“Everything is pushing in the direction of digital transformation”

1. Colleagues and I had been thinking for a while about learning from the digital work we’d been doing, looking forward to see how we could scale it and embed it, and what challenges were on the horizon.

For example, how could we go from monitoring 500 patients with macular degeneration at home, using a smartphone app, to doing that for 10,000 patients? That requires a huge amount of work, not just in terms of deploying new technologies within the hospital and maintaining them - there’s also an entire piece of work around getting your workforce ready to do that. This whole field is very new. There are all kinds of skills that our clinicians need to develop to deliver these services. That was a major part of the thinking behind the Department of Digital Medicine: to create a central entity within Moorfields that could help staff to develop skills, to make sure that when we identify a need to deliver care digitally we are immediately able to connect all the stakeholders up with information governance and clinical safety, and to make services as scalable and as safe as possible for our patients.

We need to consider that we’ve got all these exciting new technologies coming along, and they have a lot of promise for improving and maybe even automating care, but it is very different to things that we've done in hospital in the past. We need to get the governance and the systems right.

2. We started formally writing documents for the Department of Digital Medicine towards the latter half of 2020, and then formally created it in February 2021.

We’re now in the process of bringing together all the components that will make up the department going forward, and making sure we’ve got the right senior leadership, governance structure and project management in place. It’s an ongoing process, but it is happening quite rapidly.

We need to consider that we’ve got all these exciting new technologies coming along, and they have a lot of promise for improving and maybe even automating care, but it is very different to things that we’ve done in hospital in the past

I think when COVID-19 struck, even those of us who were really optimistic about this were surprised by how quickly it was possible to adapt. I think it’s the same story across a lot of NHS trusts, that people are saying they’ve achieved more in the last six months than they have in the previous six years, because suddenly everything was pushing in the direction of digital transformation.

3. There was a growing realisation that this wasn’t going to be something that our traditional hospital structures were going to be able to cope with.

If we have a quarter of a million decisions being made a year, by different artificial intelligence (AI) systems, we need a new entity. So, people have started to talk about departments of clinical artificial intelligence, for example, to oversee these processes. That was another part of the logic behind our Department of Digital Medicine, to make sure we’re not taken by surprise when we do get these capabilities – that we’ve really thought through how we’re going to deploy them into clinical care.

This is a clinical department, and the idea is that it gets clinicians really centrally involved in this kind of work. They’re the ones who can be leading this, bringing the perspective that clinicians bring to these situations, because they’re the experts.

4. I’ll be the first head of the department.

We’re now bringing through other senior leaders, and getting all the different aspects of the department coordinated and hopefully then rapidly working over the rest of this year.

I think when COVID-19 struck, even those of us who were really optimistic about this were surprised by how quickly it was possible to adapt

We’re doing a lot of work with NHS X, NHS England and NHS Digital around the national transformation of ophthalmology with digital technology, and this has really been the first big project where all these entities within Moorfields are now working closely together. We’re already underway with the first big projects.

5. The question has been how we can ensure that we are delivering services that patients want.

There are considerations not just around technology, but also about how you support patients using an app. Not all patients are technologically comfortable. There are a lot of questions around making sure data privacy and information governance is at the highest standard. Part of the logic of the department is to make sure we’ve got a real centre of expertise, that every time the clinical service decides they’d like to set up a digital service, they don’t have to do it alone and from scratch – that there is this central entity in the hospital that has the expertise that means service can be set up quickly.

6. Just as we have to get systems right, we have to ensure that staff are happy too.

If you are asking staff to do video consultations, you need to ensure you’re supporting them to deliver those consultations in a way that works for them. That goes all through hospital technology: to make sure the technology we ask clinicians to interact with works as well as possible. We’re trying to make sure the systems our clinicians interact with support them to do their work efficiently.

We’ve got some real leaders here. I’m inundated with enthusiasm from ophthalmologists and optometrists who want to get involved in this kind of work and see that as a major part of their career going forward.

7. We’ve tried to get the initial set-up future-proofed, making sure we’ve got a work stream dedicated to clinical safety and one dedicated to hospital technology.

I hope that we’re setting up a structure that’s going to be robust to future development, so that when AI comes along, for example, we’ve got that appropriate clinical safety work stream that can handle, implement and monitor it and make sure we're getting all the benefits without any risks.

I’m inundated with enthusiasm from ophthalmologists and optometrists who want to get involved in this kind of work and see that as a major part of their career going forward

We’ve tried to think ahead. I think for us the major goal is to make everything that happens in the hospital as slick as possible using technology.

8. Part of the drive is to make sure that we’re able to make our expertise available digitally.

There’s a general move towards better connectivity between primary care and the hospital. If there is a community optometrist or an ophthalmologist in another centre that needs a sub-specialist opinion for something very rare, the Department of Digital Medicine will be able to support us in receiving those requests and giving clinical advice to support care happening outside the hospital.

Reducing the amount of care that we centralise in hospital is in most people’s roadmaps. I think we can use digital means to support that. By linking people together, you support the entire system to improve.

• As told to Lucy Miller.