The Health Service Executive (HSE), Ireland’s public health organization, is playing a game of EHR catch up with other countries.
The health system, which was founded in 2005, cares for the country's population of roughly 4.7 million people. While the system’s scope is large, the HSE is still lacking a digital environment according to Fran Thompson, assistant national director of engagement and delivery at HSE.
If you walk into a clinic or hospital in Ireland and want to find a patient’s chart, chances are you may find paper records, said Thompson. But this creates safety concerns.
“I’ve talked to people from various different areas and have said 'Does anybody think that is safe? Does anybody think that is what we should be doing? Does anybody think that is how we should be looking out for ourselves?'” Thompson said at Enterprise Ireland’s North America Healthcare Forum in Dublin, Ireland in September. “Most of the providers say no.”
Looking to the future
But Ireland is changing the playbook for its public EHR system. In May of 2016, the HSE approved a a Business Case for the technology, which then went on for consideration by the Department of Health.
“While technology solutions are a key component, there will be a primary focus on how clinicians and administrative staff work with this technology in a way that closely aligns with and underpins the ambition for Integrated Care and other national healthcare reform priorities,” the HSE’s webpage reads. “The national EHR program represents a significant transformation in the use of technology and data to underpin effective and efficient care.”
The fact that Ireland is behind other countries in the EHR world isn’t necessarily a bad thing in the long run. It could give the government a chance to learn from others, Thompson said.
“We looked at international experiences and said 'How do we best deploy EHR?'" he said. "We are late and have a fantastic opportunity to catch up and take over from countries that have invested lots of money, and have had lots success and lots of mistakes.”
There certainly have been a lot of hiccups in EHR implementation globally, notably the interoperability problem. For example, although the majority of providers in the UK’s NHS system are using EHRs, there is not one uniformed platform. This makes it difficult for EHRs to talk to each other and for hospitals to share information.
The US has also faced interoperability obstacles with its EHR system. In 2009, President Barack Obama kicked off a program to incentivize providers that went to electronic records. While the adoption rate of EHRs by American providers skyrocketed during this time period — from only 9 percent of hospitals having the systems to 80 percent in 2013 — in the rush to create these systems, hospitals went to different EHR vendors, and those vendors didn't take the time to come to a consensus about storing and sharing data in standardized ways.
Meanwhile, other countries have emerged as front runners in the field. For example, Estonia uses blockchain technology to help give its citizens control over their health records and facilitate proper use of the records by the medical community.
What an EHR means in Ireland
While Ireland will use different countries as models, it will develop its own unique system.
“We look at our EHR. It does mean different things in different countries. So we tried to define, what does it mean in Ireland?” Thompson said.
He said that in Ireland it will be made up of four components: a national shared care record, acute operational systems, community care EHRs, and an integration program.
These components could be supported by four different vendors, or could all be supported by one company.
Thompson noted that showing the financial impact of an EHR is challenging. Using the technology may lead to better patient outcomes; however, that doesn’t always equate to a return on investment. But implementing the system essentially comes down to a patient safety measure.
“Ultimately it [will] deliver better patient safety,” Thompson said. “Today I can guarantee anyone will have multiple health records. And you can’t see them when you see a clinician. You can only see a snap shot. ‘What meds are you on?' 'Oh, the blue, the red, and the green one.’ That’s not safe. Every time you go to hospital two things happen — you don’t bring your meds so we dump them, then we start again because we don’t know what you are on. So we need to have access right across the system.”
Dublin’s new children’s hospital, which is currently under development, will be the first to deploy the technology. Meanwhile, Thompson and his team will be looking at incrementally implementing the systems in older hospitals.
Thompson said that beyond EHRs, the HSE is looking to further its digital health efforts, employing the help of startups.
“We are working with Enterprise Ireland to do an SBIR [small business innovation research] challenge. We don’t have the answers,” he said. “There are lots of people developing really good technology — not expensive, but that will really help people.”
It’s not uncommon for governments to turn to the private sector to help tackle some of its hairiest problems — for example, the US Health and Human Services department put together a code-a-thon to address the opioid crisis. Moreover, the health and technology sector is growing in Ireland, Thompson said, and the government is pooling its efforts towards growing both its indigenous and multinational healthcare efforts.
“The government is very supportive of medtech research for both multinational and indigenous companies, which is vital to creating innovative solutions using the most revolutionary technology,” Heather Humphreys, minister of business, enterprise and innovation for the Irish government, said at the conference. “The way the ecosystem in Ireland is structured means that Irish companies are at the cutting edge of medtech advances globally, and it is easy to access key innovators in specialized areas across industry and academia.”
The HSE has used private companies in the past to solve problems — for example, the service has been working with a startup that makes digital temperature gauges for diabetic patients at risk of amputation. These kinds of partnerships have the potential to save the HSE a significant amount of money and also improve patient outcomes.
“How do we, working with Enterprise Ireland, come up with challenges that we can [bring] to market,” Thompson said. “We can say 'Alright, help us cure some of the issues we know are there.' We can come up with the problem. We’ve got lots of them.”