Managing complex responsibilities is a common task for digital leaders. However, for Erik Mayer, transformation chief clinical information officer (CCIO) at Imperial College London and Imperial College Healthcare NHS Trust, the mix of responsibilities is central to his role.
He spends about 40% of his time in the clinic and the rest helping to define the future of digital healthcare.
“I enjoy both roles because, actually, they should be intertwined,” he says. “I have many conversations with clinical and academic colleagues who say, ‘Can I get access to this data?’ That’s why it should be intertwined, because what you put in is what you get out.”
Mayer’s successful transition from the surgery room to the IT department began during his PhD research from 2006 to 2009, when he analysed data to produce evidence for centralising cancer services and improving patient care. Through his role at the trust, he became involved in technology implementation projects.
“I’ve always been in and around data and producing robust evidence for why we should or shouldn’t do things,” he says.
“Then, at Imperial Trust, I was a surgical trainee and became involved in IT, informatics and data warehouse-type environments. I was heavily involved in the work when we went live with the Cerner electronic patient record in 2014.”
As Mayer’s experience grew, so did the opportunities to move into new areas. In 2018, after a competitive process, he was appointed to his current role. He has continued to expand his compass while working on the healthcare frontline.
“I wanted to be forward-thinking about creating secure environments to support access to data for driving research and innovation,” he says.
“I wear many hats. I’m a practising surgeon, transformation CCIO, clinical social professor in Imperial College, and I head up the directorate of the iCARE Secure Data Environment (SDE), which is a digital collaboration space that spans the university and the trust.”
Fostering collaboration
Looking back on his seven years in the CCIO role, Mayer says the data environment has evolved into today’s cloud-based platform using Microsoft Azure and Snowflake technology. He says the transformation process was accelerated during the coronavirus pandemic.
“We’d already set up the environment and had some exemplar projects going on where we were supporting healthcare delivery in the trust,” he says.
“Then Covid hit and, suddenly, there was a huge appetite and urgency about accessing data to support basic decision-making around operational processes.”
These processes included monitoring the number of people with the virus and moving patients around the hospital to free up intensive care beds. Through a collaboration with the North West London Integrated Care Board, Mayer and his peers brought together two key datasets, making it possible to track trends across 2.8 million people.
“I wear many hats. I’m a practising surgeon, transformation CCIO, clinical social professor in Imperial College, and I head up the directorate of the iCARE Secure Data Environment”
Erik Mayer, Imperial College Healthcare NHS Trust
“That created a burning platform for data,” he says, looking back on the interest in information that this initiative helped to foster for the longer term. “Today, that data is now fully migrated and held in the same secure environment as the Imperial Trust data, as well as other databases across different tendencies.”
Mayer says having all these databases together in a secure data environment makes it easier for people to link insights. This capability has changed the mindset of people using data. Previously, particularly in the academic world, people and organisations had to set up data-sharing agreements. Now, collaboration is fast becoming the standard way of working.
“This project brought people into the data environment to do their research and innovation. That approach brought academics together with clinicians and data scientists, meaning we could get quick answers around risk prediction and other insights,” he says.
“Our digital transformation was about bringing the right multidisciplinary people together to work collaboratively in a secure way. Fundamentally, of course, by doing that, you maintain the public trust because you’re not selling data off or moving it around.”
Integrating data
Mayer says the implementation of Snowflake technology has been a crucial component of his data-led approach to digital transformation. While it took weeks to ingest data using previous legacy architectures, the Snowflake AI Data Cloud enables data ingestion in days, supporting the work of healthcare professionals in various roles in a secure environment.
“A lot of the projects are research, but we also focus on direct care,” he says. “So, for example, there are several dashboards that are supporting our clinicians in understanding patients and high-risk cohorts. So it’s direct care research, but it’s also about operational decision-making and efficiencies.”
Our digital transformation was about bringing the right multidisciplinary people together to work collaboratively in a secure way Erik Mayer, Imperial College Healthcare NHS Trust
The organisation is also tapping into the Snowflake Marketplace, an online platform where users source third-party data for its use in the AI Data Cloud. Through the marketplace, research and clinical teams have access to additional non-health data for research and clinical care. Potential sources include Ordnance Survey and the Met Office.
“This is an interesting area for us,” says Mayer, referring to the use of marketplace data. “We’re just starting on this journey. With some of the data, for example, you can start to understand where people live, what services they’re accessing, and why.”
This in-depth detail will be crucial as organisations attempt to support the long-term vision of the NHS 10-year health plan for neighbourhood-based healthcare services.
“You have the evidence to show what is happening, so you can start to plan better,” he says. “Bringing together data is now a way to help us support hospitals and the community.”
Mayer and his colleagues are exploring other ways to exploit the platform. One key use case is federation, including how other trusts in north-west London can share primary and secondary care data. Another use case is artificial intelligence (AI). The data team’s AI testbed in its SDE is supported by Snowflake and Accenture, with secure access to Microsoft AI services and models.
“If you can leave the source data in the separate SDEs and then federate to allow algorithms to run across those sources, you’re not duplicating the cost and resources,” he says.
“So, that’s the piece we’re just developing across environments, which will support, again, operational efficiency, direct care and, of course, research.”
“The interoperability piece for sharing information on individual patients across healthcare providers is critical,” he says. “Just in terms of time savings, you’re not having to sit there trying to understand what’s happened so far – it’s all linked up. And I’m seeing that in my practice now, it’s happening. That kind of federation is a game-changer.”
“These initiatives have gone a long way already to providing a front door for access to data with an explanation around what it is, the clinical definitions and the metadata,” he says.
“We don’t need to reinvent the wheel. We need to build on what we’ve got so far, because that effort has been developing well over the last three or four years.”
This progress includes work in his own organisation. “Within the iCARE SDE, we have built the London analytics platform,” he says.
“We are one half of the London Secure Data Environment, so we are providing that architecture, and the data will start flowing soon. This effort is not just about our trust. It’s a framework that will support the national agenda.”
The NHS has a chequered history when it comes to IT initiatives. However, Mayer says the progress that’s been made recently in data-led projects is impressive. While digital transformation across large-scale organisations can be a challenging process, he’s positive about the opportunities ahead for UK healthcare.
“Now, I think there’s a requirement for a careful thought piece around how local NHS trusts fund, resource and keep up with change, and thinking about business intelligence units, and how those areas start to shape up,” he says.
Leading transformation
Mayer reflects on the pace of change. He suggests the speed of transformation continues to quicken and that AI will play a crucial role in the future of healthcare.
From optimising schedules to reducing the administrative burden by automating clinician note-taking, emerging technologies can have a big impact. However, the key to success is identifying the right, trusted technological solutions for the business challenges.
“We need to think about the problem and the opportunity, and then look at the technology to support us, as opposed to going, ‘AI is going to solve everything’,” he says.
“We’ve got to maintain the public trust around this transformation. They’re starting to engage with these technologies, so we must consider the digital literacy piece.”
This rapid pace of change can bring new and unexpected challenges to healthcare technologists. Mayer says effective digital leaders will develop professional resilience and respect by building a sense of social capital.
“It’s about being clear about the benefits and impact of what everyone’s doing as a multi-disciplinary team,” he says. “Our team includes data engineers, data scientists, clinicians and nurses. If they can feel, metaphorically, the impact and see the effect on care delivery, then they know they’re making a difference.”
Mayer says those results also inspire him. “As a leader, I see that impact, and that’s what gets me out of bed every day,” he says. “Essentially, successful delivery is about that team environment – it’s having a clear message and clear social capital where you say, ‘This is what we’re trying to do and why’.”
I’ve always approachedtaking melatonin supplements with skepticism. They seem to help every once in a while, but your brain is already making melatonin. Beyond that, I am not a fan of the sickly-sweet tablets, gummies, and other forms of melatonin I’ve come across. No one wants a bad taste in their mouth when they’re supposed to be drifting off to sleep.
This is where Onnit’s Instant Melatonin Spray comes in. Fellow WIRED reviewer Molly Higgins first gave it a go, and reported back favorably. This spray comes in two flavors, lavender and mint, and is sweetened with stevia. While I wouldn’t consider it a gourmet taste, I appreciate that it leans more into herbal components known for sleep and relaxation.
Photograph: Molly Higgins
Onnit
Instant Melatonin Mist
Keep in mind that melatonin is meant to be a sleep aid, not a cure-all. That being said, one serving of this spray has 3 milligrams of melatonin, which takes about six pumps to dispense. While 3 milligrams may not seem like a lot to really kickstart your circadian rhythm, it’s actually the ideal dosage to get your brain’s wind-down process kicked off. Some people can do more (but don’t go over 10 milligrams!), some less, but based on what experts have relayed to me, this is the preferable amount.
A couple of reminders for any supplement: consult your doctor if and when you want to incorporate anything, melatonin included, into your nighttime regimen. Your healthcare provider can help confirm that you’re not on any medications where adding a sleep aid or supplement wouldn’t feel as effective. Onnit’s Instant Melatonin Spray is International Genetically Modified Organism Evaluation and Notification certified (IGEN) to verify that it uses truly non-GMO ingredients.
Apart from that, there may be some trial and error on the ideal amount for you, and how much time it takes to kick in. Some may feel the melatonin sooner than others. For my colleague Molly, it took about an hour. Melatonin can’t do all the heavy lifting, so make sure you’re ready to go to bed when you take it, and that your sleep space is set up for sleep success, down to your mattress, sheets, and pillows.
There’s a lever on the back for this compression mechanism that you manually press down and a separate button to open the dustbin at the bottom. You can use the compression lever when it’s both closed and open. It did help compress the hair and dust while I was vacuuming, helping me see if I had really filled the bin, though at a certain point it doesn’t compress much more. It was helpful to push debris out if needed too, versus the times I’ve had to stick my hand in both the Dyson and Shark to get the stuck hair and dust out. Dyson has this same feature on the Piston Animal V16, which is due out this year, so I’ll be curious to see which mechanism is better engineered.
Bendable Winner: Shark
Photograph: Nena Farrell
If you’re looking for a vacuum that can bend to reach under furniture, I prefer the Shark to the Bosch. Both have a similar mechanism and feel, but the Bosch tended to push debris around when I was using it with an active bend, while the Shark managed to vacuum up debris I couldn’t get with the Bosch without lifting it and placing it on top of that particular debris (in this case, rogue cat kibble).
Accessory Winner: Dyson
Dyson pulls ahead because the Dyson Gen5 Detect comes with three attachments and two heads. You’ll get a Motorbar head, a Fluffy Optic head, a hair tool, a combination tool, and a dusting and crevice tool that’s actually built into the stick tube. I love that it’s built into the vacuum so that it’s one less separate attachment to carry around, and it makes me more likely to use it.
But Bosch does well in this area, too. You’ll get an upholstery nozzle, a furniture brush, and a crevice nozzle. It’s one more attachment than you’ll get with Shark, and Bosch also includes a wall mount that you can wire the charging cord into for storage and charging, and you can mount two attachments on it. But I will say, I like that Shark includes a simple tote bag to store the attachments in. The rest of my attachments are in plastic bags for each vacuum, and keeping track of attachments is the most annoying part of a cordless vacuum.
Build Winner: Tie
Photograph: Nena Farrell
All three of these vacuums have a good build quality, but each one feels like it focuses on something different. Bosch feels the lightest of the three and stands up the easiest on its own, but all three do need something to lean against to stay upright. The Dyson is the worst at this; it also needs a ledge or table wedged under the canister, or it’ll roll forward and tip over. The Bosch has a sleek black look and a colorful LED screen that will show you a picture of carpet or hardwood depending on what mode it’s vacuuming in. The vacuum head itself feels like the lightest plastic of the bunch, though.
Brandon Herrera, a prominent gun influencer with over 4 million followers on YouTube, said in a video posted this week that while it was unfortunate that Pretti died, ultimately the fault was his own.
“Pretti didn’t deserve to die, but it also wasn’t just a baseless execution,” Herrera said, adding without evidence that Pretti’s purpose was to disrupt ICE operations. “If you’re interfering with arrests and things like that, that’s a crime. If you get in the fucking officer’s way, that will probably be escalated to physical force, whether it’s arresting you or just getting you the fuck out of the way, which then can lead to a tussle, which, if you’re armed, can lead to a fatal shooting.” He described the situation as “lawful but awful.”
Herrera was joined in the video by former police officer and fellow gun influencer Cody Garrett, known online as Donut Operator.
Both men took the opportunity to deride immigrants, with Herrera saying “every news outlet is going to jump onto this because it’s current thing and they’re going to ignore the 12 drunk drivers who killed you know, American citizens yesterday that were all illegals or H-1Bs or whatever.”
Herrera also referenced his “friend” Kyle Rittenhouse, who has become central to much of the debate about the shooting.
On August 25, 2020, Rittenhouse, who was 17 at the time, traveled from his home in Illinois to a protest in Kenosha, Wisconsin, brandishing an AR-15-style rifle, claiming he was there to protect local businesses. He killed two people and shot another in the arm that night.
Critics of ICE’s actions in Minneapolis quickly highlighted what they saw as the hypocrisy of the right’s defense of Rittenhouse and attacks on Pretti.
“Kyle Rittenhouse was a conservative hero for walking into a protest actually brandishing a weapon, but this guy who had a legal permit to carry and already had had his gun removed is to some people an instigator, when he was actually going to help a woman,” Jessica Tarlov, a Democratic strategist, said on Fox News this week.
Rittenhouse also waded into the debate, writing on X: “The correct way to approach law enforcement when armed,” above a picture of himself with his hands up in front of police after he killed two people. He added in another post that “ICE messed up.”
The claim that Pretti was to blame was repeated in private Facebook groups run by armed militias, according to data shared with WIRED by the Tech Transparency Project, as well as on extremist Telegram channels.
“I’m sorry for him and his family,” one member of a Facebook group called American Patriots wrote. “My question though, why did he go to these riots armed with a gun and extra magazines if he wasn’t planning on using them?”
Some extremist groups, such as the far-right Boogaloo movement, have been highly critical of the administration’s comments on being armed at a protest.
“To the ‘dont bring a gun to a protest’ crowd, fuck you,” one member of a private Boogaloo group wrote on Facebook this week. “To the fucking turn coats thinking disarming is the answer and dont think it would happen to you as well, fuck you. To the federal government who I’ve watched murder citizens just for saying no to them, fuck you. Shall not be infringed.”
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