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The cost of a single electronic solution

An Bord Pleanála’s decision to grant permission for the new National Children’s Hospital (NCH) at St James’s Hospital in Dublin has dominated the health headlines over the last fortnight. At a projected cost of €700 million, it is the largest ever capital project in the history of the Irish health service.

However, in terms of scale, costs and possible impact on patients and medical professionals, the National Electronic Health Record (EHR) Programme, if implemented, will arguably surpass the impact of the NCH.

As exclusively revealed by www.medicalindependent.ie in March, the National EHR programme will cost an estimated €875 million to roll-out over a 10-year period, making it potentially the most ambitious and expensive single project undertaken by the State in the health sector, and certainly the biggest ever healthcare ICT project, dwarfing the maligned PPARs project.

Costings

The Strategic Business Case for the EHR, a copy of which has been seen by the Medical Independent (MI), has now been signed-off by the HSE Board for submission to the Department of Health for approval.

The Business Case outlines the costs over the next decade, but the first 12 months from June 2016 will see €9 million spent on “immediate mobilisation requirements”, something that the new Government will have to grapple with right away.

Projected capital costs for an EHR for public health services in Ireland, spread over the period 2016 to 2022, amount to €467 million, while the revenue costs over a longer period, up to 2026, are estimated at €408 million.

MI’s revelations of the cost of the project generated some negative reactions online from readers concerned over the high price tag.

However, Mr Richard Corbridge, HSE Chief Information Officer (CIO), has staunchly defended the cost of the EHR.

“The costing models for the EHR have been completed to indicate the total cost of implementation and delivery, not just the procurement of the technology,” he told MI.

“In reality, the cost is around 0.7 per cent of the total health budget over the longer period of time; some of the costs for delivery would be part of the IT budget the health service has in place,” he said.

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Mr Richard Corbridge, HSE CIO

“It is well documented that the Irish healthcare system has not invested in technology in the same way as other EU jurisdictions and therefore, if we are to create a digital healthcare system, one that enables a reformed healthcare system, then there will need to be a new level of investment in technology and the ensuing business change capacity.”

International

Mr Corbridge says that international experience has fed into the development of the Strategic Business Case.

 “The way Ireland has set up the delivery of healthcare IT allows us to apply lessons from other countries and avoid the large public sector IT project issues seen in several other countries,” he told MI.

“Ireland has a higher degree of clinical engagement in the delivery of technology than any other country this early in its journey ever has.

HSE ICT: From ‘black sheep of the family’ to rising star? 

The national Tech Excellence Awards are Ireland’s principal badge of honour in the IT industry. Along with its partners, the HSE has been nominated for a total of four awards this year.

Two nominations go to members of the eHealth Ireland senior management team in the category of  IT Professionals of the year —Ms Yvonne Goff, Chief Clinical Information Officer for eHealth Ireland and Ms Gemma Garvin, National Lead for the eHealth Ireland HealthLink programme of work.

The remaining two award nominations go to partner organisations of eHealth Ireland, again to projects led by women in IT. The recent aggressive programme of IT replacement across the HSE is in the Public Sector Project of the Year category through the partnership with PFH, a project led by Ms Ursula O’Sullivan within the Technology Office of the HSE. The remaining project nominated is by pTools for their work on the eHealth Ireland digital strategy. This project was managed by Ms Carmel Cullen and Ms Elaine Naughton.

The award winners will be announced on 12 May.

Meanwhile, last month Mr Richard Corbridge, HSE CIO, was also named by CIO Magazine as number 5 in its top 100 CIO list, maintaining the position he held last year. In a new move, the global publication also divided the top 100 into sub-categories, and Mr Corbridge was named the top CIO in health.   

“Additionally, Ireland now has a national IT function that is set up to deliver national solutions that can be configured to deliver local business benefit rather than single solutions that place unrealistic demands on local clinical time and capacity.

“The EHR Business Case has been developed in such a way as to allow parts of it to be approved and benefits to be released before moving to additional elements — this, we believe, allows the approving organisations to test the HSE and its ability to deliver throughout, rather than approve a single large business case; we are asking for approval of the direction at this stage rather than the full amount.”

According to the Strategic Business Case, a significant element of the EHR cost arises out of the difficulty with developing a single national system, especially in the area of acute care.

“The realisation of a true single EHR solution within all hospitals in Ireland will take many years,” it states.

“And over the course of this journey, a multi-vendor EHR environment will exist and need to be managed.

“All new investments will be made in line with this solution strategy and any decision to deviate from the strategy will be taken on an exception basis.”

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Ms Yvonne Goff, eHealth Ireland

The difficulties caused by the various different IT systems currently in place across the country in acute services means that this will be an issue that the EHR will have to deal with as a matter of “urgency”.

“The primary complexity is that various systems of significant importance in the EHR landscape already exist in the hospitals and/or are currently being deployed.”

The HSE’s eHealth team does not shy away from admitting the huge challenges it faces.

“The EHR Business Case outlines the complexity that is the delivery of an EHR across Ireland,” Ms Yvonne Goff, Chief Clinical Information Officer for eHealth Ireland, acknowledged to MI.

“It’s a huge challenge and not just a technology programme but a transformation programme, which will require strong clinical leadership to manage this change. This transformation programme will ensure a more efficient and safer delivery of healthcare for all.”

Benefits

The HSE envisages the EHR as a comprehensive and combined solution that supports the creation and sharing of key patient information. The EHR will cover functions such as ePrescribing and case management, along with the ability to aggregate data from these systems into a comprehensive national record, accessible to health and social care professionals, and also to patients, service users and carers.

Ms Goff was keen to stress the benefits the EHR will bring to Irish health services, for both patients and clinicians. “A National EHR will change the role the patient plays, empowering them to have a greater role and voice in their healthcare, using the patient portal and other mobile applications. The EHR will allow clinicians to provide on-time, accurate, age-appropriate, gender-specific and evidence-based healthcare. Moving away from individual treatment silos, a National EHR will make geography less relevant in this connected health environment.”

Ambitious

The Business Case makes clear that it does not see the development towards a single national EHR as a “big bang” moment or a “top-down” process.

“There is broad recognition that such an ambitious programme cannot be achieved in a single step and that the journey will take many years,” warns the Business Case.

“It is also clear that there are many ongoing initiatives of varying scales that will contribute to the final vision of a single solution set in Ireland.”

For example, the area of community care as opposed to acute care is more of a “Greenfield site” when it comes to the EHR, because there “is virtually no EHR capabilities currently in place” in the community, reads the Business Case document.

As the HSE moves to a single system, it is envisaged that other national existing ICT-related systems such as NIMIS will be integrated or “retired”.

“The EHR is a beginning, not an end. Public and clinician engagement and consultation will continue with the aim of ensuring the EHR directly enhances quality of care and outcomes,” commented Dr Seamus Mac Suibhne, a member of the CCIO Steering Group.

EHR pilots through the ‘Lighthouse’

The EHR is currently being piloted through three different HSE ‘Lighthouse’ projects, in both the hospital and community settings.

According to Ms Mary Fitzsimons, Programme Manager, Epilepsy Lighthouse Project, the EHR is an essential bedrock for the delivery of the evolving model of individualised, precision medicine and healthcare. 

“The National Institutes of Medicine (NIH) in the US describes precision medicine as ‘an emerging approach for disease prevention and treatment that takes into account individual variations in genes, environment and lifestyle’.”

Various technologies are associated with individualising healthcare. For example, advances in genomic medicine are resulting in clinical benefits such as identifying the underlying cause of a range of conditions, tailoring targeted therapies and predicting an individual’s drug response, she said. The use of electronic patient portals, mobile devices and sensors can permit real-world monitoring of physiological data, individual behaviours, disease control and treatment outcomes. 

Meanwhile, based on interrogation of large volumes of data, clinical analytics is generating new discoveries, insights and knowledge about disease risk factors, disease progression and clinical decision support. “These technologies can improve quality, safety and value for patient care. An EHR is key to embedding these scientific and technological advances into the healthcare pathway,” Ms Fitzsimons said.

An EHR for all women and babies in maternity services in Ireland (the Maternal and Newborn Clinical Management System) is also being rolled out on a phased basis this year.

  1. Anne Burke on June 28, 2016 at 5:46 pm

    Work has already begun on the Cerner Millenium system which will provide a national co-ordinated laboratory record accessible 24/7 by hospitals and healthcare workers across all sites.

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