Digitisation of health service is being impeded by ‘bad actors’, former department head says

Martin Curley, who resigned last week, says efforts to introduce new solutions were repeatedly blocked

The Health Service Executive (HSE) has “no vision” for the digitisation of the health service and efforts to change this are being impeded by “bad actors”, according to its recently-departed head of digital transformation.

Prof Martin Curley, who resigned last week after four years, said his efforts to introduce new technology solutions were repeatedly blocked by senior administrators.

Patients are at risk of adverse outcomes and even death as a result of the lack of information and communication in the health service caused by poor IT infrastructure, he told The Irish Times.

Senior HSE officials are due to appear before the Oireachtas health committee on Wednesday to answer questions about the slow pace of technological change in the health service. Ireland is regarded as a laggard in Europe for digitisation and the introduction of electronic health records.


Prof Curley said his plans to test new technology solutions for health challenges were blocked by senior administrators, as were the governance structures he had put in place to oversee projects.

The European Investment Bank loaned the State €200 million to implement electronic health records more than three years ago but these funds have not been used, he said.

“I have no idea why this money has not been used. We could give everyone in Ireland a personal electronic health record on a phone for tens of millions, and make a huge dint in doing the same for acute hospitals across the country for €100 million.”

The State has had an electronic health record strategy since 2004 but it has “failed to deliver”, with the exception of a few hospitals, Prof Curley pointed out.

Now, he believes, it has the chance to “leapfrog” other developed countries that put electronic health records into their hospitals by basing a strategy around patients and their mobile phones.

The HSE is at a crisis point that requires the application of new thinking, Prof Curley said. “There are many fine people in the HSE, and mostly it’s a systems problem, but there are some bad actors, as there are in every system.”

Prof Curley said the HSE had “no vision” and it was currently fulfilling Einstein’s definition of insanity by “keeping doing what you’re doing and expecting different results”.

“We’re pouring more and more money in and results are getting worse. We’re at a crux, but there is a new vision that is better for patients and clinicians,” Prof Curley said.

“Things can go horribly wrong due to a lack of information and communication,” he warned. “Doctors and nurses are making decision in high-pressure situations based on partial information. Inevitably, they will make the wrong decision on some occasions, and these can be fatal.”

Prof Curley said bullying was a well-recognised problem in the health service. “It happens everywhere but in corporate environments it’s stamped out immediately.”

He described digitisation as “the best medicine for a sick healthcare system”.

“We have to acknowledge we have a system that is very sick. We’re spending the equivalent of Denmark or Austria and our performance is far poorer.

“Industries like banking, music, manufacturing have achieved significant productivity increases, whereas productivity in health has actually declined.”

Doctors and nurses are making decisions about patients with only a fraction of the information that should be available to them, he said. “You couldn’t drive a car or fly a plane like that.”

Digital technologies can allow a doctor monitor dozens of patients in place of seeing just one, significantly reduce hospitalisations of heart failure patients through home monitoring and cut triage times in emergency departments from hours to minutes, Prof Curley said.

HSE chief information officer Fran Thompson will tell the health committee that the health service is being held back with inefficient and often paper-based patient interaction. As a result, patients have to be present due to a lack of tools rather than based on their needs.

“Our current system lacks access to timely, accurate and robust data that is essential to informing decision making and assessing resource utilisation across operational, clinical and strategic departments,” Mr Thompson says.

Mr Thompson says the HSE sought approval in 2018/19 for procurement of an electronic health system but this was deferred pending a review of the introduction of electronic health records in Children’s Health Ireland. As a result, it has had to deliver “multiple tactical solutions” to deliver on the eHealth agenda.

While investment in eHealth in the past was very low, it has increased considerably since 2020, he says. “Rectifying the historic underspend will take a number of years, even with the additional resources, however real progress has and is being made.”

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times