Mr. Muiris O'Connor:

Deputy Durkan asked a range of interesting and pertinent questions. In regard to where Ireland stands in the international context in terms of e-health and the use of health information, as alluded most EU countries are quite a bit ahead of Ireland in terms of their investments in information technology and how co-ordinated those investments have been. The UK and Denmark have been cited in this regard. Belgium also has a very sophisticated system. The Scandinavian countries more generally operate population registers, which are so comprehensive they do not need to undertake census of population, as we do every five years. The population registers provide information on citizens' basic characteristics and their interactions with all kinds of State services. The richness and comprehensiveness of the evidence base available to other health systems is considerably superior to ours. I am confident that we can catch up on other countries.

We have a very focused ambition to do so. Basic but fundamental building blocks such as the individual health identifier are critical differentiators that other countries have had ahead of us. The UK has an NHS number which is like a bank account number and allows service providers to recognise individuals. The health information we get includes an enormous amount of metrics generated from service provision. The individual health identifier will allow us to anchor all that noise against a frame of reference that looks at the impact of all of this service provision on the health and well-being of people in Ireland. That is a critical move.

In terms of capacity, I have mentioned the more concerted investments in ICT leadership through the establishment of the CIO's office in the HSE and of my own division in the Department as well as through HIQA and other bodies. There was sanctioned in 2016 to expand by an extra 49 people to build capability into that. This is to move from a situation of fragmented localised investments in often disconnected technologies to national programmes of investment. There is an electronic health record business case with the Department from the HSE that looks at a multi-annual plan to ensure the development of a comprehensive electronic health record for all citizens based on investments in acute and primary. That shared view for people with a legitimate professional relationship with a citizen for his or her health or social care is critical to better integrated care and the greater integration between primary and secondary care that has been in each programme for Government for the last number of Governments. We are getting there. We are making big progress and I am confident that we can catch up with other countries.

It is similarly the case in health research. We have some very strong performers in health research in the medical and academic worlds in Ireland but some of the provisions in section 3 will allow us to move into research of greater scale and significance in terms of analysing the impacts of various health and social care interventions on population health outcomes and utilising anonymised data to look at scale. A great deal of energy goes into doing sample surveys at a small level and that generally does not get us to the global standard we need to get to. The provisions in section 3 and the streamlined research ethics committees will, we hope, facilitate greater research projects of scale where Irish medics and academics can collaborate domestically and internationally to improve things.

Patient rights and their awareness of data protection are things we seriously prioritise as can be seen from the provisions of the HIPS Bill. We prioritise the rights of patients to privacy and to have their data used in appropriate ways only and are very aware that further reflection and, potentially, further legislation will be required as we move to the implementation of electronic health records. One of the main things that is found in other countries is that even with a great deal of consultation, patients can have little awareness of what happens to their data and of the value of their consent to have data used for health or research. The CIO in the HSE will develop over the immediate months ahead an approach to public engagement and devising a more practical consultation strategy. In that regard, a number of hypothetical personas are being devised. It might be an elderly lady of 75 with certain conditions or it might be a middle-aged person or a young person. These hypothetical personas are being developed with hypothetical electronic health records so that issues around privacy can be discussed in a much more practical way. These things are often deliberated in very abstract terms that do not mean a whole lot to the citizen. We want citizens to know about their privacy rights and to know, in particular, about the value that attaches to them and the public more generally when data can be used appropriately for health research and understanding the outcomes of clinical interventions.

We were asked about patient safety and Dr. MacLellan will speak more on its enhancement.