Most patients who attend outpatient clinics or emergency departments across Ireland will be familiar with cumbersome hospital records that are an integral part of their hospital experience.
They contain everything from patient address labels attached to each new test result, drug prescription or X-ray to handwritten notes that medical staff add to share patient progress with colleagues.
At a time when most of our personal information is digitized, it seems extraordinary that so many of our health records are still on paper. Yes, GPs have electronic health records (EHRs) for their patients, but the problem is that this treasure trove of information about current complaints, past medications and diagnoses cannot currently be shared with hospital IT systems. often obsolete.
Ireland is the fourth latest country in Europe to adopt the widespread introduction of electronic health records (EHRs) for patients, according to Professor Martin Curley, professor of innovation at Maynooth University, who has been appointed Head of Digital Transformation and Innovation at the Health Service Executive. in 2019.
Some say the pandemic has slowed progress in introducing electronic health records in this country, while others say bureaucratic inertia within the Irish healthcare system is the main reason for the delay.
HSE plans to introduce digitized patient records dating back to 2010, if not earlier. The business case for EHRs was approved by HSE management in 2016, but their eHealth website has no new information for the past four years. The European Digital Innovation Framework aims to have EHRs in 90% of European cities by 2030.
“There was a huge missed opportunity when everyone got their Covid vaccine to have an individual health ID which could then have been populated with data from GP visits and in two to three years we would know the Ireland’s health,” says Charles Larkin, research director at the Institute for Policy Research at the University of Bath and former adviser to Dr Michael Harty, retired Clare TD and co-author of the original Sláintecare report.
Individual Health ID legislation was introduced in 2014 but has yet to be developed. Harnessing Digital, the new Digital Ireland Framework, launched in February 2022, pays little attention to the EHR, but the so-called Electronic National Patient Summary was listed by the Sláintecare Implementation Plan in 2018 as a crucial element of Ireland’s national eHealth policy and a key area for the modernization of the health and social care system in Ireland.
“E-health is a key element of Sláintecare. Dr. Harty used to say that digital health was the magic dust that would make Sláintecare work. It would help us manage our health services better than we do now,” Larkin says.
The two main advantages of EHRs are that patients would not have to share their personal health information over and over again when they visit the hospital – and, most importantly, digitized health records would mean that chronic illnesses, medication records, etc., would be instantly available. to ambulance personnel in the event of a health emergency. The other benefit is that a public health system could be better planned with a more complete understanding of the disease burden across the country.
Not only has the Covid-19 vaccination rollout been reasonably successful on a digital platform, but new fast-track legislation that allowed doctors to securely send patient prescriptions to pharmacies via ePrescribing simplified prescribing practices and prevented errors due to handwritten scripts. So why haven’t examples like these given the healthcare system more impetus to introduce EHRs now?
Some experts say privacy and data security remain strong concerns among patients, especially after the May 2021 cyberattacks. Yet a survey by the Health Information Quality Authority (Hiqa) in September 2021 found that 86% of people would like all healthcare professionals involved in their care to have access to their digital records. And 99% of respondents said a hospital doctor should be able to access their medical information electronically without their permission when they are unconscious. Ninety percent said they trust their GP to keep their information safe and to only share relevant information.
“People will always have concerns about security and privacy and it will be an ongoing long-term process. Cybersecurity must be absolute sacrosanct. Challenges [to introducing shared patient digital records] are more about interoperability so that different IT systems can communicate with each other through a middle layer,” says Dr Donal Bailey, director of critical innovation at Centrix Health, which runs 60 GP practices across Ireland.
All patients at St James’s Hospital Dublin, Tallaght Hospital, Dún Laoghaire National Rehabilitation Hospital and maternity patients at University Hospital Cork, Rotunda Hospital and the Kerry University Hospital have electronic health records. But according to Professor Curley, 85% of Irish hospital records remain on paper.
His response was to set up the Irish Digital Health Leadership Group (IDHLG) with a number of other health and IT experts. “This coalition of 60 experts from public and private practice, academia and patients has been put together to shape the future of healthcare in Ireland. It’s too big to be left to the HSE and the Department of Health,’ says Professor Curley
He believes that by introducing EHRs to patients who visit their local pharmacy for a quick health assessment, 90% of the population could have a personal digital health record within two years at the same cost as a PCR test for each person.
“We want to take the leap [over the obstacles] and rather than putting the EHR in every acute hospital, we want to put one in every person’s hand. Each person could receive the results of this rapid health assessment on their device within 24 hours with digital treatment advice to help them improve their health,” says Curley.
The reason for this bottom-up approach is that pharmacies are an easy access point and once individuals’ EHRs have been set up they can then be linked to their records at their GP and ultimately linked future hospital records.
The IDHLG is currently testing the introduction of this approach, in partnership with the Centrix Health GP network and practice software provider Clanwilliam GP. “General practitioners can easily connect to it via their practice software. They will be able to import patient records, test results and patient prescriptions. We are currently testing it in the departments of Letterkenny and Portlaoise hospitals,” says Curley.
The Patients Know Best app, founded by Mohammad Al-Ubakdli and currently used across the UK, is the one currently being tested in Ireland. “GPs, consultants and social care providers capture the information, which is legally held by the patient. We encrypt it. There’s no advertising, no selling of data, just storage,” says Al-Ubakdli, who set up the social enterprise Patients Know Best in the UK in 2008.
Dr. Bailey acknowledges that a nationwide introduction of electronic health records would require a massive health and technology literacy campaign. “The biggest gains will be for people who are already managing a chronic health condition, rather than someone who needs an antibiotic for a sinus infection,” says Dr. Bailey.
It is estimated that chronic rather than acute diseases will account for 70% of the global burden of disease in 2030.
Professor Curley suggests the next step is to carry out larger trials with 500 patients by September and then with 10,000 patients by the end of 2022/early 2023 before going to the HSE and the Department of Health with recommendations and l business case for its introduction. He thinks these EHRs could be linked to fitness and wellness devices and HSE apps for patients to transform the Irish approach to healthcare from a ‘sickness system to a well-being system’. be “.
He says that while his approach to introducing EHRs to patients in this way is not yet an HSE policy or strategy, “the Hippocratic oaths have been misinterpreted and rather than doing no harm, they do nothing. There is risk avoidance, reliance on external consultants and lack of accountability for delivery. The IDHLG takes responsibility for achieving this.