Given the increasing importance of information technology within the health sector, the lack of a national IT health strategy has been seen as a fundamental gap that has prevented the Department of Health and the HSE from running a fully modernised service.
Also, while the Government had been working on a Health Information Bill for the last number of years, which would facilitate the much heralded unique patient identifiers, there was little sign that this legislation was being progressed. These two factors combined meant that Ireland was far from leading the way in the area of eHealth.
Finally, however, things have changed.
Before the end of last year, Health Minister James Reilly published the eHealth Strategy for Ireland, as well as the Health Identifiers Bill 2013 and announced the recruitment of a Chief Information Officer (CIO) for the health service.
eHealth, as defined in the strategy, involves the integration of all information and knowledge sources involved in the delivery of healthcare via information technology-based systems, including patients and their records.
Examples of standard eHealth systems include electronic prescribing (ePrescribing) whereby patients can order repeat prescriptions online, online patient scheduling and referral systems and telehealthcare systems whereby patients with for example, diabetes or heart failure, can manage their own healthcare from the home environment. eHealth systems also include newer technologies such as ambient assistive living systems, robotic surgical systems and body-worn sensor devices.
The new strategy states that the development of a coherent eHealth strategy is an important strand of tackling the budgetary and demographic challenges that are facing the health service.
The strategy admits that the healthcare sector has lagged behind other sectors in adapting information technology.
“I think that eHealth has the potential to transform health systems, very much in the same way that ICT has transformed many other sectors such as finance and travel,” Director of Health Information Directorate in HIQA, Professor Jane Grimson, told IMN.
“It really does have the potential to support a healthcare system that is genuinely patient-centred that delivers personalised healthcare, tailored to the individual and delivered to the most appropriate place, whether it is in the community, or the acute sector or wherever. So eHealth has that real potential, and I think that the strategy recognises its transformational and disruptive potential. That is a firm statement of intent that Ireland is going down the eHealth route. We were rather late coming to the table, but that is not necessarily a bad thing. Because we really have an opportunity to learn from what has happened in other countries, and what hasn’t worked. I don’t think it is necessarily a bad thing to be a later adopter of this technology.”
Prof Grimson points to the UK as an example of a country who got it wrong by trying to do too much, too soon. The rollout of the National Summary Care Record was hampered as companies involved in the tendering process felt the implementation timeframe was too ambitious, while local trusts complained of a lack of consultation on the project.
The British Medical Association asked the UK Government to suspend the roll-out of the database in March 2010 as it was an “imperfect system” being rushed into service prematurely, with accusations that data had been uploaded without giving patients the opportunity to opt out a primary concern.
“Denmark had a similar problem. It tried to deliver a national electronic health record in three years or something, and they only realised after a couple of years that this was far too complicated,” Prof Grimson explained.
“It really comes down to the fact that eHealth is very much a transformative, disruptive technology and if you start introducing electronic records, which is usually the ultimate goal of most national eHealth programmes, to have ultimately some kind of shared record, it is major change. It is every bit as major a change as having online bookings for airlines and so on, it is a very significant change, and if you ignore that whole change management piece you will run into difficulties.”
Under the strategy, a new entity called “eHealth Ireland” will be established, initially on an administrative basis within the System Reform Group (SRG) of the HSE. Over time, as the HSE is dismantled, this new organisation will be formed as an independent entity within a new institutional framework for shared services for the health sector as a whole.
eHealth Ireland will be headed up by a new CIO who will work closely with all of the key business organisations within the health service, in order to drive forward the eHealth strategy and ensure that key IT systems are implemented on time and to budget.
A spokesperson for the Department of Health told IMN it is not anticipated that there will be any substantial costs in 2014 in setting up a supporting structure within the HSE, but failed to specify how much it will cost how much it will cost when it goes out on its own.
Prof Grimson welcomed the formation of the authority to lead the strategy as it will pull different work strands together and fix the current fragmented system. She cites Canada Health Infoway and the National eHealth Transition Authority in Australia as two of the best examples of similar eHealth organisations.
A new detailed IT strategy for the health system as a whole will be published in early 2014 by eHealth Ireland working closely with the SRG, the Department of Health and other relevant departments/organisations. Approval and recruitment for the post of CIO will begin this month along with appointing a Chair and Board for eHealth Ireland. It is hoped to have these appointments in place within three to four months.
Priority projects include: The development of appropriate health informatics skills and/National Health Identifier Infrastructure; ePrescribing Systems; online referrals and scheduling; telehealthcare – particularly relating to the management of chronic diseases; development of patient summary records; online access to health information; and a national patient portal.
Health Identifiers Bill
The Health Identifiers Bill 2013, which was also published, provides the legal basis for unique health identifiers for health service users and also unique identifiers for health service providers. The identifiers will be used across the health service, both public and private. As revealed by IMN, the unique patient identifiers were originally going to be progressed through a Health Information Bill. However, in order to progress the initiative, which has been beset with delays, it was decided to publish a separate piece of legislation to allow for the faster introduction of unique patient identifiers into the health service.
A provision for health identifiers was included in the Health Information Bill and heads of a Health information Bill were approved by Government in 2009. More recently, in the context of a commitment given to the Troika in June to publish legislation giving a statutory basis to health identifiers, it became clear that it would not be possible to have all the provisions of that Bill ready in time to meet the Troika commitment; it was, therefore, decided to fast-track the identifier elements into a separate focussed Bill.
A National Individual Health Identifier Register will now be established containing the identifier and other identifying particulars relating to the individual. These are set out in the Bill. There are two key privacy points here. The first is that an identifier will be a number which in itself will contain no personal data whatsoever. The second is that no clinical information whatsoever may be contained in the register.
Access to the register will be restricted to health service providers and other entities under the Bill. The Bill provides that measures must be put in place to help ensure that the register is accessed only for relevant purposes and by people who are permitted to access it. There are offences and penalties set out in the Bill on inappropriate access.
Health service providers – health professionals, organisations and some employees – will also have a unique identifier. Again, providers will have to use their identifier on their patient records and in relevant communications.
Assigning identifiers and establishing and maintaining the related registers are functions of the Health Minister under the Bill. However, for operational reasons, the Bill allows for the possible delegation of these functions to the HSE.
A spokesperson for the Department told IMN that work is still ongoing on the development of a Health Information Bill, which, it is intended, will address a range of matters that will facilitate information management processes relevant to a modern health system.
Those matters will include provisions for a more streamlined ethics approval process for health research not governed by statutory regulation and EU Law and provisions dealing with data matching programmes and provisions dealing with health information resources (patient registries).
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Autor(en)/Author(s): Paul Mulholland
Quelle/Source: Irish Medical News, 31.01.2014
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