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.That Great Business Show has a very interesting interview with Martin Curley who is Head of Digital Transformation at the HSE
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.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.
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.Now the hospitals in cork use the same patient identifier and I believe have NImis
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.
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.
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.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
What's the right solution from your standpoint, and what is stopping us getting to it?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.
HSE is limited in its authority to impose NIMIS on a non-HSE public hospital such as St Vincent's.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.
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.What's the right solution from your standpoint, and what is stopping us getting to it?
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.St Vincent's is not a HSE hospital, which is where some of the problems lie.
Is there a good reason we as patients do not have copies of our own data?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.
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.Is there a good reason we as patients do not have copies of our own data?
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.Is there a good reason we as patients do not have copies of our own data?
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.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.
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.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.
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.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.
The deal only covers large centralized services and works contrary to the much-trumpeted move to primary care as the way forward. From the blurb:- "Primary care systems are not covered by the deal."
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.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.
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.I suspect that the new Children's Hospital will be a testing ground for a national EHR
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