Information technology has a major role in terms of meeting the objectives of Ireland’s 10- year Health Strategy 2001 Plan. The Plan consists of three pillars: Setting the Scene, Improving the System, and Implementing Change. Explicit IT-related elements are concentrated in the second, on determining ways and means to improve the healthcare system. The Plan was buttressed in 2003 by a National Health Information Strategy, which paid specific attention to issues such as mobile communications, electronic patient records and information sharing, and a secure nationwide health communications infrastructure.
Independent Health Information and Quality
To deliver high-quality services, based on evidence-supported best practice, the Health Information and Quality Authority will be set up as an autonomous, statutory body. It will ensure that healthcare services meet nationally agreed standards (at both clinical and managerial levels) and determine whether best possible outcomes are attained within the resources available. The Authority, which will provide regular reviews and reports, has a sweeping mandate. It will:
Ó Develop health information systems in line with the forthcoming National Health Information Strategy.
The Authority will be provided with top-level responsibility for standards, as well as best-practice and other guidelines - on information access, security and privacy, and patient safety; the latter includes liaison with the proposed Irish Clinical Negligence Claims Agency on risk management. On its part, the government has committed to introduce new legislation to enable attainment of such objectives
Ó Promote and implement structured programmes of quality assurance
Ó Promote education, training and skills development for information staff
Ó Promote and co-ordinate national research and development on e-Health
Ó Develop a national e-library to guide decision-making
Ó Oversee accreditation and development of formal health technology assessment (HTA) programmes. In 2001, a Value for Money Audit revealed that Ireland lacks a coherent structure for carrying out evidence-based HTA, resulting in a slow response to changes in health technology
Ó Ensure effective procurement of health information technology. This will include working closely with the forthcoming Hospitals Accreditation Body.
National Health Information Strategy 2003
Inadequate information was cited by the 2001 Value for Money Audit as a critical weakness which limits prioritisation, planning, evidence-based decision-making, efficient service delivery, and the monitoring and evaluation of healthcare at all levels of the system. In turn, this impacts negatively on healthcare delivery.
The government strongly believes such a challenge can be faced by leveraging global developments in IT and communications technology, which provide the foundations for comprehensive and efficient flows of high-quality shared information. Its Strategy paper is emphatic: «Information plays a central role in supporting strategic goals and in underpinning the principles of the Health Strategy. It must not be seen merely as an add-on.»
One specific goal of the Strategy is to develop and maintain a national health information database inventory. Ireland, like other EU Member States, also plans to synergise IT infrastructure for eGovernment as a critical enabler of e-Health, and increased responsiveness by the healthcare system. Once again, in parallel with developments elsewhere in Europe, there are several initiatives to provide and improve public access to health information, above all via a national health information Portal (which will provide data on health and medical/surgical care as well as the availability of local health services and entitlements).
Modern IT systems can also provide rapid access to clinical and administrative records as well as a range of knowledge to assist with decision-making and evaluation of best practices. On its part, the government intends to pay specific attention to pilots and early-stage implementation projects under way. Ireland’s Healthlink messaging project, for example, provides laboratory results, radiology results, discharge summary, A&E attendance notification, waiting list updates and outpatient appointment information. It is already being used by 6 hospitals and another 14 are preparing to join.
One specific area earmarked for attention consists of mobile communication technologies, especially for new anytime, anywhere specialist e-Health service delivery models. In addition, the government also hopes to use IT for making an «evaluation of the real service impact of investment decisions.»
Phased Introduction of
Patient Records and
The introduction of electronic patient records (EPR) is to be achieved in a phased manner, given that it is a developing technology. The EPR, in turn, offers considerable support for the clinical process and quality of care; their eventual interconnection into an electronic health record (EHR) will provide further benefits.
In Ireland, the government has proposed an extension of the personal public services number (PPSN) (which covers all public services) to e-Health systems.
National Secure Health Communications
The government is aware of the need for a robust and secure communications network for the effective sharing of health information. While individual agencies and organisations have developed networks on a local or regional basis, experts are now considering a government network for healthcare services.
The REACH project is a cross-departmental project set up to deliver specific eGovernment services in Ireland. It is managed by a Board drawn from the Departments of Health, Environment and Local Government, Justice, Social and Family Affairs, Agriculture as well as the Revenue Commission.
REACH’s mission is to develop and operate services collectively known as the Public Services Broker (PSB). In essence, the PSB is based on a Services Oriented Architecture (SOA) approach, with a flexibly- coupled messaging hub based on XML messaging.
One specific area of attention (especially in terms of the vast bandwidth requirements for secure video and imaging transfer in e-Health) is scalability; this is under study by REACH.
Making Good with Investments
The Irish government acknowledges that considerable development of the IT infrastructure will be required to support improvements in the availability and quality of health information as well as the operational delivery of health services.
However, it also admits that healthcare IT funding has fallen short of its counterparts in other industry sectors. It has therefore committed to a “sustained programme of investment in the development of national health information systems,” in line with the National Health Information Strategy.
In summer 2007, the government put hard money behind its healthcare modernisation plans by announcing a half billion Euro investment in e- Health, covering a period of 7 years.
Spending will be focused on patientcare systems, with a particular emphasis on supporting communitybased
health professionals in the areas of chronic disease management, emergency medicine, medication management and health surveillance.
Further investments are planned in e-Health supporting services such as radiology and hospital laboratory systems. Overall, outlays on healthcare in the 2007-2013 period are specified in the pre-vious article.
Key Properties of Healthcare Strategies 2001
Ó Action 48: A national standardised approach to measurement of patient satisfaction will be introduced
Ó Action 49: Best practice models of customer care including a statutory system of complaint handling will be introduced
Ó Action 52: Provision will be made for the participation of the community in decisions about the delivery of health and personal socials services
Ó Action 84: The organisation and management of services will be enhanced to the greatest benefit of patients
Ó Action 85: The operation of outpatient departments will be improved
Ó Action 86: A substantial programme of improvements in accident and emergency departments will be introduced.