HSE needs more Government support to roll-out national EHR

The slow and difficult process in implementing the HSE’s e-health agenda recently made the headlines with the resignation of Director of Digital Transformation and Open Innovation Mr Martin Curley. Speaking to RTÉ’s Drivetime following his resignation, Mr Curley said the HSE was not fit-for-purpose and was extremely resistant to change.

The challenges in reforming the health service’s outdated IT infrastructure were the subject of a joint Oireachtas committee on health meeting on 25 January. Much of the debate focused on the failure to establish a national electronic healthcare record (EHR).

In response to questions from delegates, the HSE Chief Information Officer Mr Fran Thompson explained how the HSE submitted a business case for an EHR to the Department of Public Expenditure and Reform (DPER) and the Department of Health, as part of the 2015 e-health strategy.

However, in 2018, DPER rejected the submission.

Mr Thompson said DPER “wanted to see the outcomes and benefits from the investments” made in the New Children’s Hospital prior to making such a national investment.

He added it was his understanding that the rejection was not only due to funding, but also doubts about the overall capacity to deliver the project.

“Within e-health, we had a very small team starting off,” he pointed out.

In his opening statement, Mr Thompson said that the rejection meant the HSE had to work on “multiple tactical solutions” to digitise and deliver on the e-health 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,” according to Mr Thompson.

Currently, 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 the maternity hospitals also have an EHR. 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 University Hospital Limerick. 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. The implementation of this EHR is underway and on track to be delivered in tandem with the opening of the main hospital. In addition, the HSE is deploying an EHR into the new facilities at the National Forensic Hospital and the National Rehabilitation Hospital.

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 approval. 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. Existing electronic record data can populate the portal and if the national EHR is approved, it will populate the portal as well.

While Mr Curley’s comments about the HSE’s resistance to change are likely not far from the truth, the Executive needs more support than the Government has provided to date if a national EHR is ever going to become a reality.