In actual fact, Martin Curley is Head of Digital Transformation in spite of the HSE. If you look closely, you'll see that all of the initiatives are based on being able to circumvent the quagmire of HSE-internal chaotic IT mismanagement, and in that respect, he may well succeed.
Health policy Digital innovation in the HSE
- Thread starter Brendan Burgess
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Health policy
It doesn’t work. I have a sick kid. A couple of years ago I got home from work and she took a tumble and hit her chin. Nothing to worry about but for the kid potentially a serious concern. Phoned her normal team who sent us off to the local emergency dept for x-rays. Saw the doctor within an hour, x-rays done an hour later. All good, but after another 2 hours still no report. Asked the doctor the result but he was waiting for a more senior doctor. Spotted the two of them huddled around a monitor an hour later and eventually they came to speak to us.
Had reviewed x-rays. Were very unusual which we all agreed on given nature of illness. But, I asked were they different to previous x-rays? Did the fall cause new damage? And then they admitted that neither of them could access previous x-rays. Now the hospitals in cork use the same patient identifier and I believe have NImis, but no luck in the emergency dept. We had some x-rays the previous week in Crumlin, can you access those? No joy, until I remembered the kid has taken some screen shots of the x-rays with her iPhone while we were waiting for the doctors in Crumlin. In the end they used her phone images to compare to the current x-rays and we were good to go, no new damage.
Spoke later to our normal consultant who had no problems accessing all the x-rays because of consultant access. Poor SHO in emergency dept or his registrar that night had no access and they were proposing we stay as inpatients until we recalled the photos on the iPhone.
Until the patient has electronic access to all information and data this scenario plays out over and over in every hospital and department every day.
CUH is not on NIMIS so they wouldn't have been able to get the images. They introduced some access workarounds recently but it's not the full implementation. It's long overdue. Proves the point that NIMIS is a big positive. We use it daily and it's made a huge difference to wait times and workflows.
Agreed - people should have full access to all of their info any time, anywhere. You own your own data and should be able to control who views/uses it. Better experience for patients and would make it easier to do our jobs.
This should really be a top tier complaint for every politician who canvasses a vote. Mystifies me that people do not take them to task more often.
It mystifies me why the HSE would allow hospitals to decline to use a common system. NIMIS should be available in all hospitals not just the majority. The poor doctors have to move from one hospital to the next and should be able to use the same system throughout. It really helps with the joined up thinking.
settlement
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As I doctor working in and out of the system for 9 years all I can say is that the whole thing is an absolute shambles and it is getting worse every year.
time to plan
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St Vincent's is not a HSE hospital, which is where some of the problems lie. GDPR excuses are however a nonsense but this seems to be prevalent across many sectors, not just healthcare as the new 'health and safety' excuse.
What's the right solution from your standpoint, and what is stopping us getting to it?
time to plan
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HSE is limited in its authority to impose NIMIS on a non-HSE public hospital such as St Vincent's.
settlement
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I think we need to do the simple things first such as provide enough doctors, enough nurses, enough speech therapists, enough physios etc...the list goes on. Then provide enough beds, enough scanners, enough clinics. If we had an adequately staffed and paid health service that would be a start. Electronic health records don't help as much as you think they will (and they also cause trouble) – I worked with a national electronic health record in australia. I'm all for modernising the service etc but there are bigger problems at hand.
Vincent's doctors & services see HSE patients on a referral basis, therefore integration with and use of HSE "systems" such as they are must be an obligation. They stick out like a very sore thumb in a lot of respects IME.
DazedInPontoon
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Is there a good reason we as patients do not have copies of our own data?
I do not know for certain, but patient records are in doctor to doctor speak, and health professionals (not all) believe that the best way to communicate information is for the health professional to interpret the report/scan/blood test result, because the patient may be upset by the language and terms of the doctor to doctor speak, of focus on inconsequential information or whatever.
I do know with our sick child the consultants copied lots of letters to our GP who used to just photocopy them and give them to me, and he trusted we would not get hysterical about phrases like “the parents have a good understanding of the severity of the condition” or “no clear pathway for treatment is available”.
But I do know the person who cares the most about your health is yourself or a family member and if I had all the data available to me I felt it would be of assistance in determining next steps and treatments. Things like Doc A said in his letter to you doc B last Christmas to test for x because of y so let’s organise the test please. To expect doc b to remember everything significant in a complex history when you are 1 of 20 patients he is seeing in that clinic that day is a bit much, so the patient armoured with all the info can help process and speed decision making along.
I know when we were stuck in Crumlin with the kid and the doctors were like tell us everything significant that happened to you kid in the last 13 years and were there any X-rays and when and why and what date, I would have much preferred to have a folder or USB drive with copies to hand over.
Technically, no. There are already apps and websites out there, that allow you to create your own health record (as in medical history, medications etc.) and then optionally give (and revoke!) consent to any health professional to access them.
In reality however, the main reason you can't access or share your own health data in Ireland today is because the former Health Boards were dissolved overnight in 2005 on foot of a decision rooted in political ideology, to form the HSE without any plan as to what might happen with the existing IT processes. This has resulted in an utterly dysfunctional hodge-podge of decades-old systems on life support (pun not intended!).
Imagine, for example, a merger of eleven major companies, with no overarching corporation in charge; what would you think might happen to the their individual IT systems, with the IT staff of each individual company left scratching their heads in a communications vacuum, wondering what just happened?
Factor into that the recruitment freeze that was in place even prior to the financial crash, the incentivised retirement (and loss) of experienced staff following the crash, the fact that many HSE IT staff still take home less pay than they did in 2009, the resultant difficulty in recruiting new staff, and the final sucker punch, the inevitable and entirely predictable cyberattack in 2021.
That entire megashambles can be bypassed thanks to the internet, technological innovations and the lateral thinking of visionaries such as Martin Curley. If you haven't yet done so, please, please listen to the entire one-hour show, and you'll understand. It's worth your time, and it's important.
time to plan
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No they don't see HSE patients. They see publicly funded St Vincent's patients, who in some circumstances have been referred into them by the HSE. Just as the HSE sees HSE patients who in some circumstances have been referred into them by publicly funded voluntary hospitals . I'm not saying that St Vincent's shouldn't adopt NIMIS, just that the HSE can't oblige them to. Look at it this way: the St Vincent's Board has the legal obligation for safe delivery of care in St Vincent's. If the St. Vincent's Radiologists advise the hospital management that they consider that the Radiology Information System component of NIMIS presents an unacceptable patient safety risk in comparison to their current system, even if they accept that the imaging component of NIMIS is acceptable, then that puts the Board in a difficult position.
What the HSE can do, is decline to fund any development of the St Vincent's Radiology systems.
time to plan
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The megashambles unfortunately also needs the rather less sexy €1 billion + investment over 10 years to implement modern Electronic Patient Record systems across all publicly funded acute and community services. Ireland is the only developed country in the world without this (outside of St James's Hospital which has managed to achieve this). Not taking a pop at Martin Curley's innovative approach but it doesn't bypass that need. And the main blocker here is DPER.
Exactly. Ironically the very circumstances that allowed Vincent's to stay out of NIMIS are the reason that James's could leapfrog the HSE and implement electronic records. If they had waited for DoH/HSE/DPER they would still be on paper.
Look at Northern Ireland where they are bringing in Epic (a high-end electronic record system) across the region: https://www.digitalhealth.net/2020/06/northern-ireland-epic-epr/
I wouldn't jump to any conclusions based on that. We don't know what the plans are for primary care - GPs have had EHRs for decades so they may plan to integrate existing systems, there may be technical/admin reasons they are not doing it, or they may be planning to add primary care at a later date. What they are doing now is a massive improvement that we would be lucky to get here.
I suspect that the new Children's Hospital will be a testing ground for a national EHR, so if it works well there they may go to tender for a national one. Another decade or so maybe...
No, that's what the then CIO claimed it needed. They would probably say they need double that now. When builders really don't want to take on that job you asked them to do, they will quote you astronomical figures too.
It'll be a testing ground for a lot of things, especially when people realise that the currently quoted figures in the media don't include the IT costs.
But why wait for, or expect that a national EHR will magically solve everything? In a connected world, people are not going to wait for the monolithic, Kafkaesque wheels of the Department of Health, the HSE, and -- now -- the newly-formed Regional Health Areas (a.k.a. the "new old Health Boards") to begin turning. This is what Martin Curley is talking about -- there are quick wins to be had with very little investment; he uses the term "leap-frogging", but what it is really doing is putting two fingers up to the dysfunctional, self-serving wasteland that HSE IT has become.
I salute the man.