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Health system

Would it work here: Could Ireland bring in a national electronic healthcare record for everyone?

Electronic healthcare records are already in place in several European countries.

IRELAND’S USE OF information technology for healthcare is patchy: in some areas it’s excellent, whereas in others there are information gaps and significant fragmentation. 

The introduction of a national electronic healthcare record (EHR) containing digitally-stored medical information on patients, accessible to treating clinicians, could radically change this, however.

EHRs are established in several European countries. Around 99% of GPs in the Netherlands use EHRs for patients, for example.   

A similarly high rate exists in the United Kingdom and many countries have successfully used EHRs for over a decade now.

Indeed, it is widely accepted that electronic records will form part of all effective digital healthcare systems in the future, as good quality information provide better overall patient care, thereby reducing treatment and medication errors, to name but one advantage.

But how best to implement such a system is a matter many countries, including Ireland, are grappling with. 

The lack of joined-up records is a problem: the Health Information and Quality Authority (HIQA) has advised that within the Irish healthcare system “information can be lost, documentation is poor, and there is over-reliance on memory”. 

“Those responsible for planning our services experience great difficulty in bringing together information in order to make informed decisions,” HIQA says. “Variability in practice leads to variability in outcomes and cost of care.”

So, where does Ireland stand on developing national electronic health records right now?  

According to Dr Conor O’Shea, a Drogheda-based GP and the national coordinator of  a group that encourages the use of digital tools among GPs, if a European league table were to exist, Ireland would be “somewhere in the middle”.  

There’s a big difference between GPs and hospitals: electronic patient records are maintained by the majority of GPs through sophisticated practice management systems. 

In stark contrast, in many hospitals paper records exist in abundance.  

According to Dr O’Shea, Ireland is introducing a ‘satellite’ EHR system containing several parts. 

A central ‘hub’ will contain a shared electronic healthcare record and a summary care record.  

The former will include “information such as test results, referrals [and] hospital discharge”. The summary care record would be “a slimmer version of the shared record”.  

Surrounding this central hub will be several separate but connected satellites, including digital information from general practice, pharmacy, community and hospital systems.  

An individual health identifier or specific number for each patient will be used to ensure the right record is linked to the correct person. This has been legislated for under the 2014 Health Identifiers Act. 

The above system of smaller electronic records, connected by “interoperability”, is different to what is planned in Northern Ireland, according to Dr O’Shea, where one single “monolithic” system has been proposed.   

“In the North [Northern Ireland] they have recently signed a contract to completely transform what they’re doing and have one single EHR that does everything in the six counties. But that will be a few years of conversion to get there.” 

What is available in Ireland at present? 

There is already a lot of electronically-held information in Ireland. For example, GPs receive laboratory and X-ray results electronically. Some hospitals provide electronic patient discharge reports. 

What is lacking is a central repository, according to Dr O’Shea, the absence of which is particularly acute when a person requires emergency care and is treated by a healthcare professional unfamiliar with a patient’s medical history. 

“If you go to the emergency department tonight, because there is no central record pulling all various sources of information together, the doctor may not have the full information about you.”

Some hospitals and areas of the healthcare system have been planning their own switchover to digital for some time. 

In 2018, St James’s Hospital in Dublin launched an electronic patient record system and the new National Children’s Hospital, when it opens in 2024, will be fully digital.  

By the end of 2023 six of the country’s 19 maternity units will use an electronic record system known as the Maternal and Newborn Clinical Management System (MN-CMS)) for all women and babies being cared for in maternity, newborn and gynaecology services.

This development will mean that 70% of babies born in Ireland will have electronic records by the end of next year.  

The National Rehabilitation Hospital and National Forensics Hospital have also introduced electronic patient records.  

Community services are also digitising. “A community digital oversight team at the HSE are developing plans for an electronic patient record system for non-acute care,” a Department of Health spokesman said.   

According to Dr O’Shea, this system will be rolled out in HSE community care sites and used by public health nurses, occupational therapists and speech and language therapists, among other community care specialists.   

Pandemic and cyber attack impact 

The pandemic, perversely, in the area of e-health did “more good than harm”, Dr O’Shea believes.  

“Because there was a need for healthcare to be delivered in different ways we lent more on electronic and digital health to assist us in delivery care during the pandemic.

“One of the great improvements was the ability to transfer prescriptions electronically to pharmacies. Work was done to allow vaccine information to be sent electronically to the Department… and we would like to see that continue to include all vaccinations.”

But the cyber attack on HSE systems in May 2021 caused delays in many e-health projects, according to a Department of Health spokesman.

“The HSE now has enhanced cyber security monitoring, surveillance and containment systems in place which will be a benefit to eHealth in the longer term,” said the spokesman, adding that these systems are short-term and further investment would be required.

The attack illustrated that if EHRs are to be successfully introduced with security and privacy matters fully addressed, significant future investment in this area is critical. 

Timeline and costs  

According to a spokesman for the Department of Health, overall costs “vary depending on the system being deployed”.  

The 2022 National Service Plan allocated €333 million for ICT and ehealth. Some €130 million is for ICT capital and a further €203 million is for “recurring current expenditure”. The allocation for EHR projects specifically in 2022 is almost €15 million.  

Dr O’Shea welcomed the fact that ICT budgets have increased in recent years. Yet it is clear that greater funding must be provided if a national EHR system is to be realised. It could yet be another decade before this occurs.  

According to a Department of Health spokeswoman, based on experience from other countries and due to the “complexities associated with deploying EHRs, it is likely this programme will continue for over 10 years”. 

This work is also co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work are the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here

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