Ireland plans five year e-health journey

Ireland’s new chief information officer for health, Richard Corbridge, has issued a ‘Knowledge and Information Strategy’ that sets out the building blocks for a transformation of the country’s health services using e-health.

Corbridge took up his post as CIO of Ireland’s Health Service Executive in December, and told Digital Health News at the time that he was “getting in at the ground floor” with the opportunity to “start from the beginning, add to a strategy, and pull a team together.”

The Knowledge and Information Strategy launched yesterday follows up on this by focusing on the basics of getting a new IT infrastructure, interoperable systems, data use and patient services in place; and on creating the leadership to do it.

A more detailed business case and planning phase will follow, but the strategy says the plans will take at least five years to implement and require significant investment.

“Based on international experience, it is expected that the total investment required for this programme will be significant; measured in the hundreds of millions of Euro,” the document says.

It adds that the requirements will be “compounded by the chronic underinvestment during past years”, with Ireland having historically spent just 0.85% of its health budget on IT, in comparison with an EU norm of 2-3% per year.

The strategy starts from the basics, outlining the ‘target principles’ that those working on the programme will use, and management structures.

It says that clinical leadership is key and a “role of chief medical information officer of the HSE will be developed” to provide leadership.

A “council of clinical information officers” will also be appointed to “provide oversight to the portfolio of clinical information systems proposed” and the strategy says these people “will have the key design authority role over each phase of the programme.”

When it comes to electronic health records, the strategy says that providers should have systems to hold detailed records that support clinical activity, while feeding a “summary care record to enable patient care along the pathway.”

However, the Irish approach to achieving this has more in common with the approach of the old NHS Information Authority in England, than that pursued by the National Programme for IT, on which Corbridge worked.

It says that providers will use IT that can be integrated with HSE core services, but it places an even stronger emphasis on standards to enforce this, saying their use will be mandatory and enforced by a new enterprise architecture function and design authority.

Over time, the strategy suggests, local systems could also be replaced by nationally developed or procured systems, as has happened in Scotland and Wales.

Meanwhile, the HSE’s core services will include patient registration and messaging through the integration layer, support for the summary care record, a portal for patients, and a new data service built around HSE defined datasets and a shift to patient level information costing.  

National systems for finance, procurement and HR are also proposed. In a foreword, Corbridge says his office is focused on delivering technology to support healthcare, grounded in the outcomes it delivers, and not deploying technology for its own sake.”

He outlines some of the benefits as “improving the healthcare system”, improving efficiency, and “providing tools to enable the people of Ireland to access usable information to keep them fit and healthy.”

However, the conclusion strikes a pragmatic note, saying that filling out the building blocks and creating momentum around the strategy is "probably best described as built for the future without breaking the present on the way!”