Health policy Digital innovation in the HSE

[Brendan Burgess]

That Great Business Show has a very interesting interview with Martin Curley who is Head of Digital Transformation at the HSE

Episode 90 - That Great Business Show - Martin Curley - Prof of Innovation NUI Maynooth, Director of Digital Transformation at the Health Service Executive HSE

That Great Business Show · Episode

open.spotify.com

Medical knowledge is doubling every 79 days!

Martin Curley, former Intel Vice President, now in charge of the digital transformation of Ireland's health service says we will have the best health service in Europe by 2025. Yes, you read that right. In under 36 months Ireland could go from 80th in the world for its health service to 1st in Europe. He is so confident he has brought Tourism Ireland on board as he sees a massive business opportunity in health tourism.




He says that medicine, with the amount of data it produces from patients, is made for digital interrogation, a process that is going to revolutionise day-to-day medicine in a matter of a couple of years. He explains how the 'diagnostic waiting list' can be eliminated in less that a year (yes, you also read that correctly!)




He explains what the Irish Digital Health Leadership Steering Group is doing.

Using a Medtronic made camera 'pill' that he had in studio, he says that colonoscopies can be done ten or maybe twenty times faster - again eliminating queues. This is already deployed in Tallaght hospital.

Using a different technology they have managed to cut the level of hospitalisations of a group of heart patients by 10X as Professor Curley likes to say, so one tenth the number of hospitalisations in other words.

He explains how an app called 'Patients know best' works and he explains that 90% of European hospitals DON'T share data with the patient (that owns it) but that will have to change now.

His Group now has 50 proof points (live examples) of how digital is revolutionising medical care in Ireland. He talks of the two clinicians in Our Lady of Lourdes hospital who adopted an Irish made piece of tech that has cut bed night numbers by a staggering 170,000. Another Irish made app, 'Balance' can predict in 30" how likely someone vulnerable is likely to fall. Avoiding falling means avoiding hip operations or worse. He was also wearing a smartwatch developed by Wexford based Tunstall that knows when someone falls and intervenes in 20 seconds. Cork based PMD has developed the world's first continuous respiratory rate monitor, respiration being the first vital sign the starts to deteriorate. Another innovative company he references is Bluedrop Medical in Galway that works with diabetics.



He is quite open about the difficulty in getting the measures adopted by the HSE.

It's an hour-long podcast, but well worth listening to.

Brendan

 

[mathepac]

I am attending two hospitals in Waterford and Dublin, both requiring images of various portions of my body, each prescribing treatments for different ailments and illnesses. Neither hospital, for technical reasons I'm told, can share images with the other. Yet I can take the images from either location, export them onto an external medium and take them to my computer at home for viewing. The hospitals have refused to accept my offer of assistance in getting the images from one place to the other, quoting variously, GDPR, technical difficulties, the potential for virus infections passing between sites, and other nonsense as the reasons they cannot accept my offers. I haven't had any of my computers or devices on my home network shut down by hackers any time recently or in the past. It's a bit more than they can say.



I could even take the images, compress them with zero loss of image quality so they are "emailable" (the files tend to be very large), speed the entire process up and eliminate all the manual interventions, transcriptions and errors. I have offered to demo what I can do and the savings I could achieve, but GDPR apparently prevents me from using images taken of me for demonstration purposes.



At the moment, images taken in one hospital are used to produce a textual report dictated by a local expert that is typed up and forwarded in hard copy form to the other location. One such report, based on my images, read to me by a doctor in one hospital at my request, specifies queries about the "2nd rib, R/H side" but fails to specify front or back ribs. There were other Es&Os in the same report. She seemed as shocked as I was at just how bad the report was. Other such errors and inconsistencies are common, based on access to my own records.



It is not uncommon for admitting doctors to show up with no notes and expect me to give a full medical history off the cuff and to dictate a full, up-to-date list of my medicines. All of this information is already stored in multiple HSE patient and medication databases, tied together by my PPSN or Medical Card number, but, as neither number is used as a reference in any hospital system (there are multiple such systems in each HSE area, each having its own unique patient reference) there is no way of accessing that existing information locally, and no way of tying the different reference numbers to one patient. I could do this easily as I've done something eerily similar for a vary large European financial institution.



For each hospital appointment or consultation, I now carry with me in typed form, information on all of my medications and hospital admissions and hand them to the admitting physician for them to staple to my notes. Invariable they manually transcribe the printed information in medic scrawl to their blank note sheets and hand me back my clear printed documents.



Here at home, my pharmacist, my GP, and I have informally agreed to a protocol to keep my medication lists up to date, to forward renewals from GP to the pharmacist, and to request monthly call-offs from the pharmacist to me. During lock-down, this reduced the number of physical visits to different premises, sped the processes up, and generally improved the effectiveness and efficiency of information and medication flow amongst and between us.



The HSE is a dinosaur, a disaster area, and point solutions like those mentioned in the podcast are just fiddling at the edges while the entire system heads for a total meltdown. Work practices must change, against the wishes of any and all of the unions or other vested interests. They've had their day. It's now past time the HSE focussed on patients.



Last week in a Dublin hospital I was being transported between the admission/prep areas and the area where my treatment was to take place. As I was on a trolley, the porter escorting me had to use the lift. Several lifts arrived at our floor but we were refused admission as the lifts were filled with suits wearing hospital ID tags and lanyards as well as uniformed staff, doctors, nurses, HCAs, and admins. The lift doors are clearly labeled, "PATIENT USE ONLY". The porters escorting me and a patient in a wheelchair remarked as yet another lift departed our floor with no patients on board, "So much for putting patients first and having them at the forefront of our work."



It's like the notion, purely a notion" of St Vincent's University Hospital being a smoke-free campus; it probably is if you ignore the dozens of taxi drivers, staff, patients, and visitors smoking outside the main entrance and across the road at the benches near the little bus stop. Strangely, while ash bins are supplied in a smoke-free campus, no one bothers to use them for their designated purpose. The entrance is ankle-deep in cigarette butts, ash, discarded drinks bottles, sweet wrappers, and other detritus.



Just like the idea of technological innovation, the HSE's notion of rules and regulations and implementing or adhering to them is purely notional.



I'll be back with more

 

[mathepac]

He was also wearing a smartwatch developed by Wexford based Tunstall that knows when someone falls and intervenes in 20 seconds.

Apple did this at least five years ago with the Apple Watch, WatchOS. Mine, a Series 4, is enabled to detect a fall and if there is no intervention from me, it phones emergency contacts (sister, daughter, brother, GP, emergency services (999 or 112)). This isn't an addon or addin, it's built into the watch from the factory. It requires opt-in and setup, obviously.

The user has the option for "Always ON" fall detection or only during workouts, integrating it into the Exercise apps. Readily accessible under Emergency SOS settings.

Not knowing this basic information about a mainstream off-the-shelf consumer product leads me to question the entire premise of the article and podcast. Like the HSE itself, it misses the target and the point, very, very widely. Besides, what has a 3rd party commercial product, even one supposedly Made in EIRE de novo (IP anyone?), got to do with an organization which can't/won't enforce rules it wrote itself, on its own staff, on its own premises?

FYI and the Head of Digital Transformation at the HSE.

watchOS 11

watchOS 11 helps you better understand your daily health status using your overnight vitals and shows you how workouts impact your body over time.

www.apple.com

 

[mathepac]

He explains how an app called 'Patients know best' works and he explains that 90% of European hospitals DON'T share data with the patient (that owns it) but that will have to change now.

The HSE can't even share patient information internally, across different premises or even within different disciplines or departments on the same premises. They cannot get discharge summaries to GPs in a timely effective manner or sometimes at all. This is the situation with my GP who still has no complete, up-to-date information about my diagnoses, prognosis, or treatment plans dating back to December last year. I try to keep him updated but am also meeting the GDPR rule wall about my own health information from certain departments.

They can't even issue patients with accurate appointment information. Waterford University Hospital sent me an appointment for the end of this month to review imaging results with the discipline experts. The problem is, no new images have been taken, another set of CT scans. I phoned the area concerned and told them. They stated imaging had begun giving Saturday appointments recently and that might have caused the confusion. (Imaging in Galway has been issuing weekend appointments for years). They transferred me to imaging appointments who told me I had already missed two appointments. I set the record straight by stating I had canceled the original appointment in April due to a date conflict with another health area and was still awaiting a replacement date. I was told I'd failed to show up for an appointment in early May.

I was able to establish the date, time, and the person I'd spoken with to cancel the April appointment, and with no phone call or proof of delivery for the May appointment, they offered me another for June 25th (a Saturday). No letter of confirmation yet, but we live in hope.

Here is a great example of a human system that doesn't work and is not suitable for automation or technological innovation. First, get the human system working, effectively and efficiently; then and only then assess its suitability for technological support. OD technology certainly needed, but not computer technology which is non-deterministic.

 

[Paul O Mahoney]

I am attending two hospitals in Waterford and Dublin, both requiring images of various portions of my body, each prescribing treatments for different ailments and illnesses. Neither hospital, for technical reasons I'm told, can share images with the other. Yet I can take the images from either location, export them onto an external medium and take them to my computer at home for viewing. The hospitals have refused to accept my offer of assistance in getting the images from one place to the other, quoting variously, GDPR, technical difficulties, the potential for virus infections passing between sites, and other nonsense as the reasons they cannot accept my offers. I haven't had any of my computers or devices on my home network shut down by hackers any time recently or in the past. It's a bit more than they can say.



I could even take the images, compress them with zero loss of image quality so they are "emailable" (the files tend to be very large), speed the entire process up and eliminate all the manual interventions, transcriptions and errors. I have offered to demo what I can do and the savings I could achieve, but GDPR apparently prevents me from using images taken of me for demonstration purposes.



At the moment, images taken in one hospital are used to produce a textual report dictated by a local expert that is typed up and forwarded in hard copy form to the other location. One such report, based on my images, read to me by a doctor in one hospital at my request, specifies queries about the "2nd rib, R/H side" but fails to specify front or back ribs. There were other Es&Os in the same report. She seemed as shocked as I was at just how bad the report was. Other such errors and inconsistencies are common, based on access to my own records.



It is not uncommon for admitting doctors to show up with no notes and expect me to give a full medical history off the cuff and to dictate a full, up-to-date list of my medicines. All of this information is already stored in multiple HSE patient and medication databases, tied together by my PPSN or Medical Card number, but, as neither number is used as a reference in any hospital system (there are multiple such systems in each HSE area, each having its own unique patient reference) there is no way of accessing that existing information locally, and no way of tying the different reference numbers to one patient. I could do this easily as I've done something eerily similar for a vary large European financial institution.



For each hospital appointment or consultation, I now carry with me in typed form, information on all of my medications and hospital admissions and hand them to the admitting physician for them to staple to my notes. Invariable they manually transcribe the printed information in medic scrawl to their blank note sheets and hand me back my clear printed documents.



Here at home, my pharmacist, my GP, and I have informally agreed to a protocol to keep my medication lists up to date, to forward renewals from GP to the pharmacist, and to request monthly call-offs from the pharmacist to me. During lock-down, this reduced the number of physical visits to different premises, sped the processesl up, and generally improved the effectiveness and efficiency of information and medication flows amongst and between us.



The HSE is a dinosaur, a disaster area, and point solutions like those mentioned in the podcast are just fiddling at the edges while the entire system heads for a total meltdown. Work practices must change, against the wishes of any and all of the unions or other vested interests. They've had their day. It's now past time the HSE focussed on patients.



Last week in a Dublin hospital I was being transported between the admission/prep areas and the area where my treatment was to take place. As I was on a trolley, the porter escorting me had to use the lift. Several lifts arrived at our floor but we were refused admission as the lifts were filled with suits wearing hospital ID tags and lanyards as well uniformed staff, doctors, nurses, HCAs, and admins. The lift doors are clearly labeled, "PATIENT USE ONLY". The porters escorting me and a patient in a wheelchair remarked as yet another lift departed our floor with no patients on board, "So much for putting patients first and having them at the forefront of our work."



It's like the notion, purely a notion" of St Vincent's University Hospital being a smoke-free campus; it probably is if you ignore the dozens of taxi drivers, staff, patients, and visitors smoking outside the main entrance and across the road at the benches at the little bus stop. Strangely, while ash bins are supplied in a smoke-free campus, no one bothers to use them for their designated purpose. The entrance is ankle-deep in cigarette butts, ash, discarded drinks bottles, sweet wrappers, and other detritus.



Just like the idea of technological innovation, the HSE's notion of rules and regulations and implementing or adhering to them is purely notional.



I'll be back with more

I honestly thought that since I was sick 2007 to 2013 the hospitals would have at least gotten rid of the " hospital number " practice, it's the most backward recording system I have ever encountered.

My main hospital of care was Tallaght, all chemo, bloods , MRIs were done there over the initial 12 month battle, my cancer " was gone", based on blood readings in May 2008 , in July it returned and I had to have "high dose chemotherapy " which meant having my stem cells harvested, high dose chemotherapy, which kills every cell, isolation for 3 months and then stem cells reintroduced to rebuild my immune system.

All the high dose stuff was done in James, my radiation treatment for the brain tumors and lesions was done in St Luke's and weekly bloods were done in Naas eventhough Tallaght was nearer and more accessible due to public transport , I gave up driving, as I really did have chemo head.

Despite the public system having " saved my life" the inefficient way things are done is unbelievable......

Each hospital gave me a unique number not connected to any of the other numbers, hospital or what medical treatments were carried out in those locations.

Rarely was information shared, probably only on request from Oncologist.

Additionally I'd have bloods taken in Tallaght, go to James only to be stabbed for blood again 2 hours later, why couldn't the results be simply be shared by email, ( was suffering from collapsing veins and arms were black from puncture holes)

This is just a very quick summary of my experience and I will say that I did rock the boat a lot in hospital, apparently the CEO left due to my many thousand emails due to being on a trolley during chemo, and I pointed out other basic inefficiencies that would have saved money and made the patient experience better and probably would have led to better information on me being created and saved, perhaps to help others too.

But, the bottom line is it saved my life and I'm very very grateful. As most people are, and we move on.

If we do have the best doctors and medical staff perhaps this initiative will show that, but this is the HSE and if you ask the question " how many work in it"? the answer is "about half ", and we've all witnessed this " reform " before.

I hope this works we are 5m people spending billions on a system running in the 1950s mentality, and " medical tourism " let's slay the dragon " first.

 

[Brendan Burgess]

point solutions like those mentioned in the podcast are just fiddling at the edges while the entire system heads for a total meltdown.

Hi mathepac

If you listen until the end he speaks about redesigning the architecture of the health system.

Brendan

 

[mathepac]

Sorry Brendan we've heard it all before. The HSE was the answer invented by Mary Harney. From the chaos of the health boards to the enormous Frankenstein chaos of the HSE, to breaking the enormous HSE back into other "manageable" bits have all been failed efforts at doing what he describes.

Shoot it stone dead. Put it and us out of our collective misery, thereby saving misery and billions of euro, maybe even lives.

 

[Steven Barrett]

In Dermatology, you can upload a photo of your skin issue and it will be looked at remotely by a consultant dermatologist. Appointments within 2 weeks. This is done privately though and not through the HSE. Appointments through the public service currently have a waiting time of over 12 months. The HSE has a long way to go.

 

[Sophrosyne]

About time, I have been emailing various Ministers and T.D.s for years.
This should also help with medical research.

 

[arbitron]

I am attending two hospitals in Waterford and Dublin, both requiring images of various portions of my body, each prescribing treatments for different ailments and illnesses. Neither hospital, for technical reasons I'm told, can share images with the other. Yet I can take the images from either location, export them onto an external medium and take them to my computer at home for viewing. The hospitals have refused to accept my offer of assistance in getting the images from one place to the other, quoting variously, GDPR, technical difficulties, the potential for virus infections passing between sites, and other nonsense as the reasons they cannot accept my offers. I haven't had any of my computers or devices on my home network shut down by hackers any time recently or in the past. It's a bit more than they can say.

Plenty to slate the HSE for but also lots of good stuff being done.

Interestingly we actually have one of the most connected radiology/imaging systems in the world. At last count 56 out of the 66 public hospitals in Ireland (93%) are connected to NIMIS, a national system that allows each hospital to see x-rays, CTs, MRIs, etc. from every other hospital in the network. The only ones in Dublin still not connected are Vincents and Michael's in Dun Laoghaire (they chose not to be part of the system, that wasn't a HSE decision). Private hospitals are not connected yet but that's on the way.

Our diabetic retinopathy screening service is one of the best internationally. The national cancer IT system is live in more than half the sites across the country and will be one of the most advanced in the world. MedLis will be a national system for sharing lab results (bloods, biopsies, etc.) and would be in place now only for the cyberattack. Maternity hospitals have very advanced IT and the new children's hospital will have the Rolls Royce of systems called Epic. Lots of work being done on patient portals and personal health records which will give patients full access and control over their own information. Clinical staff are very keen for all of this as it makes life much easier for everyone.

Contrary to popular belief, the unions don't have much to do with any of it. If anything, they're in favour.

We do need government to move on the individual health identifier - a single patient identification number that will allow all of these systems to work together. It was agreed years ago (remember the discussions over IHI versus PPSN?) but then was not prioritised.

 

[Protocol]

@arbitron

great to hear about all these improvements.

I want a system whereby if I collapse 100km from my house, I want all paramedics / hosp in that place 100km from home to see my medical history.

If I switch GP, or move home 200km, I want GP records to move at touch of button to new GP.

I want all GP to be linked to all hosp.

So no matter which GP / pharmacy I go to, my diagnosis, treatment, prescription, etc., can be seen by other GP, and by any hosp.

 

[mathepac]

and will be one of the most advanced in the world. MedLis will be a national system for sharing lab results (bloods, biopsies, etc.) and would be in place now only for the cyberattack. Maternity hospitals have very advanced IT and the new children's hospital will have the Rolls Royce of systems called Epic. Lots of work being done on patient portals and personal health records which will give patients full access and control over their own information.

a single patient identification number that will allow all of these systems to work together.

All "will bes" unfortunately.

 

[nest egg]

.....The only ones in Dublin still not connected are Vincents and Michael's in Dun Laoghaire (they chose not to be part of the system, that wasn't a HSE decision)....

That comment alone speaks volumes, why was this a choice?

 

[nest egg]

Here is a great example of a human system that doesn't work and is not suitable for automation or technological innovation. First, get the human system working, effectively and efficiently; then and only then assess its suitability for technological support. OD technology certainly needed, but not computer technology which is non-deterministic.

Couldn't agree more, get the process right first, then look at the tools (i.e. technology) to further improve its efficiency.

 

[Up Rovers]

Maternity hospitals have very advanced IT

Unfortunately not in the Coombe hence their two cyber attacks in the last year.

 

[Paul O Mahoney]

Plenty to slate the HSE for but also lots of good stuff being done.

Interestingly we actually have one of the most connected radiology/imaging systems in the world. At last count 56 out of the 66 public hospitals in Ireland (93%) are connected to NIMIS, a national system that allows each hospital to see x-rays, CTs, MRIs, etc. from every other hospital in the network. The only ones in Dublin still not connected are Vincents and Michael's in Dun Laoghaire (they chose not to be part of the system, that wasn't a HSE decision). Private hospitals are not connected yet but that's on the way.

Our diabetic retinopathy screening service is one of the best internationally. The national cancer IT system is live in more than half the sites across the country and will be one of the most advanced in the world. MedLis will be a national system for sharing lab results (bloods, biopsies, etc.) and would be in place now only for the cyberattack. Maternity hospitals have very advanced IT and the new children's hospital will have the Rolls Royce of systems called Epic. Lots of work being done on patient portals and personal health records which will give patients full access and control over their own information. Clinical staff are very keen for all of this as it makes life much easier for everyone.

Contrary to popular belief, the unions don't have much to do with any of it. If anything, they're in favour.

We do need government to move on the individual health identifier - a single patient identification number that will allow all of these systems to work together. It was agreed years ago (remember the discussions over IHI versus PPSN?) but then was not prioritised.

It has and has done for millions of us, but its really terrible, and that's a shame because the people in it are stupendous, ie front line.


I assaulted??? Trevor Sargent in Tallaght one day I was walking with my drips slowly and hanging blood in a discrete bag and said "Minister what photo OP is happening today since Health isnt your department........blah blah blah and I got really emotional and told him, " You're in Government and people are dying due to your policies , Got heated, apparently he was there to open a fresh food yoke for staff while patients got food cooked 3 days earlier, frozen and then reheated........

If my cancer came back tomorrow I'd rather die than be in an Irish Hospital again, despite be saved once.

Apologies but this is raw and I'm emotionally attached but still 15 years later, computers don't save lives, and "medical tourism " ah here.

And treatment cost Laya €378,569 which took the HSE almost 5 years to bill???????

 

[Up Rovers]

If my cancer came back tomorrow I'd rather die than be in an Irish Hospital again, despite be saved once.

Paul, sorry to hear that you had such a bad experience that you would prefer to die rather than being in hospital again.

I'm so lucky that I can afford to have VHI because I was told last year that if I was going public in Tallaght that I would be waiting one year if I was an emergency and four years if not urgent. That level of being on a waiting list is not a proper service.

 

[Paul O Mahoney]

Paul, sorry to hear that you had such a bad experience that you would prefer to die rather than being in hospital again.

I'm so lucky that I can afford to have VHI because I was told last year that if I was going public in Tallaght that I would be waiting one year if I was an emergency and four years if not urgent. That level of being on a waiting list is not a proper service.

Dude I'm private and pay the fees in Tallaght etc, but we need to stop the waste and it's at every level from Unions to Senior management to the Government......its simply a waste.

Don't be sorry it's my life and I'll fill it whatever the length, like the par 4 today index 2 , had a 6 on my second ball.

We can't allow the Health System to be " digitally overhauled " when the physical system is on its knees.

I don't agree with a " hospital " in every parish either but people need to be educated on how travelling a bit further to save your life isn't armageddon..

 

[mathepac]

Define a "bit further"?

Last week I attended St Vincent's in Dublin for further assessments on my cancer diagnosis and to get the all clear to begin treatment.

I drove, costing me €48 petrol, €2.70 in tolls and I'd have had to pay for HSE parking but for my sister's offer to leave my car at hers. She then drove me across to Vincent's and collected me later. This is our free health service.

This week I have to make a return trip to Waterford for scans and back the following week for the ENT clinic. €64 in petrol for the two trips, plus €8 in tolls plus HSE parking fees and coffee at €3.50 per small cup and another day running the gauntlet of the smokers gathered around the main entrance on a non-smoking campus.

IT won't fix these problems, designing a health service to suit patients could.

Before anyone suggests it, the free train and bus services won't get me to appointments and back on the same day - Dublin and back would be three days. Like the health services, nothing joins up.

Are those hospitals a bit further away?

 

[Paul O Mahoney]

Define a "bit further"?

Last week I attended St Vincent's in Dublin for further assessments on my cancer diagnosis and to get the all clear to begin treatment.

I drove, costing me €48 petrol, €2.70 in tolls and I'd have had to pay for HSE parking but for my sister's offer to leave my car at hers. She then drove me across to Vincent's and collected me later. This is our free health service.

This week I have to make a return trip to Waterford for scans and back the following week for the ENT clinic. €64 in petrol for the two trips, plus €8 in tolls plus HSE parking fees and coffee at €3.50 per small cup and another day running the gauntlet of the smokers gathered around the main entrance on a non-smoking campus.

IT won't fix these problems, designing a health service to suit patients could.

Before anyone suggests it, the free train and bus services won't get me to appointments and back on the same day - Dublin and back would be three days. Like the health services, nothing joins up.

Are those hospitals a bit further away?

Legend