eHealth in Ireland: We can learn from the mistakes of others

Surprising as it may seem, Ireland is one of the last countries in Europe to fully use technology to improve use of public health services. In spite of our high usage of smartphones for virtually everything else, the so-called eHealth sector has seriously developed only in the past 18 months or so.

"Healthcare is the only business in the world that doesn't ask its customers for their digital identity," says Richard Corbridge, chief information officer on the HSE's eHealth Ireland initiative.

Text reminders for outpatients’ appointments have been around for some time but projects such as e-referrals for public hospital appointments are being fully introduced this year. The 24-hour electronic access to medical laboratory results and X-rays is scheduled to go live in all public hospitals by February 2017.

The Individual Patient Identifier (unique personal numbers used across all public health and social services) was deemed so important that the IMF-ECB-EU troika encouraged the government to fast-track it into legislation (Individual Health Identifier Act, 2014) in advance of setting up electronic health records for everyone.

The Health Information and Patient Safety Bill 2015, which will provide the legislation for the introduction of Electronic Health Records, awaits enactment.

In spite of the late start, many experts believe we can turn our late adoption of eHealth to our advantage by learning from the mistakes other countries have made.

The eHealth early adopters and advocates laid out their cases for what needs to happen at two Dublin events in June: the Irish Platform for Patients Organisations, Science and Industry (IPPOSI)/eHealth Ireland meeting on Person-Centred eHealth, and the eHealth Ireland Ecosystem meeting.

"Ehealth has the power to change the current health system, which is centred on the service providers to one that is more patient centred," says Dr Derick Mitchell, chief executive of IPPOSI.

Patient involvement

Mitchell is, however, adamant that patients need to be involved at every stage of the development of health technology. “We want patients to be the drivers of their own data which will allow them to gain control of their health.

“We need to ensure that eHealth is driven by people’s needs and not by technology, products or suppliers.”

Muiris O'Connor, the recently appointed assistant secretary for research and development and health analytics at the Department of Health, asked whether we are doing enough to design integrated care [in which patient care is shared between primary care centres and hospitals] around people rather than illnesses and conditions.

“Our use of information must be person-focused because if you automate a mess, you just get an automated mess. It’s also important that we don’t replicate existing practices but instead develop new ways of connecting,” he says.

Olive O’Connor, a parent advocate speaking at the IPPOSI/eHealth Ireland meeting, believes patients and their carers can give input on exactly what data should be collected and what the end product should look like.

“Patients are often only involved after the design has been finalised. And, there is too much focus on individual illnesses rather than the pathway of care.”

Anyone attending an outpatients’ department will have direct experience of the large patient files, often held together with elastic bands. Lost referral letters, fading fax scripts and illegible post-it notes on patients’ files have led to serious errors and sometimes fatal consequences within our health services.

Research has shown that the introduction of electronic health records for one US healthcare insurer reduced medical error and hospitalisations by more than 50 per cent.

Electronic health records also have the potential to give back time to patients and doctors for more meaningful discussions rather than checking through previous illnesses, medications and operations. The availability of the patient history to health professionals throughout the country should also ease diagnosis and treatment whether the person is on holidays or at home.

The new National Children’s Hospital at St James’s Hospital will become the first publicly-funded hospital using electronic health records.

Corbridge is upbeat about the progress Ireland has made in eHealth in the past 18 months.

“There are 700 eHealth projects live in Ireland now and we are the first European state to have a health-cloud first policy which will allow us to draw on cloud computing in many specialities.”

Leader in eHealth

Corbridge says a WHO representative recently described Ireland as a leader in eHealth, and the NHS has asked for our expertise. "Our next job is to digitally connect 45,000 people who work in health by the end of 2016 and create two health information portals – one for clinicians and another for patients for the sharing of health information. We are also attempting to be the first EU state that will allow patients to see which clinicians have viewed their health data."

Meanwhile, all advocates of eHealth are keenly awaiting the publication of the business case for electronic health records by the Department of Health.

“We have estimated that eHealth will cost €800 million over nine years. That works out at about €17 per tax payer each year,” says Corbridge.

See ehealthireland.ie and #IrishMed for a twitter hour on innovations in health on July 20th, 10pm-11pm. A public showcase of eHealth innovations will be in the Science Gallery, Pearse St, Dublin, November 22nd- 23rd.

Irish Haemophilia Society: Early eHealth adopter

The Irish Haemophilia Society is a forerunner in its use of technology for people with inherited blood disorders.

An electronic patient record system, which was set up in 2008, allows medical professionals from the five specialist haemophilia centres across Ireland to access patients’ data either at the hospitals or remotely.

“This means if someone is on holidays, they can go to another centre for treatment,” says Brian O’Mahony, chief executive of the Irish Haemophilia Society.

The electronic patient record system also allows individuals with haemophilia to record the exact dose and batch of blood clotting agent they inject at home through a mobile phone app.

“In the old paper system, people had to write down the treatment they took and post it to the clinic so it was there when they go for their clinical review once or twice a year.

“This way, it’s sent immediately and the clinical nurse specialist can respond if the person needs to take another dose or if he or she needs to come into the clinic,” says O’Mahony.

Almost 90 per cent of treatment for haemophilia is self-administered either for prophylactic reasons or following a bleeding episode.

A barcode on each dose is also an electronic record should there be any recall of medications.

“It allows for much better clinical management although we’ve never had a recall since the system was put in place,” says O’Mahony.

Members of the Irish Haemophilia Society were actively involved in the development of the technology – which they specifically requested be a mobile phone app rather than a standalone device. “Patients across all ages and levels of comfort with technology were involved in the initial design and every step of the way. We didn’t want clever software engineers designing a system that people didn’t like. Our next step is to design a patient portal so that people can take control of their own health and be proactive about responding to new symptoms.”

This article was amended on July 11th, 2016, to clarify that the new National Children’s Hospital at St James’s Hospital will become the first publicly-funded hospital using electronic health records.