In June 1922 the opening act of the Irish Civil War saw a massive explosion tear through the Four Courts, and with it the catastrophic loss of centuries of records, including census, tax and legal documents.
The documentary spine of our nation rose over Dublin in fragments and drifted back to the streets as ash.
Four years later the first census of the independent State was conducted. One century on, when those records were released to the public, they were viewed more than four million times in just 12 hours. On this evidence, we are a people who prize our records.
As Ireland prepares to procure a national electronic health record, the real question is: who will ultimately control it? Health data has become one of the most valuable assets a nation holds, traded and fought over as oil and gold once were.
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Our health data has already been seized once: in 2021 the Conti ransomware attack crippled the health service. The destruction of records came not from artillery but from an infected email attachment.
Overnight, hospitals and clinical practice regressed decades. Staff reverted to paper and memory. Appointments were lost, results were chased by phone, X-rays went unreported and operating lists were cancelled.
A digital health record is not a filing cabinet, but a clinical instrument in its own right. It warns us of allergies we may be unaware of. It lets us look at a CT scan at 3am to decide whether a patient needs surgery overnight. It gives a longitudinal view of a patient’s health, providing context for their current presentation. It is the thread of each patient’s care.
For years, Ireland has lagged others on healthcare digitisation, instead relying on fragmented, paper-based systems. A comprehensive digital health strategy is long overdue, and the One Health Record will be among the most consequential reforms in the history of the health service.
But it is also something more: a decision about who will ultimately control the health data of every citizen. The legal framework under which that data is held should be robust, and subject to the influence and control of the State.
The environment into which we will deploy that record is increasingly uncertain. While the EU is building a sovereign, interoperable, open-standards home for European health data, the United States is moving in another direction. Under the US CLOUD Act, a US-headquartered company may be compelled to produce data within its possession, custody or control, even where that data is stored outside the US.
Hosting data in Dublin is, therefore, not by itself an answer to the sovereignty question: who controls the provider may matter as much as where the data is stored. Even the legal arrangements for EU–US data transfers have twice been struck down, and the latest framework is again under challenge.
This is no longer hypothetical. Last year, after the prosecutor of the International Criminal Court was sanctioned by executive order, he reportedly lost access to his email. A sanctioned judge described how an e-book she had paid for vanished from her device and her smart speaker stopped responding.
Digital infrastructure became a lever of state power the moment sanctions were applied. Disputes once settled with artillery can now be pressed through the network. Health records are not immune.
Every interaction between citizens and the State, including healthcare, relies on trust. The 1926 census worked because citizens trusted the new Free State to safeguard their details for a century, then release them with care.
[ What Census 1926 reveals about lives of children 100 years agoOpens in new window ]
A health record relies on the same trust. Patients tell clinicians things they tell no one else: about their fears, their mental health, their sexual history, their addictions, on the understanding that they remain confidential. Those who lose that confidence may conceal parts of their story. The cost is clinical: an incomplete record, lost context, downstream error.
The stakes rise as the record becomes the raw material for artificial intelligence. AI scribes, decision support and predictive analytics are already emerging. Once such systems are integrated into the national record, who controls the underlying data matters more than ever. The record will no longer be merely a repository of past care; it will become part of how future care is interpreted, predicted and delivered.
A national record will serve generations and, once embedded, is difficult to unwind. That is why governance and jurisdiction deserve transparent consideration at the outset. We would never hand the master switch of the electricity grid or the water supply to an entity beyond our control; a national health record belongs in that same tier of critical infrastructure.
We should demand open standards, genuine portability and a guaranteed right of exit, so no provider can hold the State to ransom. These principles should apply equally to all vendors, whether European, American or otherwise.
The European Commission is expected to publish a strategy grading cloud service providers on genuine sovereignty, including metrics such as who controls the service, the data and the infrastructure. Some vendors have already signalled they would legally challenge any US demand for access to their information: a reassurance that rather concedes the danger, and one a national health service would be unwise to rely on.
We have spent years and millions reconstructing what burned in 1922 and recovering what was lost in 2021. The third threat may come more quietly: not as artillery, and not as malware, but as a contract offered to us for signature. We should not pay a third time to learn what our records are worth.
Conor Shields is associate clinical professor at UCD and clinical lead with Dedalus Ireland
