Health policy Martin Curley: Digitialisation of health service is being impeded

[Brendan Burgess]

Digitisation of health service is being impeded by ‘bad actors’, former department head says

Martin Curley, who resigned last week, says efforts to introduce new solutions were repeatedly blocked

www.irishtimes.com

The Health Service Executive (HSE) has “no vision” for the digitisation of the health service and efforts to change this are being impeded by “bad actors”, according to its recently-departed head of digital transformation.

Prof Martin Curley, who resigned last week after four years, said his efforts to introduce new technology solutions were repeatedly blocked by senior administrators.

Patients are at risk of adverse outcomes and even death as a result of the lack of information and communication in the health service caused by poor IT infrastructure, he told The Irish Times.

 

[nest egg]

“Things can go horribly wrong due to a lack of information and communication,” he warned. “Doctors and nurses are making decision in high-pressure situations based on partial information. Inevitably, they will make the wrong decision on some occasions, and these can be fatal.”

You really would despair. Who suffers as a result of all this? Not the HSE, it's the patient.

While a lot is made of the technology/systems/digitisation, fundamentally this is a problem about people and process. The technology is the tool, but in itself cannot drive change.

We need to see far more media attention here - linking the consequences of inaction in the general public's mind, with the increased risk to patient safety, which may impact on them and their loved ones one day. Covid proved the HSE can move quickly when the will is there. No more excuses.

 

[Sophrosyne]

Interesting to know that it was senior administrators that blocked Mr Curley's progress.

 

[Sophrosyne]

I watched today’s meeting of the Joint Committee on Health, which discussed electronic medical records. Scroll down to Recent Videos and then to Topic: Discussion on electronic records in healthcare and related issues.

It was excruciating.

The HSE did not follow the 2015 eHealth strategy.

Instead, they “pivoted” from that strategy and were proud that they developed mini disjointed eCare systems that don’t interact with each other.

Laudable as many of those systems are, they benefit a small fraction of patients and don’t follow those patients when they move from one regional group to another.

I felt the HSE witnesses were putting on a brave face and questions were answered following numerous, often irrelevant, qualifications.

However, I am loathe to over-criticize public servants as they are often blamed for matters outside of their control.

For instance, for me the nub of the issue was the reply to a TD Neasa Hourigan’s question. She was told that a HSE business case for electronic hospital records (EHR) was rejected in 2018 by the Department of Public Expenditure & Reform.

It seems that DPER would not approve national financing until it could see how EHR operated in the proposed Children’s Hospital.

So, approval has been held up since 2018 on the basis of how EHR would operate in the God knows when it will open Children’s Hospital. Even then it would take considerable time to populate it with enough data so that it could be analysed.

Apparently, it was DPER and not the HSE that made the linkage to the Children’s Hospital

If that were true, who on earth made that decision despite any amount of available global evidence? Who knew about it?

About into 2:17 into the video, Dr Avril Kennan CEO of Health Research Charities Ireland representing over 1m people, related - in a powerful way - the importance of electronic medical records to research and disease prevention. Well worth a listen.

 

[nest egg]

She was told that a HSE business case for electronic hospital records (EHR) was rejected in 2018 by the Department of Public Expenditure & Reform.

Getting knock-backed on business cases happens all the time. If we don't get approval for a business case at work, we regroup, rethink and resubmit. What did those who submitted this business case do about it for the past 5 years?

 

[Sophrosyne]

If you look at the video it was difficult to get a straight answer from the HSE representatives. But it appears that they did not persist in seeking approval. Instead they implemented small "tactical" projects in different locations.

They were not questioned on who approved or funded those projects.

 

[ClubMan]

Anybody else think that your man's resignation tweet was a bit bonkers? Everest and all that? Maybe the problems weren't all on one side in this matter?

 

[mathepac]

I saw his appointment as being a bit mad and can't help but suspect that his modus operandi and the HSE bureaucracy were a poor fit to begin with. Maybe he was made promises that couldn't be fulfilled about cooperation at the highest levels and it comes as no suprise to me that the pushback was from admins. The smart medics know the kind of help they need and how his toolkit could have helped. Such a shame that the admins, internal and external to the HSE, have veto powers on his kind of stuff.

 

[NoRegretsCoyote]

A lot of this comes down to scaremongering from privacy activists about PPSNs over the years.

Most of Europe uses a single national identification number for tax, welfare, and health services. Your GP knows it and you provide it for every hospital visit. Once the appropriate privacy safeguards are in place it works fine and medical records can be shared easily between providers. Meanwhile in Ireland some people treat their PPSN as it it's the third secret of Fatima.

Meanwhile Ireland now has a parallel unique health identifier system parallel to the PPS system. Nobody knows of this outside the health service, and it seems that it's only partially used. The whole thing is a huge shame.

 

[odyssey06]

A lot of this comes down to scaremongering from privacy activists about PPSNs over the years.

Most of Europe uses a single national identification number for tax, welfare, and health services. Your GP knows it and you provide it for every hospital visit. Once the appropriate privacy safeguards are in place it works fine and medical records can be shared easily between providers. Meanwhile in Ireland some people treat their PPSN as it it's the third secret of Fatima.

Meanwhile Ireland now has a parallel unique health identifier system parallel to the PPS system. Nobody knows of this outside the health service, and it seems that it's only partially used. The whole thing is a huge shame.

Once the appropriate privacy safeguards are put in place - yes.

It is not just down to 'scaremongerong'.

One of the reason why many people have concerns about PPS, people who could be persuaded of its merits as you have outlined - was governments attempting to do this by the back door without those safeguards.

 

[NoRegretsCoyote]

was governments attempting to do this by the back door without those safeguards.

Where was there a lack of safeguards?

By this I mean (broadly) that access to PPSNs (individual and aggregate) is limited to those with a need to know, with strong internal controls and robust IT systems in place to guarantee this.

I never saw any evidence that a random civil servant in the Department of Foreign Affairs would ever be able to look at your PRSI record, for example.

 

[Peanuts20]

My late fathers files required a a trolley to have them wheeled around the hospital and when my mother ended up in a hospital last year in another part of the country, that hospital more or less had to start from scratch again and at least we were there to explain what meds she was on at the time.

I've also been in a few HSE offices over the years for work, the one that jumps out at me was a brand new office block where the boxes of printer paper were stacked floor to ceiling. Everything seemed to be printed, I've even seen emails printed out. Utter madness in this day and age

This is not rocket science to digitise the records but it is a massive undertaking. It requires an incredible amount of resiliance built in because if the digital system fails, people could die. Medical records could and should be seperate from payment and other records. A surgeon doing a bypass doesn't need to know a person's PPS and someone sending out a bill doesn't need to see the details of any treatment, just the high level needed to send out the bill. However that is relatively easy to set up based on user roles/privaleges

So what is needed here?

• An acceptance by all that the current system needs to change. That includes staff, unions, medical staff and Govt. To me, this is the biggest one and it will fail miserably unless they have staff buy in or those staff who object or are obstructive unnecessarily are removed. HSE needs to get out of the "this is the way we've always done it" mentality
• A strategy as to how to do it and by when. Plenty of options and companies globally who do this for a living
• A significant budget to do this. We're talking potentially a €1b programme here
• An agreed set of security protocols to lock the system down and lock down what is in it
• A very robust and resiliant network
• Training for the staff

 

[odyssey06]

Where was there a lack of safeguards?

By this I mean (broadly) that access to PPSNs (individual and aggregate) is limited to those with a need to know, with strong internal controls and robust IT systems in place to guarantee this.

I never saw any evidence that a random civil servant in the Department of Foreign Affairs would ever be able to look at your PRSI record, for example.

Data Protection Commission

Following the completion of a detailed and lengthy investigation, the Data Protection Commission (DPC) has today published its findings on certain aspects of the Public Services Card (“PSC”). Rationale for the investigation

www.dataprotection.ie

 

[NoRegretsCoyote]

I've also been in a few HSE offices over the years for work, the one that jumps out at me was a brand new office block where the boxes of printer paper were stacked floor to ceiling. Everything seemed to be printed, I've even seen emails printed out. Utter madness in this day and age

An old friend works in admin in the HSE and shared a selfie of him at work a while ago. It looked like an office from 1998, paper files everywhere and a fax machine prominent.

A few years ago my own father went in to see a hospital consultant and the consultant had been given the paper file of my late grandfather who had the same name.

Utterly ridiculous in the 21st century.

 

[ClubMan]

An old friend works in admin in the HSE and shared a selfie of him at work a while ago. It looked like an office from 1998, paper files everywhere and a fax machine prominent.

I worked in a very successful US tech multinational up to recently and our office was like that too.

 

[T McGibney]

An old friend works in admin in the HSE and shared a selfie of him at work a while ago. It looked like an office from 1998, paper files everywhere and a fax machine prominent.

Until very recently, I had a not-particularly-old Canon multifunction printer/copier at my desk that was capable of sending/receiving faxes if only I'd bothered to configure it for that.

A few years ago my own father went in to see a hospital consultant and the consultant had been given the paper file of my late grandfather who had the same name.

My late father's ultimately terminal illness in the mid-2000s was considerably worsened by the two hospitals he was attending repeatedly mislaying paper files in transit between them.

 

[Sophrosyne]

The other point is that so long as development of standalone disparate systems is allowed to continue, the more difficult integration of those systems becomes.

As mentioned despite superficial endorsement of the national eCare strategy surely the Government has a case to answer. The HSE are not developing these costly mini projects under the radar.

 

[nest egg]

As mentioned despite superficial endorsement of the national eCare strategy surely the Government has a case to answer.

But which Government? This is going on 20+ years. The average tenure for a minister is probably 18 months, most of them have no background in health nor management, and their horizon stretches only as far as the next election.

The problems with our health service are deep rooted, they have no easy nor quick solutions and require long term thinking to resolve. This is exactly why we have the HSE, it is permanent, it is supposed to drive the vision and the strategy, but there is zero accountability, nor it would seem any consequence, for those who continue to run a system which delivers poor results relative to the amount we spend on it.

Martin Curley's comments are a case in point, where is the response from the HSE? The silence is deafening.

 

[Sophrosyne]

The eHealth strategy was established 8 years ago in 2015.

The present Government is responsible for what is happening now.

Unless pressure is brought on the Government, the scenario you describe within the HSE will continue.

Accountability has to start somewhere.

 

[nest egg]

The eHealth strategy was established 8 years ago in 2015.

The present Government is responsible for what is happening now.

Unless pressure is brought on the Government, the scenario you describe within the HSE will continue.

Accountability has to start somewhere.

While in theory I agree that's the idea, history has shown in practice the model of having the Govt of the day hold the HSE to account doesn't work. That's before we even touch on the other side of the coin, which is the political interference exerted on the HSE's decision making process too. The current model isn't fit for purpose, and we'll still be talking about the same problems with our healthcare system in another 20 years unless we change tack.