The health service in Ireland is in the middle of a digital transformation that will bring patients, clinicians and the start-up community together to develop a new generation of capabilities.
This has been driven by Richard Corbridge, chief information officer of the Health Service Executive (HSE), and his small, but dedicated and motivated team.
TechPro spoke to Corbridge and Maria O’Loughlin, eHealth Ireland Advisor at Health Service Executive, for an update on achievements, ongoing initiatives and the next steps in digital.
“2016 was largely about putting in place foundations for the things that would allow us to move forward with the electronic health record (EHR) programme,” said Corbridge. “Also, to give us the opportunity to test both the structures we had put in place and our ability as a health system to adopt digital quickly, and with patient focus at the centre of everything.”
“We built and populated the individual health identifier (IHI); now ready to go as soon as the minister signs the final act. That will give us a digital identity, unique for every patient in Ireland, that can be used almost as an account number or key for all health information across the system.”
But there are important issues of consent for patients in this process too, he acknowledges.
Information ownership
“Ireland is taking an approach similar to Estonia,” said Corbridge, “where the ownership of information and information audit can be pushed out as far to the patient as possible to try and remove, or at least aid removing, concerns around privacy.”
“The consent piece is that you can decide not to have your information shared. There is an assumption that everybody wants to have their information shared, but somebody can say that they don’t want it shared and is to be kept only in the place where the care was provided.”
Corbridge said that the Irish system contains two consent flags to accommodate such wishes, though they are usually confined to a relatively small number of the patient population.
One per cent
“Looking at the NHS, as an example, between 1 and 7% of people did not want information shared digitally. What we tried to do, creating the facility from the beginning, was if you don’t want to share information, for whatever reason, the opportunity is there to do it. Because the NHS didn’t have that, it derailed big programmes such as Care.Data. That failed because patients were not given the option to opt out or made it simple to do so.”
“The fear of the 1% stopped the 99%, who are ambivalent,” he said.
“So we have a consent to share which is assumed for medical purposes, and a consent to share for clinical research which a patient has to actively select. Also, we are working with the minister’s office to put in an organ donor facility as well, which would make sense if we can sort out policy around that.”
Despite the various challenges around such issues, these important foundations are now in place, and allow the service to build other much needed capabilities.
“In 2016 we completed the implementation of electronic referral into every hospital. Now, a GP can refer anyone from their practice to a hospital, saving money, improving efficiency and moving information through the system cleanly.”
“This also gives transparency on referral patterns, which is very useful. This has highlighted, and started addressing, multiple referrals, where people may have been on multiple waiting lists for the same thing, artificially inflating them.
“That doesn’t happen with eReferrals where there is one record only,” said Cordbridge.
ePrescribing
Another key achievement is ePrescribing, which went live in December.
Fifteen pharmacies and a number of GP practices in Mallow, Cork, were involved in the launch, where barcode-based electronic prescribing was rolled out.
“No more old fashioned printers like dot matrix, now LaserJets print out a barcode per prescription item one for the patient. The pharmacist scans the barcode and it goes into the system, and one pharmacist even has an automated dispensing capability.”
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