Digital healthcare is the buzzword for 2024. What does it mean for sick people in Ireland?
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The switch from relying on paper to using digital devices or records is like waiting for the motorway from Cork to Dublin to be built some time ago, according to the HSE’s Dr Colm Henry.
“It was only ever as good as its slowest bits. People always said ‘this is a great patch of road but I still have to drive through Fermoy’, he said.
He quickly added: “No slur meant to the town of Fermoy, but that you went through it very slowly, and we [the HSE] haven’t built the entire motorway yet.
“That’s where we are at the moment, there’s great patches of road where you go very fast and then you slow down rapidly, to go through.”
A HSE Telehealth Roadmap 2024-2027 was recently announced, with plans for incremental change.
Most patients are interested to hear about electronic health records, with their health information visible to doctors in one place — so goodbye to retelling your symptoms to every new face at the clinic.
The switch is not just about this, however.
Use of tele-medicine and video appointments exploded during the pandemic. In some areas, a patient can sit with their GP and have a video consult from hospital doctors at the same time.
GPs and pharmacists are already sharing e-prescriptions online.
Virtual wards are now being seen as part of solutions to overcrowding, a HSE conference on the roadmap heard recently.
These are being trialled next year at University Hospital Limerick and Dublin — patients can be discharged home from hospital but stay connected to doctors through digital devices.
The challenge is joining these projects into a national system so patients in Dublin, Donegal, or Dingle get the same access.
Ireland was recently criticised by the OECD for our low ability to share or link health data, marked as worst of 22 countries even as they highlighted barriers in many other countries also.
For now, access to digital records depends on where you live and what kind of patient you are.
Pregnant women at Cork University Maternity Hospital were the first to benefit from this system because the hospital was a pilot site for a national programme.
Professor Richard Greene, an obstetrician in Cork, and now also HSE chief clinical information officer, said it went live in 2016 and the switch made care safer.
“We have allergy alerts so if I try and give a medication to a patient, and if they have an allergy documented, it will tell me there’s an allergy there,” he said.
It was expected all 19 maternity units would follow suit, but so far only three more have.
One is CUMH’s sister unit at University Hospital Kerry.
Prof Greene said this has made sharing care for women who are transferred between the two sites much easier.
He points to the 2021 cyberattack on the HSE as one reason for delays to national rollouts, saying the maternity digital system was now hosted remotely in the cloud, which is safer.
“It’s on a very stable footing now, and we can now begin to roll again,” he said.
University Maternity Hospital Limerick is next in line for the switch.
Funding appears to have also been an obstacle.
HSE chief information officer Fran Thompson revealed in January that back in 2018 they applied to the Department of Public Expenditure for national digital funding.
They were declined as officials wanted to first see how digital records function at the new children’s hospital.
The patchwork nature of what, by necessity, followed that decision is at the base of OECD criticisms.
Tracey Wall, clinical transformation lead with Children's Health Ireland said the new children’s hospital was designed as a paper-less site.
“We’ve got a patient portal, called MyChart,” she said.
“Parents and patients can actually access their own chart, and be able to see what medications they’re on.”
Parents can check appointment dates or see who is on their child’s team.
She is hopeful the digital environment would help with recruitment too.
“When you have an appointment with the child, it’s exactly what you do now — you write in the chart, except the chart is digital,” she said. “We’re really looking forward to that.”
Monitors and other medical equipment will also feed into the records when the hospital opens.
Tallaght University Hospital decided not to wait for the national programme but went ahead, using a mix of internal and HSE funding.
Chief information officer David Wall took up his role about eight years ago and said patients were seeing differences now.
The first step was deciding how to deal with their existing IT systems.
The choice, he said, was between “rip and replace for a single solution, or make the best of what we have.” They went for the latter approach.
The practical steps included training for staff and installing good wifi.
“They love the fact they have all the information all in one place,” he said of the system, called Synergy.
It offers staff access to test results and medication, and is seen as particularly useful for patients with serious conditions attending doctors from different units.
Ultimately, they hope GPs can access this and it can be integrated into a national system.
They are planning a patient portal, which could allow patients book appointments, he said.
This change has happened in stages across different parts of the hospital.
“There are some areas where it is actually quicker to document on paper, so there will be a small amount of paper left,” Mr Wall said.
They plan to be 80% to 90% digital when the switch is complete.
He said reassuringly the hospital came through the 2021 cyberattack with “minimal impact”, as its system is stored in the cloud and was protected.
They do simulated phishing attacks occasionally to keep staff on their toes, just in case.
Across the city, patients at the Mater Hospital can get faster scan results thanks to use of artificial intelligence AI.
This year, more than 700 pathologies were correctly flagged within two to three minutes of a scan, 500 intracranial haemorrhages and 200 pulmonary emboli identified.
Some patients will, however, have reservations around digital change, and Prof Greene said it was important to remember this.
People may not have a smartphone as became clear during the pandemic, when digital barriers became a real issue for some communities.
Health literacy or privacy concerns have also to be taken into account, he said, stressing patient consent would be vital to any data-sharing as the HSE moves forward.