Mr. Fran Thompson:

Thank you. I wish the Chairman and members good morning. I thank the committee for the invitation to meet to discuss electronic health records, EHRs. I am joined by my colleagues Mr. Michael Redmond, chief operating officer e-health, and Dr. Brendan Murphy, consultant paediatrician and neonatologist previously in Cork University Hospital, now in University Hospital Waterford.

The HSE e-health vision is that e-health provides connected and complete digital patient records across all patient pathways and care settings. Implementing technology and e-health solutions and accelerating the digitisation of our health service are key enablers of delivering integrated care which will support the culture of continuous improvement and innovation. It will allow for increased access, sharing and analysis of information across the health service. Technology will provide predictive health delivery, identifying where services are needed most and supporting person-centred healthcare. Our technology and e-health solutions must be radically overhauled to provide the solutions required in a modern health service. Today, our health service is being held back by inefficient and often paper-based patient interactions, with the patient’s presence required due to a lack of tools, rather than patient need. While a patient’s presence is critical in a healthcare setting in some cases, it is not required in all settings. We need e-health platforms to allow information-sharing across care teams - with patient and service user consent - regardless of location or setting. This will optimise the efficiency of our healthcare staff while improving the experience of patients by delivering safe, integrated and high-quality care. By delivering these e-health platforms, we will be able to leverage appropriate innovative and emerging technologies that will enable a greater proportion of care to be delivered within community settings and allow patients to access care closer to home.

Insights are limited without good electronic information. Data and information are integral parts of the healthcare system and are essential supports for the delivery of high-quality and effective health and social care. People expect their healthcare information to be available to them and those responsible for helping them when and where they need it. At the same time, we want to assure them that their personal information is being handled appropriately, safely and securely in an approved and controlled way. Our current system lacks access to timely, accurate and robust data, which is essential for informing decision-making and assessing resource utilisation across operational, clinical and strategic departments. In 2018 and 2019, the HSE sought approval for procurement of a national electronic health record programme. This work included an electronic health record for acute and community services and provided a portal for patients to access their data. Approval was deferred in 2019 until a review of the outcomes of the Children's Health Ireland electronic health record was completed, which was approved. As a result of this decision, the HSE had to deliver multiple tactical solutions to digitise and deliver on the eHealth agenda. The reality however is that no matter how many point systems are delivered, from a holistic clinical and patient perspective, this approach will always be sub-optimal.

Concerning current solutions, there is a range of successfully-delivered digital solutions which fundamentally change service delivery at the front line. Examples include the national integrated medical imaging system, NIMIS, one of the largest in the world, which has fully digitised our radiology services, reduces waiting times for reports and ensures that services are provided in a safe and efficient manner. Another example is BloodTrack, a clinical bedside transfusion verification and transfusion software solution that electronically verifies that the right blood is being transfused to the right patient at the bedside. The national renal system facilitates clinical management of all patients with kidney diseases from first presentation to the renal centre and through to dialysis. The community audiology system is a community audiology solution which supports clinical teams delivering an audiology service. InterRAI assessment supports assessment of needs for care and social support. These are just a few examples.

While delivery and roll-out of these solutions have delivered significant value, the reality is that these solutions are tactical. Investments in e-health in the past were historically very low compared with other countries, which manifested in the inability to keep up with technology changes and limited our ability to deploy new solutions. Since 2020, that investment has increased considerably, with a 100% growth in staffing with an additional 400 ICT professionals and a 48% increase in capital expenditure, combined with a 230% growth in revenue expenditure. Rectifying the historical underspend will take several years, even with additional resources, but real progress is being made.

An electronic health record is a digital version of a patient’s paper chart. EHRs are real-time, patient-centred records that make information available instantly and securely to the authorised user. The benefits of an integrated EHR are well documented internationally and include the following examples. I will not go through all of them but I will highlight some of the main points. The benefits include a comprehensive view of patient records, which provides a dynamic, patient-centred record to enable clinicians to track patients over the continuum of care. Another benefit is seamless care pathways, as with digital records, clinicians can more easily co-ordinate and track patient care across practices and facilities. There may be a reduction in medical errors as digital records allow for better tracking and more standardised documentation of patient interactions, which has the potential to improve patient safety and reduce medical errors. Workflows are streamlined because EHRs increase the productivity and efficiency of clinicians while cutting down on paperwork. Patients and staff have fewer forms to fill out, leaving clinicians with more time to see patients. Data can be used to inform health strategy, as continuous data collection allows for greater personalisation of care, permitting providers to address health issues in a preventive manner. Big data analytics and aggregated patient data may alert providers of larger health trends such as potential outbreaks and which flu strains are predominant during flu season. There is greater efficiency and cost savings because digital records and integrated communication methods can significantly cut administrative overheads, including reducing the need for transcriptions and physical chart storage, as well as facilitating care co-ordination and reducing the time it takes for hard copy communication among clinicians, laboratories and pharmacies. An electric healthcare record is a key requirement for the efficient enablement of integrated care. It provides us with a North Star, or an ultimate destination for the digital transformation of our health service. Existing strategic investments and individual point solutions must be integrated into an electronic health record.

Today there are several examples of modern EHRs within the health service. St. James's hospital has an EHR for all its patients and four of our maternity hospitals also have an EHR. Cork University Maternity hospital, the maternity unit in Kerry University Hospital, the Rotunda Hospital and the National Maternity Hospital all share a common solution. Dr. Murphy has really good clinical experience in this area which he can share during this session. The board of the HSE has sanctioned the expansion of the newborn and maternal EHR to the Coombe Women's and Infants' University Hospital and to the maternity unit in Limerick University Hospital. This will start in 2023 and is scheduled to be completed in 2024.

The new children’s hospital has completed a procurement for an EHR for the hospital. The implementation of this solution is under way and on track to be delivered in tandem with the opening of the main hospital. In addition, we are deploying an EHR into the new facilities at the national forensic hospital and the national rehabilitation hospital. As well as the core system, each EHR implementation requires substantial associated people and ICT infrastructure investment to complement and maximise the core EHR investment. Deploying EHRs is challenging, complex and costly but the benefits are substantial. These are not one-off investments. They require continued sustained investment over their lifetime to ensure that they provide ongoing clinical and administrative benefits to both patients and clinicians.

A key principle for EHRs is that the data belongs to the patients. They own their data and they must have access to their record. They must be able to view the data and in an ideal world contribute to the record with data they generate, for example, through home blood pressure monitors. Part of the original national EHR proposal, which was not approved, was to deploy a patient-clinical portal. The HSE is in the process of updating a business case and has been in discussions with the Department of Health to ensure the success of the business case approval and overall project. The proposed portal will utilise the data from the existing HSE systems to populate the portal. Patients will have access to view their records and clinicians will have access to the portal to support them in their work. Patient-clinical portals are deployed in many European countries with considerable success. Existing electronic record data can populate the portal and if the national EHR is approved, it will populate the portal as well. The portal can bring together any clinical data into one location for viewing. As with all e-health solutions, the key principle will be data privacy by design.

Innovation takes place at many levels within the HSE - locally, regionally and nationally. The definition of innovation which is used is "the practical implementation of ideas that result in the introduction of new goods or services or improvement in offering goods or services". There are many examples of innovation within the HSE, within teams, within individual clinical and non-clinical locations, within wider regions and nationally. Innovation is a team effort. Clinical e-health innovation starts with an idea and then utilises the skills of existing staff, working together, to bring this to completion. The proposed solution must be clinically safe, it must integrate with existing processes and it must share and receive data with other parts of the health care system. It must be funded, sustainable and must comply with existing laws on procurement and data protection. Having an idea is just the start of the process. Turning that idea into a successful pilot and then scaling the idea in a sustainable way is essential. For clinical innovations, e-health works in partnership with the chief clinical information officer who is part of the chief clinical officers team.

There are many brilliant examples of clinical innovations across the wider HSE and, in particular, within e-health. Video-enabled care, for example, utilises collaboration tools to enable the patient to be seen virtually, where clinically safe. Over 360,000 remote consultations have taken place in the past two years. E-prescribing enables GPs to safely send prescriptions via the HSE's HealthMail service to nominated pharmacies, thus reducing transcription errors and allowing for repeat prescriptions to be sought virtually. Remote respiratory rate monitoring, is live in 22 hospitals over 40 wards. More than 2,000 healthcare professionals have been trained in its use. On average, two patients per ward are monitored remotely, with admission on diagnosis of COPD, pneumonia, asthma and so on. These and many other innovations were undertaken in partnership with the clinical community. They integrate with our existing solutions and are scalable across the whole organisation. That concludes my opening statement.