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It has been an exciting few weeks for eHealth Ireland and the concept of a digital fabric for the health system of Ireland. The electronic health record (EHR) business case has progressed well through the approval systems, the last hospitals have gone live with eReferral, making digital referral possible in every hospital in Ireland, and the team received a number of nominations and awards in the technology sector in Ireland and across the EU.
The next part of the process that will see Ireland adopt an EHR is the part where it is so easy to lose the commitment of clinicians and the public, and that is approval and procurement.
I remember vividly Easter Sunday 2015, going to the supermarket to see the front of one of the newspapers exclaiming that the HSE IT function had failed to implement a system to support the delivery of care in the maternity hospitals of Ireland. I was confused — I knew that only a couple of weeks earlier the contracts had been agreed, so quite why this was an IT failure already was something I needed to understand more about; what lessons could we learn here?
The issue we had in this case was that the amount of time the procurement and approval process took was seen as ‘IT time’ by the public and media, rather than time taken to be sure it was the right thing to do and that the right supplier had been chosen.
With an EHR for Ireland, we have a different idea about how we will tackle both of these areas, which are traditionally done at a certain speed. We cannot (and must not try to) bypass the care and governance required for agreement on the approach to be reached, but we need to do this in an agile way.
The HSE created the eHealth Ireland Committee as a Committee of the Directorate in the spring of 2015. The group is an independent advisory group from across the EU that provides the Directorate (the most senior leadership of the HSE) with advice and guidance on technology in health. It has been suggested that this group could provide a review of the business case for Government, ensuring that the information reviewed in the case is done by a cohort of eHealth experts and also ensuring that there can be some agility to the delivery of a final review and comments for the Department of Health and, indeed, Government itself.
Another positive for the EHR business case is the way in which it has been created as a modular solution to a system-wide problem. There are four key components that make up the business case and even in isolation, these components can be a foundation for the reform of the health system.
The components are:
The ability for a clinician and patient to have ‘single sign-on’ with the requisite legitimate relationship to information from disparate systems that make up the EHR.
The ability to pass information through the system securely and in an integrated manner.
The acute hospital EHR solution available on a framework for each Hospital Group to draw down when they have met the requisite readiness criteria.
The Community Health Organisation (CHO) EHR available on a framework when each CHO can demonstrate appropriate readiness to implement and release benefits.
The importance of these elements being available in isolation, as well as a solution set for health, has been described as fundamental to the success of the solution’s deployment.
As eHealth Ireland has always made clear though, the EHR is one of a series of projects that will see a digital fabric for the health system being created. In 2016, a series of challenges have been set for the team. These challenges can only be met with the release of additional resources to eHealth Ireland that were promised in the service planning round but the team are confident that the success that they have made of 2015/16 will enable this promise to be met.
The challenges set include:
A digital identity for every member of the health workforce to enable them to log on to new clinical systems and to communicate digitally with colleagues. This is to be implemented by December 2016.
The implementation of a digital prescription in more than 50 per cent of GP practices and community pharmacies by October 2016.
The removal of the need to have ‘tractor printers’ in all GP surgeries by November 2016.
The creation of the EU’s first Health Cloud First policy. This would be the guidance and framework to enable health to avail of a ‘health cloud’ for information, where data security and information governance are key principles and where information storage is guaranteed to be in Ireland. This is targeted for August 2016.
The delivery of phase two of eReferrals, including the ability to have an eDischarge from hospitals to GPs by May 2017.
The completion of the eMeds reconciliation projects and an evaluation of this by September 2016.
Each of these individual projects add to the EHR solution and ensure that we deliver an end-to-end eHealth fabric over the next three-and-a-half years.
Festival of eHealth at the 2016 Future Health Summit
The Festival of eHealth at the Future Health Summit on 26 May at Citywest, Dublin, demonstrated Ireland’s commitment to eHealth and how technology is delivered to health in Ireland.
eHealth news from the Summit:
IMS Maxims took the stage as part of the eHealth Festival and announced that it would make all of the IMS solutions available to the Irish State free of charge under an open source agreement, identical to the successful work the Irish company has delivered in the NHS.
The #eHealthMoments initiative was launched — a social media-based connection programme to celebrate the success being achieved, in every small way, of the eHealth investment in the HSE. Whether it is the go-live of wi-fi in a hospital or a solution deployed for a clinical issue, each individual step towards an eHealth fabric should be acknowledged in some way.
eHealth4All — Connect: A programme to enable innovators and SMEs across Ireland to engage better with the HSE accessing clinicians and delivering new solutions from Ireland, to Ireland.
QIC Programme (Quality Innovation Corridor) — An internal programme to enable clinicians with technology innovations to be supported through eHealth Ireland to ensure the solution can be considered as part of the national solution set.