Will a digital makeover be good for our health service?

The Government’s eHealth strategy is being rolled out with the appointment of a board of eHealth Ireland due in the next few weeks.

But what is eHealth and what kind of changes can we expect to see in the Irish healthcare system as a result?

Kevin Conlon, who heads the ICT (Information and Communication Technology) unit at the Department of Health, describes the strategy as one which aims to leverage the power of the internet and information technologies we have come to rely on in so many other aspects of our lives and apply them to health.

He points to a number of examples where information technology could be used to improve and streamline patient services: eRecords, allowing patients to access their health records and test results in a secure environment; ePrescribing, which would see patients able to order repeat prescriptions online; and tele-health systems where patients and their doctors communicate without having to meet face to face.

It also encompasses sensors and other monitoring technology, among them blood pressure monitors, glucometers and lung capacity monitors, which take regular measurements and transmit the data back to a healthcare provider, enabling patients to be monitored remotely.

Conlon says, “eHealth is about population wellbeing. It’s about empowering patients to look after themselves better, which, in turn, keeps people out of acute setting and helps reduce cost.”

One US organisation which has embraced the approach is Kaiser Permanente, a medical group which offers insurance and healthcare plans, as well as operating its own hospitals and medical facilities. Proactive use of patient data is the norm in the organisation.

Dr Scott Smith is associate medical director for operations with Kaiser Permanente in Colorado which provides services to 545,000 people, each of whom can access their medical records via a secure internet portal which is also accessible by all healthcare professionals dealing with their case.

Similar to online banking
Smith equates the system to an online bank account with an equivalent level of security and accessibility: "The same way as you can go to your online account and find out your balance, you can go to your laptop and find out when your next test is due."

Patients can also email their doctor, who should reply to them within 24 hours, circumventing the need for a face-to-face visit for simple queries.

He says the organisation has found that by sharing information with their patients, they, in turn, empower and educate them. “It’s a drive to engage the patient more in their health.”

The electronic storage of individual patients’ medical data also means the organisation can engage much more proactively in “population health”. So, for example, the system automatically flags that a patient requires a medical test based on their history, gender, age and other relevant information.

“We set the proactive plan with the patient for their care plan,” Smith says. “Now that we have it all on our systems, we can mine our data to find people who are due a test rather than relying on a patient to come in.”

But developments are happening much closer to home and there are numerous companies providing or developing a diverse range of technologies which they say could bring about major benefits to Ireland’s health system.

Sláinte Healthcare is an example of a company with a track record of successfully applying technology in the Irish health system. In 2007 it launched Claimsure, a software system which allows healthcare organisations to manage insurance claims electronically.

According to its chief executive and founder, Andrew Murphy, Claimsure, which is now in place across much of the HSE, has resulted in substantial savings for the Irish health system.

Heath data
The company's latest offering is Vitro, a technological approach to managing patient's health data in hospitals. Essentially, the system replaces the patient charts commonly found in paper format at the bottom of every hospital bed with an "intelligent" electronic chart which mimics the paper layout.

It is available on hardware including tablets, desktops and laptops and will be enabled for smartphones later this year. Murphy says because it replicates the paper chart, it takes the same amount of time to complete but comes with all the benefits of holding the information electronically.

The data is also immediately available to all members of that patient’s healthcare team. What’s more, it can support clinical decision making, for example, with an early warning system if a patient’s vitals are abnormal.

Vitro is in use across health systems in Australia and the Middle East, and will have been rolled out to more than 40 hospitals by the end of the year.

But while Sláinte Healthcare’s technology focuses on applying information technology to the hospital setting, the aim of another system being developed in Ireland is to keep patients out of hospital for as long as possible.

Dr Johnny Walker of Health Founders and an interventional radiologist in the Hermitage Clinic in Dublin, thinks there is scope for many more people to be treated from the comfort of their own homes.

Remote care
The Australian is developing Jinga Life, which aims to keep people out of the acute setting for as long as possible using a combination of technologies: an electronic record of patients' health information; a video tool which allows users to communicate with their healthcare provider remotely; and sensor technology.

He estimates 25-45 per cent of cases could be dealt with in the home, obviating the time and expense associated with those individuals being treated in an acute setting. “What we want to do is to stop people coming into hospital by keeping them well in the community,” Walker says.

But given that we have become used to the application of many of these types of technologies in other aspects of our lives, why has healthcare taken so long to catch up?

Kevin Conlon of the Department of Health’s ICT unit says the lag in applying such technologies has partially been due to the complexity and sensitivity of health data, concerns around data protection and a lack of an individual health identifier number.

The Health Identifiers Bill – which will see each patient assigned a unique number used to identify them and the health information associated with them – is progressing through the Oireachtas .

Conlon say this is one of a number of pieces of legislation which will be required to “ensure that the governance of eHealth is managed in an efficient and secure way to underpin patient safety and confidentiality”.

The Health and Information Quality Authority (Hiqa) also has a major role in setting standards for health information technologies including information governance and data protection.

Prof Jane Grimson, director of Health Information and deputy chief executive of Hiqa and professor of health informatics at Trinity College Dublin, adds that Hiqa also has a role to play in ensuring that the data we already collect is put to best use.

“We will be making recommendations in due course in relation to better integration of our national data collections to improve the quality and safety of services and provide population health benefits,” she says.