In Megabuyte, January 2014. Original article (£).
The Megabuyte Interview: Chris Spencer
“I talk to folks and encourage them to understand the business. I don’t mind talking,” says Chris Spencer, asked what he’s up to in London today. Down from Emis’ headquarters in Yorkshire, the CEO is too nice to say it but some meetings are more glamorous than others: next up is Whitehall. “Those meetings are an important part of what we do, because we get most of our largest contracts from government sources,” says Spencer. “The NHS is a supertanker of 1.7 million people, with somebody standing at the front saying, ‘Let’s go that way.’ And it’s going that way. But not to think it will move overnight.”
Chris Spencer certainly does not mind talking though. Before our hour is up, the open and cheerful CEO has made me laugh and cringe, the latter at the story of his eye surgery which he shares as as an explanation how his company is working to solve some of the inefficiencies in healthcare. The conversation may be different over in Whitehall, but don’t we all have a soft spot for the NHS? Emis, the UK’s leading supplier of clinical software to primary care, and increasingly also secondary care, may be a public company, but everything it does taps into something personal. As Spencer says: “You don’t have to work too hard to get people motivated with the idea of the NHS.”
Linking up the chain
But what this means on a daily basis is that Spencer has a 1600-people-strong company to run. Last year marked a major milestone with the roll-out of Emis Web, and the company recently launched a series of apps, including one where patients can book appointments and get repeat prescription. It’s sounds simple but of course it’s very complicated; after all, the NHS consists of 200-odd organisations, all with their own ways of running things. “It’s counter-intuitive, isn’t it?” says Spencer, pointing to how we all can get money from any cash machine and the banks sort it out behind the scenes, seamlessly.
This is essentially what Emis is working on: making all the branches of the healthcare system talk to each other. An immense task of course, and one plagued with concerns over cost and security. “The NHS as policymaker want it to happen because it will be faster, better and cheaper for the public. It’s like ‘pick your own strawberries’: you’re getting the public to look after themselves,” says Spencer. “For a lot of patients the downside is around security and information floating around in the Cloud, so there’s an education piece.” Then in the middle there’s the clinicians, who have all sorts of reasons for not wanting to share information. “They might say, ‘It’s a record where I make all sorts of notes.’ You know, historically they might have made notes like DTS, for the fuller figure.’” Spencer leans forward, conspiratorially: “That means ‘Danger To Shipping’.” I laugh, horrified. Digital transformation, it seems, may have unintended consequences for bedside manners.
The healthcare universe
While only stepping into the CEO position earlier this year, none of these issues are new for Spencer; he has been with Emis for 14 years as Chief Administrative Officer. But how does it feel to be in the big seat? “It’s absolutely different, sure. Suddenly it’s you and only you, and you have the desk with the sign that says, ‘The buck stops here.’ … There’s an enormous sense of responsibility, but there’s also the freedom to push things forward.”
Spencer thinks he has a fair bit in common with Sean Riddell, from who he inherited the CEO post in February ahead of his permanent appointment in July. “We are both really quiet people. Wouldn’t say ‘boo’ to a goose. But I think we approach things differently. I tend to go for a lot of fact-gathering, a lot of engagement with folks, and then I make the decision.” The other difference is that Emis no longer has the steely primary care focus of previous years, now aiming to tie in more aspects of the healthcare universe. “We’ve taken quite a long time to join certain things up historically. Take our pharmacy system, which has been with us since 2011. Is it as joined up as I’d like it to be? No! That’s because we’ve been concentrating on some other, really important stuff. But I want to encourage multi-tasking.”
This is where Spencer tells the story of his eye surgery: earlier this year the CEO needed immediate surgery for a detached retina. Having been transferred between hospitals with handwritten documents, a comedy of errors ensued where the new hospital got his name wrong, his bed was given away after surgery, he was given the wrong medication, and his prescription wasn’t prepared. They operated on the correct eye though, just about. Not long after this ordeal, in September, Emis acquired pharmacy and prescribing specialist Ascribe, meaning the new world is one where a joined-up EMIS and Ascribe will hopefully prevent this sort of muddle.
“Let’s look at that in the sort of world I think we should be in,” says Spencer, having re-lived the harrowing story. Ascribe is number two in A&E systems, meaning Spencer would have been transferred with an electronic record, for one, “and they wouldn’t have called me Spence all the way through!”. Ascribe is also number two in hospital pharmacies, meaning the prescription history would have been on hand. The bed management system would have kept track of everyone’s sleeping arrangements, and everything would have linked back to the GP, via Emis Web. “So you’re getting this virtuous circle, where information is flowing from one to the other.” Owning Ascribe will make this process simpler for Emis, however the group also has arrangements with competitors INPS and TPP to ensure data can flow through the systems: “You can now get 95% of data plugged in from the [joint venture] Medical Interoperability Gateway, even if it’s not one of our integrated systems.”
So all those big providers spent a decade cocking this up, and little Emis solved it? “Fundamentally, yes!” Spencer laughs. The secret to the company’s success, he believes, is not trying to do every system at once, and to not assume midwives, brain surgeons and psychiatric nurses all have the same needs. And to talk to the people doing the work on the ground and get them onboard, because it won’t work if the doctors don’t want it to.
“We engage with the various people who we think might be interested in doing things within healthcare. We have our national user group for Emis, which is for GPs and folks in the community, and we have our national user group for Ascribe. We’re engaging with users, and of course, … our own staff. They know a great deal about the NHS too, because they either use it themselves or they’ve got a granny or a child who’s involved in it. It’s a real personal thing.”
Spencer’s path to becoming CEO of a healthcare software company may not be the most obvious: he was the General Manager at Markgraaf Patents, after founding software outfit Solicitec, eventually acquired by Lexis Nexis. But his first job, while reading law at university, was in psychogeriatric terminal care. “I learned most of my lessons in life on those wards. You’re dealing with real people who are going to die, some of them very soon. One of the things you have to do then, is to really care for them. And the other thing is that you have to toughen up a bit.” The first patient Spencer lost was a former chorister, and the two of them used to sing together. The piece was ‘Deep Harmony’. “When he died it nearly broke my heart. I mean, seriously. Did I ever get as close to a patient after that? No, because I couldn’t have done the job. So it started there with caring about healthcare, but thinking about it in a professional, compassionate way. Not to be hard or unpleasant, but you’ve got to have the right balance between the two.”
After becoming a lawyer, Spencer rose to the rank of partner in the Leeds firm where he’d trained, before going on to co-found his own law firm. He lectured law for five years, and then he ran a patent and trademark agency. “You may be saying, ‘Where’s the IT then in all this?’ At the same time as doing all that, while at the first law firm, I formed an software IT company where we ran systems to help lawyers do all the things we for medical purposes now,” says Spencer. This is where I have to put my notepad down, because on top of all this, Spencer also raised six children. “I don’t sleep, by the way!” He chuckles. “Well, four hours usually. It’s the just the way I work.” That’s just not fair, I exclaim, jealous of all his extra time. “I do crash out occasionally. During the Ascribe deal we had a few all-nighters, and after a time of really, really limited sleep I do need to crash out for 24 hours.”
Even so, Spencer’s impressive record of multi-tasking speaks to a certain ambition, one that is not immediately revealed in the Yorkshireman’s cheery, relaxed demeanour. He claims to be like most people though: confidently gliding along, while paddling frantically beneath the surface. But most people don’t end up being CEOs, I point out, and Spencer concedes: “In the main, people who succeed in doing things aren’t normal, be in in business, sport, art or sciences. You’re driven by something that makes you do things, which then results in people saying, ‘Why on earth would you do that?’ Well, it’s because I want to be the best I can be.”
The Basso Profondo
Spencer’s kids, now aged between 22 and 32, may have inherited some of this drive from their father: “One used to be a journalist and is now training to be a solicitor, bless him. We have barristers, a couple of teachers, we have a physicist who now does Quant software. They’re all under-achievers.” Spencer jokes, proudly. I expect him to say he doesn’t have time for hobbies, but of course he does: “I am a bass singer in a couple of choirs. Well, I had to cut it down to one. We just came back from Venice where we sang in St Mark’s. I am the Basso Profondo.”
Spencer, now 56, has no plans regarding how long he wants to keep the reins at Emis, just “as long as I’m useful”. He seems the type who needs to be busy, I point out, before Spencer chuckles that his wife probably needs him to be busy too; quite driven herself, his wife works for the government handling childcare cases against parents. After a day of business meetings, hearing stories from the frontline can be sobering.
Still, it’s the opportunity to make a difference that gets Spencer out of bed in the morning. “On a ward you can make a difference to maybe 30 people. At Emis I can make a difference to literally millions of people. That may sound slightly creepy, but fundamentally we’ve got at least 39 million patient records that we’re looking after.” That’s a lot of people trusting Spencer’s company with their most intimate information, I point out, but Spencer isn’t phased by this, nor does he seem phased by much else. “No, not really. I’ve seen quite a lot of things. I was a lawyer so it’s advocacy, isn’t it? You expect things to come a bit from left-field,” says Spencer. “You can’t make people like you. You’ve just got to be yourself and hope they do.”