Obituary: Dr Leo Fogarty

1952 - 2022

 

Leo Fogarty (b: 1952, q: 1975, FRCGP 2004, FFCI 2017, d: March 2022) 

Remembered by Tom Fogarty, Nick Booth, Colin Brown, Alan Hassey, John Williams

Dr Leo Fogarty was a Founding Fellow of the UK Faculty of Clinical Informatics and a towering figure in the domain of clinical informatics in the UK and beyond. Not only was he earlier than most to delve into the detail of what we now call clinical informatics, but he also sought out and worked with others who shared his interests and became involved at national level in a number of emerging organisations. He played a key part in setting up the RCGP’s Health Informatics Group in the mid-1990s.In the early years of this millennium he subsequently took his spell as chair of that group and also of the BMA and RCGP’s Joint Computing Group. Around the same time, he was a member of the Academy of Medical Royal Colleges Information Group (ACIG) where he worked hard to set up a Steering Group with the aim of bringing a Faculty of Medical Informatics into existence. As a consequence of governmental reorganisation that attempt foundered but the idea lived on and that groundwork formed an important launching pad some eleven years later for the development of today’s Faculty of Clinical Informatics.

One of his greatest contributions to clinical informatics and to English General Practice was GP2GP record transfer. His work on this started in the late 1990s when he was the Clinical Lead for the European Union / NHS co-funded XML EPR project which applied XML syntax to what was then the ENV13606 Electronic Healthcare Record pre-standard. During this time he worked with others to set up HL7 UK and in 2000 became its first Chair. While in that role, he was involved in the development of the HL7 version 3 NHS GP2GP EHR_extract message, building directly on important lessons learnt during the earlier XML EPR project. This was part of a wider vision for international health information standards that would be adopted at scale, and he saw working with HL7 as a way to make this happen. He not only built up the HL7UK community, but also fostered the growth of HL7 affiliates in other countries, building up the international presence and influence in the HL7 organisation. He played an important role in making HL7 the international organization that it is today.  Furthermore, without that EHR_extract message the GP2GP record transfer project could not have followed. He later played a central role in setting up the end to end clinical safety assurance process that sat at the heart of that project’s testing and implementation. It took a further 10 years successfully to implement GP2GP record transfer in every kind of GP system used in England and throughout that time he was a vital source of expertise and common sense in sorting out the many interoperability issues that arose. 

Semantic interoperability and clinical safety assurance were his prime interests throughout his career and in many ways he encouraged many others to develop their interests in these areas. He was involved in discussions and influenced thinking around many things including potential archetypes for document naming, blood pressure, drug allergies, seeking a standard way across GP systems for representation of adverse drug reactions, medicines interoperability, cross mapping between Read v2 and CTV3 and SNOMED CT, safety issues relating to the inactivation of SNOMED CT concepts, the safety of the Patient Demographic Service and many other areas of digital health policy implementation in both England and Scotland. Towards the end of his career he became the clinical safety assurance lead for the English Summary Care Record.

His contributions to GP computing were recognised in 2004, when he was awarded his FRCGP. 

Leo was born in 1952 to John and Clare Fogarty in Manchester, the eldest of seven children. He had a nomadic childhood dividing his time between his parent’s house in Uganda, Mount St Mary’s College in Derbyshire and stays with his Aunts Nan and Bernie. He studied medicine at the Royal London Hospital where he met his wife Julia, becoming a GP and eventually settling the family in York where he was a partner at the Priory Medical centre for many years.  In the second half of his career, Leo moved to Scotland, where he worked as a GP in Edinburgh. During his time in Scotland, he helped to implement the Scottish Emergency Care Summary record (ECS) and was immensely proud that a roguish photo (above) of him with a real patient and her baby was chosen for the cover of the ECS leaflet and distributed to every household in Scotland. In 2012 he moved to Leeds to work at NHS Digital.

He was a polymath; his interests developing into deep expertise across a wide sphere. He took up photography as a teenager, taking and developing his own photos, which detailed the activities of the Fogarty clan over five decades. These included his love of fell walking, particularly the Lake District, which he would visit regularly as a young man.  He traversed England once and Scotland twice on separate expeditions. History was perhaps his greatest passion.  He studied the topic widely with a particular fondness for the Napoleonic wars. Leo was an early tech adopter, teaching himself Basic and writing games on a BBC Micro for his children. He loved to cook for friends and family, with regular Wednesday night dinners a highlight of the week. These were held beneath a large diagram of a proposed medical information flow diagram that he didn’t agree with, and a framed photo of Rommel, a reference to the signed picture that General Montgomery hung in his caravan to remind him of his adversary.

Leo was a valued, critical friend and stalwart supporter to the clinical informatics community. He had a wicked sense of humour, always ready with a quip about some battle, Greek mythology, the Jesuits or the workings of the Roman Catholic Church, or sometimes with references to the Three Musketeers. A wise person would never take themselves too seriously in Leo’s presence. He had a love of good food, wines and malt whiskies, not necessarily good for the heart but definitely good for the soul. He could talk eloquently and eruditely about a surprising range of topics especially when the wine and the malts were flowing. We will remember with great affection an intelligent and entertaining man, in a brown leather coat, with a glint in his eye, a glass of malt in one hand and a cheroot in the other. 

Messages from the FCI Membership
"A tour-de-force of health informatics, one of the giants on whose shoulders we stand. We send our thoughts to his family."
- Louise Wilson
"I worked with Leo Fogarty between 2001 and 2003 when I was Dean of the Faculty of Health Informatics at the Royal College of Surgeons of Edinburgh. Leo worked very hard to develop this Faculty and we all owe him a debt of gratitude for the way he pushed us forwards to ultimate success."
- Professor Angus Wallace
"I have just learnt of the passing of Dr Leo Fogarty. Understand the FCI is compiling messages. I’d like to have my name added to those who fondly remember him, he was already a much revered GP IT elder when I first appeared on the scene in 1995. I learnt a lot from him and whilst I will not claim to have always understood what he was saying, I always knew it was important! My thoughts to those he leaves behind."
- Paul Cundy

"
Truly a mentor and one from whom I learned a great deal with his attention to finer detail. Would we have had a RCGP Health Informatics Group or a Faculty without him? I worked with him on the GP2GP project over many years. We certainly would not have had that without Leo. After work we would go out for a meal with others and discussion would cover a wide range of things. Later in the evening we would talk about problems that we had encountered in the project. Typically he would respond to my potential solutions by telling me that I was “an impossible optimist…” while rubbing his brow with a quizzical look, over a malt whiskey somewhere in Leeds. And then we would set about thinking in detail through solutions to heterogenous interoperability problems that just might work - and some of them really did. A sad, sad loss."
- John Williams 

"Leo was one of the early and very active users of the Abies software - always keen to learn how he could get the most out of the software, and pushing the company to do more.  He pushed for early pathology messaging work (PMIP) and fundholder functionality. He was always willing to push boundaries - the Abies security practices improved significantly after Leo was found browsing company files in the server room during a break in a meeting. In the 1990s he setup HL7UK with Brian Love, Martin Whittiker, Charlie Bishop and David Markwell - with the early meetings being held at the Mckesson offices in Warwick. 

In the runup to the millennium he drove the GP2GP project into existence through his rich network of connections in the RGCP, NHSIA and DoH, working with Ian Purves at the SHIN institute in Newcastle. To make GP2GP happen he build trust, collaborating with David Marwell, Andrew Hiinichley, David Stables, David Robinson, and Nilesh Jain on early versions of the CEN 13606 architecture standard, the XMLEPR project [1], and the  DoH Electronic Transfer of Prescriptions project. 

Leo was pivotal in the decision to move the GP2GP project from a direct implementation of the CEN 13606 architecture as tested with GP suppliers in XMLEPR, to use the emerging HL7v3 standards and align with HL7 CDA (Clinical Document Architecture). 

This was part of a wider vision for international health information standards that would be adopted at scale, and he saw working with HL7 as a way to make this happen. 

Leo built up the HL7UK community, and fostered the growth of HL7 affiliates in other countries, building up the international presence and influence in the HL7 organisation. He played an important role in making HL7 the international organization that it is today. 

He could use long and ingenious metaphors - I recall when presenting the GP2GP project final report, Leo spent the bulk of the meeting on astronomy to illustrate the challenges of stakeholder engagement.  Whatever happened in a meeting or workshop, there was always time afterwards for discussions over drinks and good food. He was generous with his time as a mentor and friend and will be much missed."
- Charlie McCay

"
“An early paper about the GP2GP project referred to it as 'Poisoned chalice or holy grail?', which was pure Leo. He understood how hard and how important semantic interoperability would be.

Prior to GP2GP, 
he was a key player in PMIP (Pathology Messaging Implementation Programme), which emphasised the importance of safety processes in making interoperability work. The PMIP documentation was over a million words, which indicates how thorough it was. He recognised that interoperability requires a lot of effort. (At the time some people thought that having fit for purpose messages would do the job).

Leo was always a 
far-sighted and clear thinker. He would argue his point but if people did something else, he would not think the worse of them.  He would later be shown to be right, but may years might be lost.  During a period when investment in health informatics was far less than it should have been, Leo was a light in the darkness. He died far too young."
Tim Benson

"
Greatly enjoyed working with Leo in the early days of the national programme when we were setting up systems and the National Clinical Safety Officer group - Leo always added a certain dynamic to meetings. I am so sorry to hear the sad news and my thoughts are with his family at this sad time. In fond memory."
- Sebastian Alexander

I knew of Leo shortly after 
starting my role at what was then Connecting for Health in 2009; he had a knack of finding you if he felt he needed to influence what you were doing! Our paths crossed a number of times as I worked on various projects around SNOMED implementation. I was then assigned to GPSoC to set up what became the SNOMED in Primary Care project. I’m fairly sure Leo assigned himself as one of my clinical advisors on that project, but his words of wisdom were always welcomed. I always knew I needed to listen if I saw Leo heading in my direction, and if there was anything I was unsure about or needed someone to sound thoughts out on, then Leo was my best starting point. On more than one occasion I’ve been ‘summoned’ into a meeting room by him. I shall always have fond memories of Leo. He was indeed a character, always had time to listen and always made a valuable contribution. Rest in peace."
- Denise Downs
If you would like to add a message or memory to this page, please contact the FCI teamFor any members of the RCGP, we encourage you to take a look at the HIG area for more memories of Leo.