Health policy Digital innovation in the HSE

Health policy
PinkLloyd said:
....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?
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You've hit the nail on the head.

Who drives the strategy, who establishes and measures the adherence of standards, who implements common processes, who is accountable for consistency across all public health services?

Dysfunctional IT systems are a symptom of dysfunctional organisations.
 
PinkLloyd said:
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.
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€1 billion is well within international norms. You either think it can be done cheaper or you think Ireland can do without Electronic Patient Record systems that are in every other developed country. If you think it could be done cheaper it would be interesting to see 10 year cost estimates across licensing, implementation (vendor and client) support and maintenance (vendor and client) and hosting.
 
arbitron said:
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/
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NI got their EHR business case approved by Department of Finance.
 
mathepac said:
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.
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They do stick out but as I said, HSE cannot enforce NIMIS on them. They do not however see HSE patients anymore than HSE sees St Vincent’s patients. When they are referred to St Vincent’s they become St Vincent’s patients.
 
time to plan said:
They do not however see HSE patients anymore than HSE sees St Vincent’s patients. When they are referred to St Vincent’s they become St Vincent’s patients.
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That sounds like such a mess, same as the schools being in all different ownerships and types. It certainly is no longer what the public want. And innovations and new systems like electronic records, sharing, access, are stymied by this complexity in ownership and governance.

I hear of GPs despairing on having elderly patients released from hospital and no discharge information, no idea on medication changes and the poor elderly patient unsure of the details. Wouldn’t it be wonderful if the GP could check out the epr in the hospital, see the notes, records, radiographers reports without leaving their office, and then give the patient the care they needed.
 
Clamball said:
That sounds like such a mess, same as the schools being in all different ownerships and types. It certainly is no longer what the public want. And innovations and new systems like electronic records, sharing, access, are stymied by this complexity in ownership and governance.

I hear of GPs despairing on having elderly patients released from hospital and no discharge information, no idea on medication changes and the poor elderly patient unsure of the details. Wouldn’t it be wonderful if the GP could check out the epr in the hospital, see the notes, records, radiographers reports without leaving their office, and then give the patient the care they needed.
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Indeed it would. But largely the EPRs don’t exist in Irish public hospitals.

As an aside, many of the data sharing barriers between different legal entities are easily addressable via a new Health Act, which is how they are managed across the hundreds of separate legal entities in the NHS.
 
The same unions run the HSE, the Dept of Health, etc. solely for the benefit of their members. It is a fallacy that any Minister or HSE head has any degree of control or influence over any aspect of our health service. They want the HSE to kill itself off and hand the whole kit and kaboodle over to private enterprise a la the USA.

Given that the various hospitals and hospital organizations, voluntary, private, public, HSE, etc can't (won't?) share clinical data digitally, could the Minister or his next IT guru commit to making my health records available to me as Clinical Document Architecture files, CDAs, so I can carry them with me on my iPhone?

Rather than carry bits of paper with details of my medicines around with me from hospital to hospital and doctor to doctor, I now have these available digitally on my iPhone and I want to add the CDAs so I am independent of the various nefarious IT systems in misuse
 
mathepac said:
The same unions run the HSE, the Dept of Health, etc. solely for the benefit of their members. It is a fallacy that any Minister or HSE head has any degree of control or influence over any aspect of our health service. They want the HSE to kill itself off and hand the whole kit and kaboodle over to private enterprise a la the USA.
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Conspiracy much? o_O
 
time to plan said:
But largely the EPRs don’t exist in Irish public hospitals.
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Pre-HSE, I was involved in a series of significant IT upgrades in a Dublin hospital, including migration to a (at the time) modern EPR system.

I was shocked to learn that (despite a stable pre-existing EPR system), the hospital was maintaining a parallel set of paper files, and had clerical staff keeping them in sync.
 
The question remains though; why do the same people who complain about waiting lists and working conditions resist the change required to make things better?
 
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