:56:43] in and

[00:56:44] then destroy

[00:56:44] the paper.

[00:56:45] You can

[00:56:46] scan the

[00:56:46] paper,

[00:56:47] you can

[00:56:47] take a

[00:56:47] photograph

[00:56:48] of the

[00:56:48] paper.

[00:56:49] But

[00:56:49] whenever

[00:56:50] you are

[00:56:51] operating

[00:56:53] dual

[00:56:54] systems,

[00:56:56] one

[00:56:56] paper,

[00:56:57] one

[00:56:58] electronic,

[00:56:59] you have

[00:56:59] an element

[00:57:00] of risk.

[00:57:01] And

[00:57:02] the more

[00:57:03] you do

[00:57:03] it,

[00:57:03] we're

[00:57:04] talking to

[00:57:04] a hospital

[00:57:05] the other

[00:57:05] day that

[00:57:06] was 50%

[00:57:07] digital,

[00:57:08] 50%

[00:57:08] paper.

[00:57:09] That's

[00:57:10] an accident

[00:57:10] of

[00:57:10] waiting

[00:57:11] to

[00:57:11] have

[00:57:12] because

[00:57:12] you

[00:57:13] don't

[00:57:13] know

[00:57:13] what

[00:57:14] you

[00:57:14] don't

[00:57:14] know.

[00:57:15] Is it

[00:57:16] on

[00:57:16] paper?

[00:57:17] Is it

[00:57:17] in the

[00:57:18] clinical

[00:57:18] system?

[00:57:19] Where

[00:57:19] is it?

[00:57:21] That

[00:57:21] work in

[00:57:22] progress

[00:57:23] of

[00:57:24] transferring

[00:57:25] from

[00:57:26] paper

[00:57:26] to

[00:57:27] digital,

[00:57:27] they've

[00:57:28] got to

[00:57:28] be as

[00:57:28] quick

[00:57:28] as

[00:57:29] possible

[00:57:29] because

[00:57:30] the

[00:57:30] longer

[00:57:30] you

[00:57:31] run

[00:57:31] with

[00:57:31] dual

[00:57:31] systems,

[00:57:33] the

[00:57:33] longer

[00:57:33] that

[00:57:33] you

[00:57:38] I

[00:57:38] think

[00:57:38] that's

[00:57:38] a

[00:57:38] great

[00:57:39] point

[00:57:39] because

[00:57:39] sometimes

[00:57:40] things need

[00:57:41] to happen

[00:57:41] very fast

[00:57:42] in

[00:57:42] healthcare

[00:57:42] and

[00:57:43] nothing

[00:57:43] is

[00:57:44] faster

[00:57:44] than

[00:57:45] writing

[00:57:45] something

[00:57:45] down

[00:57:46] on

[00:57:46] a

[00:57:46] piece

[00:57:46] of

[00:57:46] paper.

[00:57:47] One of

[00:57:47] the

[00:57:48] most

[00:57:48] interesting

[00:57:49] thoughts

[00:57:50] that I

[00:57:51] heard

[00:57:52] eight years

[00:57:53] ago when

[00:57:53] I started

[00:57:54] doing

[00:57:54] the

[00:57:54] interviews

[00:57:55] was

[00:57:56] when

[00:57:56] a

[00:57:57] healthcare

[00:57:57] IT

[00:57:57] vendor

[00:57:58] said

[00:57:58] we're

[00:57:59] not

[00:57:59] competing

[00:58:00] with

[00:58:00] other

[00:58:00] healthcare

[00:58:00] IT

[00:58:02] vendors

[00:58:02] we're

[00:58:02] competing

[00:58:03] with

[00:58:03] paper

[00:58:03] because

[00:58:04] it's

[00:58:05] much

[00:58:07] faster

[00:58:07] for

[00:58:08] a

[00:58:08] doctor

[00:58:08] to

[00:58:08] write

[00:58:08] something

[00:58:09] down

[00:58:09] on

[00:58:09] paper

[00:58:10] than

[00:58:10] to

[00:58:11] really

[00:58:11] document

[00:58:11] it

[00:58:12] and

[00:58:12] navigate

[00:58:13] drop

[00:58:13] down

[00:58:14] menus

[00:58:14] warnings

[00:58:15] etc

[00:58:16] so

[00:58:17] there's

[00:58:17] definitely

[00:58:18] a lot

[00:58:18] of

[00:58:18] opportunities

[00:58:19] still

[00:58:20] in

[00:58:20] terms

[00:58:20] of

[00:58:20] the

[00:58:21] digital

[00:58:21] transformation

[00:58:21] in

[00:58:22] healthcare

[00:58:22] and

[00:58:22] making

[00:58:23] it

[00:58:23] very

[00:58:23] easy

[00:58:24] to

[00:58:24] use

[00:58:24] and

[00:58:25] fast

[00:58:25] for

[00:58:25] clinicians

[00:58:26] yeah

[00:58:27] speed

[00:58:27] is

[00:58:44] it

[00:58:45] can

[00:58:45] be

[00:58:45] used

[00:58:46] to

[00:58:46] generate

[00:58:46] alerts

[00:58:47] warnings

[00:58:47] none

[00:58:48] of

[00:58:49] that

[00:58:49] can

[00:58:49] happen

[00:58:49] if

[00:58:50] you're

[00:58:50] operating

[00:58:51] on

[00:58:52] a

[00:58:52] paper

[00:58:52] system

[00:58:53] but

[00:58:54] we

[00:58:54] recognise

[00:58:54] the

[00:58:55] role

[00:58:56] of

[00:58:56] paper

[00:58:56] or

[00:58:57] anything

[00:58:58] that

[00:58:59] is

[00:58:59] manual

[00:59:00] but

[00:59:00] at

[00:59:00] some

[00:59:01] point

[00:59:01] you've

[00:59:02] got to

[00:59:02] get it

[00:59:02] into

[00:59:03] the

[00:59:03] system

[00:59:06] you've

[00:59:07] been

[00:59:07] listening

[00:59:08] to

[00:59:08] Faces

[00:59:08] of

[00:59:09] Digital

[00:59:09] Health

[00:59:09] a

[00:59:10] proud

[00:59:10] member

[00:59:10] of

[00:59:11] the

[00:59:11] health

[00:59:11] podcast

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[00:59:14] a

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[00:59:15] or

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