FCI Interview with Professor John Williams

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We have a very special feature this month - for our monthly bio, we have Professor John Williams. A previous FCI Council Member and Exec Member, John was one of the driving forces behind the creation of the Faculty of Clinical Informatics and has been involved in many pioneering areas of clinical informatics research.

John was interviewed by his namesake Dr John Williams, current Chair of Trustees and former Chair of Council at the Faculty.

This is a wonderful read and celebration of John’s many achievements. Enjoy!


Key:

JW 1 = Interviewer John Williams FRCGP

JW 2 = Interviewee Prof John Williams FRCP

JW 1

John – I have to say that it is a great privilege to be given the opportunity to interview you and to draw out just how much you've contributed to clinical informatics over your career, and also to the start, and subsequent development, of the Faculty. I also must point out that our Exec colleagues simply couldn't resist the temptation to get one John Williams to interview the other!

I lay claim to being one of a very small number of people who know just how much you put into the beginnings of the Faculty and we will come back to that later. Let's start at the beginning. Using the name Williams as a convenient bridge, both of us know that there are very many more Williams’s living in England than there are in Wales. I certainly can't claim to have any Welsh pedigree - I think the nearest I can get is an address somewhere up in Manchester, several generations back! But you actually do have a genuine Welsh pedigree, so can you tell us a little bit about those Welsh connections, where you were born and where you grew up?

JW 2

I can indeed. Just before I tell you, I was reading that Williams is actually the third most common surname not only in Wales but also in the United States. I think there must be such diversity of surnames there that you don't need many to be very common.

So yes, I am a Welsh Williams. I was born in a nursing home near The Mumbles in Swansea. My father was brought up in Swansea, where his father was a GP, in Morriston. My great uncle was a surgeon at Swansea General. Soon after I was born the family moved from Swansea to Portsmouth where my father took up a newly created NHS consultant surgeon post. So I was actually brought up in Southsea, though all through my life have retained very strong connections with family and places I love in South Wales, particularly the Gower Peninsula. And it was pure serendipity that brought me back to work here, many, many years later.

JW 1

From the Gower peninsula to Southsea and back, I am going to fast forward to when you became a medical student.  I gather that you decided to join the Navy. A small number of my colleagues did something similar and joined the forces when I was a medical student, but I don't think many of them stayed with that connection for very long. But you kept that going for quite a long time. So can you tell us a bit about that? How did your career in the Navy develop and where did it take you?


JW 2

Certainly. So, there was, and still is, a medical cadet scheme where you can join the armed forces on a short Service Commission, in return for having some of your training paid for. I trained at Cambridge and then St Thomas's, and when I moved from preclinical training at Cambridge to clinical training in London, I explored the possibility of the Navy and decided I was quite attracted to it. So I sold my soul for five years, in return for being able to buy a sports car as a student.

The five years started when I qualified in 1970, but I managed to secure a succession of NHS posts before putting on uniform, which got the naval appointers a bit irritated.  However, it enabled me to get the MRCP out of the way, which I was lucky to pass quite quickly. Once I had, the Royal Navy got their pound of flesh. Initially I felt that I had been bribed into something which by then I wasn’t sure I wanted to do, but I actually found I enjoyed it. There was quite a bit of travel and excitement but it's a very professional environment and the clinical training was excellent. The naval hospitals in Plymouth and Portsmouth treated both service and civilian patients and were very busy. After five years I decided I would stay on and ended up doing a total of 21 years. I did all my training as a gastroenterologist either in the Navy or on secondment in civilian hospitals.

JW 1

So that's where you developed your specialism in gastroenterology, but am I right in saying that there was a research element in your work as well?

JW 2

Oh, yes. I was fortunate in working for a gastroenterologist, Godfrey Milton-Thompson, who was very active in research and had forged strong links with George Misiewicz at the Central Middlesex Hospital.  This was at the time that Sir James Black had hypothesized there was a second histamine receptor that should be responsible for acid secretion and I was very fortunate to be involved in the evaluation of the first H2-receptor antagonists.  We undertook a program of research to confirm gastric acid inhibition and demonstrate the efficacy of metiamide and then cimetidine. That stimulating involvement in research led to an enthusiasm for clinical research throughout my career.

JW 1

So in fact your time in the Navy not only gave you your specialism in gastroenterology.  It also gave you a sound base in academia as well?

JW 2

Yes, it did. And it gave me an opportunity to build my own research portfolio and also to lead some of the research activities in the Navy later on.

JW 1

Right. So one of the things you told me when we were talking earlier was that you found it increasingly frustrating to be surrounded by a high volume of data, and yet at the same time to be faced with a complete absence of any meaningful data that could guide your practice. Was that at this time, or did that come a bit later?

JW 2

That came a bit later, when I became a consultant and had more influence over the development of my practice.  When I was looking for ways to develop and modernize the clinical service it became increasingly apparent to me that the evidence that I needed was locked up in paper records and totally inaccessible.

Let me use the example of colitis: Some patients with ulcerative colitis would go through many months or years of chronic ill health, and eventually I would say to them: ‘Look, I'm not making you better, I think you need your colon out, you should have surgery’. This was a big decision because in those days pouch surgery was in its infancy and colectomy usually meant a permanent ileostomy. But, in spite of that, most patients would come back after surgery and say, ‘I'm so much better, why didn't you recommend this earlier?’ And I had to tell them I had no way of knowing they weren't going to get better.  All I knew was that roughly a quarter of patients get better with no more trouble, a quarter never get better and come rapidly to surgery, and about half have a chronic course characterized by unpredictable remission and relapse, though some do settle down. When it doesn’t, we resort to surgery but it would be so much better if we could predict the need from clinical data early on.  I felt sure that with so many patients with colitis, we should be able to predict which ones are going to get better and which aren't. And that's really what led me into pursuing electronic records so that we collected that data.

JW 1

That's a really interesting sequence, John, particularly when it comes from a secondary care setting. I wonder how many people have similar stories to that. But first let's move on a little bit further, and then come back later to electronic records.

I think that you said that you spent 21 years working in the Navy.  You had specialized in gastroenterology, developed an academic role in research and training. And then it came to an end.  How did that come about and where did you go next?

JW 2

I enjoyed the variety and excitement of naval life. I served on a frigate on hurricane patrol in the Caribbean, although I saw more rum than hurricanes which was a disappointment! And I had a brief but exciting visit to the South Atlantic in the Falklands war.  I also spent 18 months in Gibraltar which was very formative because although small, the hospital had responsibility for the care of about 30,000 service and family personnel.  With just four young specialists - surgeon, physician, obstetrician and anesthetist – it meant that I was not only a general physician but also the neonatologist, pediatrician, psychiatrist, pathologist, radiologist, dermatologist, rheumatologist, and of course, the gastroenterologist.  It was the most stressful but satisfying 18 months of my career.  

I have always enjoyed clinical medicine and have never wanted to give it up - indeed I still see patients now. In the mid-80s I was in a clinical-academic post as Professor of Naval Medicine and came to a crossroad when I was asked to move into administration, which would mean giving up my clinical work. After a lot of soul searching, I decided that I really wanted to stay in clinical practice, so decided to leave the Navy.  

JW 1

From our point of view, it is probably a good thing that you did that and continued in your clinical career. And you certainly didn't just retire.  Somehow that led you to an opportunity to move back to Swansea where you were able to continue caring for patients and to continue to develop your interest in gastroenterology and in academia. Could you tell us a bit about that? In particular, my understanding is that you were faced with the task of setting up a new gastroenterology department. And I think that this may be where we should talk more about your sense of being surrounded by this vast lake of data everywhere around and yet not a drop to drink.

JW 2

Sure. When I resigned my Naval commission, I had no job to go to and felt as if I was jumping off a cliff. I was looking for an NHS post with an academic element and to my delight a post in Swansea came up which was exactly what I was looking for.  The brief was primarily to establish a postgraduate medical school but with a half-time clinical role.

The clinical component was at Neath General Hospital, which at that time was the busiest general hospital in the Swansea Bay Area. But it had no gastroenterologist, so I had this fabulous opportunity to set up a gastroenterology service in a very busy DGH. And, as you say, that's where it gave me the opportunity to address this issue that we found so frustrating, of potentially being awash with data but with no information, no knowledge.

JW 1

So how did you approach that? Because as you’ve already said, there was no point in expecting paper records to be able to deliver that. So tell us how you proceeded.  Where did that lead? And what did you achieve?

JW 2

It was so fortunate because I immediately identified the need for a computerised clinical information system.  There was nothing suitable on the market at that time but with the nascent postgraduate medical school I was able to recruit the computer science expertise necessary to build the system I wanted.

We spent a lot of time discussing the requirement and we agreed that we wanted an approach that was centered on the patient - not the disease or context in which they're seen. And that meant it had to be generic, in the sense that it had a common database structure.  We used Oracle and were able to customize different views or windows on a common, generic, database tables, according to the context in which the patient was seen. We spent hours analyzing these requirements using Checkland’s soft systems methodology. In the end we created a generic clinical information system, which we were able to implement to support the processes and recording of a variety of different aspects of the practice, including patient administration, endoscopy, outpatients, and later nurse led services. The generic approach enabled us to customize it to support care in many other and diverse contexts over the years, including urology, sexual health, dietetics, chest pain clinics, diabetes and geriatrics.  We also used it for research, including as the trial and data management system for a major multi-centre trial in ulcerative colitis. 


JW 1

You make it sound so easy, John.  You were able to liaise with academic computer science colleagues and with other colleagues to come up with a detailed requirements analysis using soft systems methodology. But there you were as a single-handed gastroenterologist and on top of everything else in a hospital that hadn't had any gastroenterology so faced with the task of setting up a new department. I am sure it must have been very challenging with all of those things going on at the same time.  If you have not already done so, I am wondering if we should be asking you at some point, to write down your informatic experiences around that, because I think that would be really interesting and informative.

I just want to explore this a bit further.  You have told us how you went about sorting out the requirements, and then presumably you worked with your computer science colleagues to produce a solution that in due course met those requirements. That must have needed some resources; where did those resources come from?

JW 2

We secured a substantial grant from the Welsh Office. I hope I haven't made it sound as if I did all this! I drove it, I had the strategic vision, but I was heavily dependent on many colleagues to achieve it.

JW 1

So this must have required managing a team of people to achieve?

JW 2

It was a small but very skilled, dedicated and industrious team. It was never more than half a dozen, but very close-knit.  And it was at a time when people were struggling over the implementation of systems to support clinical care, so they were receptive to what I wanted to do. My sadness was that I was never able to persuade people more widely of the strategic need to focus on the patient, rather than the context or the disease – so fundamental if we are to achieve truly patient-centred care.  Unfortunately, we now have all sorts of disease focused systems, and huge problems with interoperability of both systems and data.  

JW 1

Very interesting. When we talked earlier, you said that it was important for the data in the system to be structured. How was the clinical data structured?  Was it is some way coded?

JW 2

It was a major problem in those in those days, because Read codes were used in primary care, and ICD9 and OPCS in secondary care.  At least primary care had a clinical terminology.  In secondary care we just had a coding system designed to support administration, not clinical care.  There was an overwhelming need for a universal terminology that was applicable across all contexts.  Martin Severs was involved in the early days of our work and used the generic system in his geriatric practice in Portsmouth.

JW 1

Not far from Southsea, by the way!

JW 2

That's right, exactly! Both of us saw this overwhelming need for clinical terminology, and that led to the Clinical Terms Project, which Martin initiated, got the funding for, and led. I led from the gastroenterology perspective and we were able to adopt clinical terms, version three in practice.

JW 1

Ah right.  So all the bits of the jigsaw suddenly start to fall together. Here begins Clinical Terms Version 3. That's absolutely fascinating. Let’s move on a bit further; we might come back to the clinical terms project in a moment. 

You had your clinical system all sorted out. I think what people will find really interesting is what that then enabled you to go on and do. So essentially there you were, weaving together your clinical practice, your academic role, and your developing interest in clinical informatics.  Over time, that led to a number of very important and positive outcomes. Can you outline what those were, and perhaps how your practice with this system contrasted with your early experience without it?

JW 2

I used the system to record coded data about my clinical activity, and that included presenting complaint, symptoms, diagnosis and procedures. Using this I was able to monitor the relentless rise in my clinical workload.  I was a single-handed gastroenterologist but I was able to demonstrate this rising workload to the management of the hospital (later the trust).  I used the data to persuade management to give me more resources so that I could get more staff.  That really showed the power of information, as I didn't have any difficulty in making those arguments.  

I also used the data to show the particular impact of chronic relapsing disorders such inflammatory bowel disease that have to remain under specialist care. I was able to demonstrate that I was not only picking up a vast pool of patients with inflammatory bowel disease that had not been pulled together before, but I was having to keep them under review. It rapidly became apparent to me that this was unsustainable, but we were able to use that data to think through alternative approaches to managing these patients.  In those days follow up in outpatients was with fixed booked appointments, which were a luxury when the patient was well, and made clinics so full it became more and more difficult to fit the really sick patients in when they needed to be seen.  It was not the most efficient or safe way to manage patients or run a service.

To address this, we introduced the concept of open access follow-up, where patients contact us when they're unwell and we don't actually see them when they're well.  We wanted to show that this was effective and efficient and were able to get funding from NIHR for a two centre randomised controlled trial of open access follow up versus booked appointments.  This trial showed that open access follow-up delivers the same quality of care as routine outpatient care but is preferred by patients and general practitioners. It uses fewer resources in secondary care but I’m afraid it didn’t make savings in primary care!

JW 1

So this employed mixed methods, and presumably for the quantitative part, much of the data came from the system that you have just told us about?

JW 2

Yes, we used the system to record the data.

JW 1

Leading to a random controlled trial, which is impressive stuff.

So that was the open access bit, which must have seemed to some people to be a bit disruptive, but in a very positive way. But I believe that you also did some similar investigative research around using specialist nurses to carry out colonoscopies? 

JW 2

Yes.  That followed on from this study, because one of the qualitative conclusions was that for open access to work effectively there must be an accessible point of contact for them at the hospital. We tried to establish that through clerical staff when we set up the trial, but it didn't work that well. It needed informed clinicians who would be always available, with access the patient record when the patient called, both to know what the background was and to be able to record what was advised. Our electronic record provided that, but we needed clinical professionals to provide the service.  So we appointed a specialist nurse, and to make the post more attractive we offered training in endoscopy because that was another component of my practice where the workload was rising relentlessly. 

I was fortunate in being able to appoint a very enthusiastic, keen and competent nurse, Phedra Dodds who took on the role of specialist nurse and started training in endoscopy. At that stage, this transfer of skills from doctors to nurses in endoscopy was very controversial. There wasn't an evidence base for it, but many of us felt it was inevitable due to the rise in endoscopy workload. Many of my colleagues were starting to train nurses in endoscopy, so we decided that we needed a robust evidence base for the effectiveness and safety of this role substitution.  This came from another multicentre trial, MINuET, in which we compared nurses with doctors undertaking endoscopy, funded by NIHR and again published in the BMJ. What we showed is very interesting - nurses are equally effective as doctors in identifying pathology, but they keep better records and patients are more satisfied.  There was no cost benefit, because nurses were more cautious and tended to request more investigations after the procedure.  The study was an important contribution to the evidence base that led to the widespread establishment of nurse endoscopy.  Now more than 20% of colonoscopies are performed by nurses.

JW 1

So this is yet another very significant change in practice all around the UK, the evidence for which basically came from the system that you developed. I am picking up themes here - one is patient centeredness, another one is working in teams, multidisciplinary teams, and another is evidence based innovation. So these are themes that seem to be developing as time goes on, and which I think come through to the Faculty.

You talked about clinical terms version three and Martin Severs and, in an earlier conversation, you also told me about your involvement in Learning to Manage Health Information. The interesting thing is that both you and I were involved in both of those projects in different ways, and at the same time.  Can you tell me a bit about your perception of those projects, what they achieved, and maybe what they did not achieve?

JW 2

In the mid-90’s I was asked to Chair a national programme on education and training in Information management and technology for clinicians - doctors, nurses, and the clinical professions.   The programme manager was Chris Pearson, who was very, very good, and superb to work with. We looked at education and training for all clinical professions at both undergraduate level and postgraduate level. We consulted widely and produced lots of guidance, including Learning to Manage Health Information which was the first stab at a competency framework.  

A spin-off was a terrific network of enthusiastic clinicians. At the end of the program, we had this fantastic network of people who shared a common vision and were working well together, and I implored the Department of Health to keep that network going when they closed the programme.  It wouldn't have taken much funding at all, but they wouldn't do it. And this is a recurring pattern; successful projects bring people together and the network is then disbanded.  The same thing happened with the clinical terms project. I think one of the things we've achieved with the Faculty is the establishment of a professional body that is not destroyable in that way.

JW 1

Very interesting observations.  Let’s hope that the Faculty will not succumb in the same way.  We are certainly continuing to work very hard to avoid that fate.

So now we get to the early 2000s. At that time, no doubt based on all of the work that you have just been describing, you were appointed as Director of Research and Development for Wales, and that enabled you to establish the pan-Wales Research Collaborative Infrastructure which must have been a bit of a trailblazer at that time. Tell us a bit about that and your Swansea Health Information Research unit, and where all of that eventually led.

JW 2

So that was in 2004 and it was at the time when Sir David Cooksey had been asked to look at the research infrastructure across the UK.  He identified poor translation of ideas from basic and clinical research into the development of new products and approaches to treatment of disease and illness, and also difficulties in the implementation of those new products and approaches into clinical practice. To address that, the research infrastructure in the whole of the UK was being radically refashioned.  Sally Davies drove it in England and I was doing the same in Wales on a much smaller scale. In Wales we established Clinical Research Collaboration Cymru, which was an attempt to bridge those gaps in translation and create a pan-Wales infrastructure. As a key part of that infrastructure, I saw a need to harness the information locked up in data routinely collected from across the spectrum of health and social care. To do that I asked colleagues in Swansea to establish a Health Information Research Unit (HIRU) to explore what could be done.  The task was to link data from different sources anonymously and this led to the establishment of SAIL (Secure, Anonymised Information Linkage). That led us to being a founding member of the national Farr Institute and then part of the wider network, Health Data Research UK.

JW 1

It is very interesting to hear how all of these things evolved. Impressive stuff! So now we have the pan-Wales research organisation, we have got the Farr Institute and you are involved in that. So again, this is having UK wide impact.

Around the same time the RCP invited you to set up the RCP Health Informatics Unit. What task did they set for you and how did you go about it? What were the eventual outcomes?

JW 2

At the Royal College of Physicians there was a committee that met every quarter, called the Medical Information Technology Committee. It was well attended but was an exceedingly frustrating and unproductive talking shop. The President at that time was Margaret Turner-Warwick, and the registrar was a gastroenterologist, Ian Gilmore, who subsequently also became President. Because the committee was so unproductive, they asked me to establish a Health Informatics Unit at the College. The remit was essentially to make things happen. They gave me enough funding to appoint a research fellow, and I was delighted to be joined by Robin Mann, who subsequently went to work for the Welsh IT Programme, and then out to Australia. 

We felt we had a real opportunity to harness the leadership of the RCP to improve the quality of patient records, and through that clinical data. We secured funding from the Department of Health and the Welsh Government to establish an Information Laboratory, or iLab, where we supported clinicians to look at the HES data held about their practice.  The research fellow was Giles Croft.  Consultants were always enthusiastic but astonished at the amount of data held about their practice and how inaccurate it was. It was clear there was huge potential to improve the data, but it needed information departments in hospitals to support the clinical as well as the operational need.  We put together advice as to how they could do this in hospital information departments and thereby engage their consultants, which should in turn improve the source data.  But we got nowhere because information departments were just too busy with waiting times and performance targets to take up the challenge.

It was very frustrating. But it led us to take a different approach – to improve records through national standards for record keeping, and the structure and content of records.  We secured funding, Ian Carpenter joined me to lead the programme, and over time we developed and published a raft of national standards. Many thanks must go to Jan Hoogewerf, our current FCI Business Manager, who was a hugely effective Programme Manager at the HIU.

JW 1

And of course what you are describing is the work on record standards, isn't it? The work started off in RCP HIU. I seem to recall that they were then adopted by the Academy of Medical Royal Colleges, and then subsequently the whole idea of Professional Records Standards Body was that it should take them forward and develop them further.

JW 2

Yes, because it immediately became clear that because these standards were needed across all disciplines and professions, it couldn't be led by one College. It had to be owned by a very broad church so we drove the establishment of the Professional Record Standards Body.

JW 1

Indeed. You have also shared the details of two very impressive Swansea University impact studies - one of which was very much about developing and implementing national standards to improve structure and content of medical records.  The other related to improving service delivery and patient care in gastroenterology. Would you like to say a few words about both of those, in particular the first one about national standards?

JW 2

Impact case studies are produced by universities as part of their submission to the research evaluation framework (REF) on which universities are judged for the quality of their research. We developed two. One described the impact of our research on the quality of patient records and the development of standards, and the other described our work on new ways to deliver services.  We were able to show that record standards were endorsed by many organisations and incorporated in many national and local initiatives in the UK and overseas.  The other showed how the way GI services are delivered was also changed, through greater open access to specialist care for patients and role substitution in endoscopy. 

JW 1

And a lot of the impact of this would have been down to the fact that you had developed your system to collect data about your practice, which was then accessible and could be used to inform decisions and to support research and to build evidence. Would that be fair comment?

JW 2

Yes, exactly.

JW 1

So again, without having that electronic record system in place, it would have been very difficult, would it not, to assemble that level of evidence?

JW 2

I couldn't have done it. It would not have just been very difficult, it would have been impossible!

JW 1

So this is all very impressive stuff. I am going to move us on to 2014 and early thoughts about the Faculty.  But first I would just like to mention that somewhere around this time, you were on the honours list and got a CBE?  That was clearly very well deserved on the basis of everything that we have been talking about.

JW 2

Thank you, John. I can just say it was a surprise but reflected a huge team effort from many people, for which I will always be grateful.

JW 1

So 2014 brings us to the time when we were starting to think about the Faculty.  That was shortly after NPfIT and Connecting for Health finally came to an end.  Some of us expressed a great sigh of relief because clinical informaticians could come out from undercover again; it had at times been a challenging experience to have been working as clinical informaticians that environment. And now there was a window of opportunity to influence government, which would have been somewhat unheard of during the NPfIT / CfH era. The AoMRC (Academy of Medical Royal Colleges) produced a report for Jeremy Hunt, who was Secretary of State at the time. You may remember that this was a very long and detailed report.  At the last minute, just before it was due to be submitted, various people in RCGP Health Informatics group and others (I suspect including yourself) on seeing the report were worried that it did not have any coherent summary to bullet point the priorities, and was at risk of falling flat on the ground.

So I remember some frenetic, last minute collaboration between RCGP Informatics group and RCP HIU to produce a succinct summary for that report. Both you and I were pretty heavily involved in that. With others we got the summary together.  While we were doing that, I recall that we debated whether or not the idea of developing a Faculty of Clinical Informatics should be included. Maureen Baker was involved in this discussion because she was the Incoming Chair of the RCGP, and collectively, I think very wisely at the time, we agreed that we would leave out any suggestion of a Faculty.  And so that report went forward and seemed to be quite well received. 

I suspect that that successful collaboration, and the discussions that we had had about the Faculty, finally triggered Maureen Baker, who of course had headed up the Clinical Safety Unit under NPfIT, into taking the view that the time had come to launch a Faculty of Medical Informatics. She relayed that message to the RCGP Health Informatics group, and I was one of the people that she approached. She agreed that I should start by exploring how RCP and RCGP might work together to get that show on the road. So I think you and I simply picked up on the earlier discussion and things developed from there - really as an extension of the collaboration on the AoMRC report.

What are your recollections of that time and of the work that we needed to do to get things going – leading up to a key meeting that took place at the RCGP on the evening of April Fool's Day 2015? I recall that we lobbied senior members of colleges, AoMRC and many other people. What are your reflections of that period?

JW 2

I think that's a really good summary of how that all evolved. I remember what was effectively a completely lost weekend writing that summary for the AoMRC report! But I also remember being quite pleased with what you and I came up with in the end.

With regard to the Faculty, you are absolutely right, we decided at that stage that it was probably a step too far to suggest the establishment of a Faculty, but Maureen kept the thought alive and was the catalyst to rekindle our enthusiasm.  My recollection is that initially you and I were pretty much on our own taking it forward.  One of my powerful memories is the debate as to whether it should be a Faculty of Medical or Clinical Informatics. We initially explored whether informatics this should be recognized as a new medical subspecialty, but the GMC weren't keen, and on reflection it was indeed ridiculous to establish this as anything based on a medical discipline – informatics crosses all clinical and care professions. It was absolutely right that the Faculty should be inclusive of all professionals working in health and social care.

My other powerful memory is that in spite of this we were perceived as pushing a medical perspective, and though we tried very hard to pull in the much bigger numerical discipline of nursing, it was challenging to make progress at first.  Other disciplines such as pharmacy and social care, were much less resistant, but progress is now good and the Faculty is developing as a very broad professional church. I think we're on the right road.

JW 1

John, you are right, it did seem to be quite a lonely time in the early stages, and there were a lot of meetings with a lot of people. And the contacts that you had, for example, with AoMRc and with senior people in your own college, I think were absolutely vital. Without having those contacts and without being able to get all of those people together, it would have been impossible to get the Faculty launched. Between the two of us, we were able to get senior people in both of our colleges to go to the Academy, and to explain what we were trying to do, and I believe that the idea of setting up a Faculty received unanimous support from Academy of Medical Royal Colleges when it was put to them. And I don't think that would have happened unless you had been actively involved, with the two of us working alongside each other to lobby the appropriate people to get us into that kind of position. But few people will know this, which is why I am deliberately emphasising it as we as we speak now.

Moving on, from the April Fool's Day meeting, we were effectively instructed to go away and set up a steering group to investigate the possibility and feasibility of setting up a Faculty. A Steering Group was duly assembled, chaired by Maureen Baker and it subsequently handed over to a Shadow Board. You were actively involved in both of those. You have already mentioned the issue about name change, and I recall a second issue around the Digital Academy, the new course which was just coming into existence, and the issues around requests that the Faculty should be accrediting that course. So what are your reflections on the Steering Group and Shadow Board stages?

JW 2

I think that the word I would use is ‘professional’. You and I both felt that we shouldn't cut any corners with establishing this new organization, it should be done with huge professionalism.  We should create an infrastructure that was sustainable, robust, defendable, and transparent. Achieving that took time, resources and effort, but it was really important that we did it properly. The rigour of the process for election to the Fellowship is a good example and election is something to be intensely proud of. 

So in setting up of the organisation, we took a very professional approach, and all credit to you John, that when you took up the Chair, you continued to do that and did not compromise in any way. By ‘professional’ I should also stress that our goal is to establish clinical informatics as a recognized professional discipline. That is why we need a competency framework, a clear career structure, standards for behaviour and performance in the discipline, and recognition of safety issues. As an aside, in many ways, this is what distinguishes clinical informatics from digital health. Digital health is innovative and exciting – bringing new ideas, developments, apps and devices to transform health and social care. That progress is really important, but it must be underpinned by professional leadership from a body of people who are prepared to look at standards, safety, and competence, and make sure that these new developments don't harm or kill people.

JW 1

And I suspect you would probably also agree that that body of people needs to make sure that everything remains person centered so technology serves people and not the other way about.

So then in June 2018, the shadow board finally handed over the reins to first FCI Council.  You were elected to that Council and became an active member and we co-opted you on to our Executive Group where you continued to provide us with your wise counsel. The Faculty has since, of course, developed into a charitable organisation bound by a set of charitable objects. What are your thoughts about those early days of ‘full Faculty’? And thinking back on all of your hopes of the Faculty as they were in the very early days, before we even had a steering group, how do you think the Faculty measures up? Is it heading in the right direction? What might you like to see it doing differently? And do you think there's anything it could be doing better?

JW 2

It was frustrating how long it took, but it I think we can say we got there, in the sense that we now have a very significant Membership and Fellowship, and the Faculty has established a very robust organisational infrastructure. It has also delivered its first major project, the competency framework, brilliantly led by Alan Hassey.  I think everyone can be very proud of what has been achieved.

You ask what else could we have done, or what haven’t we done. I suppose I wish the Faculty had established more influence as the professional body for clinical informatics. That will come when it is eventually a member of the Academy of Medical Royal Colleges, because then other colleges will see what it has to offer in that forum. But it is not yet the go-to organization for sage advice about matters relating to health informatics.

JW 1

Thank you, John, I agree that there is still a lot of work to be done in that direction. I'm sure you're right about that.

So you demitted from Council earlier this year and from Faculty Exec, and you now have the possibility of a well-earned rest from all of these things, apart from when we occasionally ring you up and ask you for a bit of help! To end on a more light-hearted note I'm just going to ask you: what do you do for relaxation?

JW 2

I enjoy what I regard as coarse woodwork. I don't make fine furniture, but I enjoy making things for the garden – planters, tables, log stores, and things like that.  I still work three days a week for the university, but when I fully retire I'm going to treat myself to a proper workshop with some very expensive woodworking kit in it.   I also enjoy the outdoors, especially when travelling in our VW campervan, though this has been very restricted this year.  Like you, John, I also enjoy cycling, but probably not quite to the strenuous extent that you do it.

JW 1

So John, let's hope that these vaccines will actually enable us all to get back to normal so you can get back to enjoying your outdoor pursuits and travelling.

John, I have really enjoyed conducting this interview and to have the opportunity to explore your impressive career, with its pioneering informatics, impacting both at individual patient level and at population level and clearly having all sorts of impacts UK wide. It is very obvious that it is all underpinned by an academic, evidence-based approach, much of it ahead of its time. On behalf of the Faculty, I would like to thank you very much for all of the hard work you've put into helping the Faculty to come into existence and I would just like to say, in case anybody is still in any doubt, I'm absolutely certain that none of this could have happened had you not been involved from the very early stages.

JW 2

John, those are very kind words, and from someone who shares my name and has undoubtedly contributed more than I have to the Faculty. But because we share a name, it's always been extremely useful to me because I'm able to pick and choose what I claim to have achieved!  But of course it is always a team effort, and many, many people have contributed along the way.  Too many to name, but they know who they are and I will always be grateful.

JW 1

That is a great message to end on.  I believe that both of us have always viewed this venture as being very much a team effort.  Without the many people who have contributed – and continue to contribute – there would be no Faculty.