Are health boards virtually sick?


3 Mar 2003

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As the Government champions the push for us all to become e-citizens in an information society, it promises changes to our everyday lives.

Last year it published a New Connections document that detailed how information and communications technologies would transform the way we interact with government services.

As part of this initiative it pledged to deliver a healthcare system that would, amongst other things, pilot e-health projects such as appointments for hospital services, access to laboratory results and exploratory use of digital TV for delivery of health-related services.

In reality, the majority of the health board websites still have a long way to go to live up to these promises. While these sites differ to some degree in what content and services they offer there is a keen sense that the majority of the content is published because they can publish it rather than from a deep conviction that it will be read.

But it’s not all bad. There is good information available on issues such as the MMR (measles, mumps and rubella) three-in-one vaccine on the South Eastern Health Board (SEHB) site (www.sehb.ie) and statistics on waiting lists on the homepage of the Southern Health Board (SHB) site (www.shb.ie) to name a few.

There is also a host of information about services and awards from medical cards to mobility allowances, including good descriptions of the type of awards available and qualifying criteria. But in most cases they seem to stop short of providing real value, such as allowing the user to apply online.

Instead, the user is directed, deep into the site, and told to download a form, complete it by hand and post it. Or worse still, on the Midland Health Board’s (MHB) website (www.mhb.ie) you’re told that it started the process of making the forms available electronically in September 2001 and the next step is to have fully interactive service requests by early 2002 but there are as yet still no forms available.

Much better is the SEHB whose link to the Reach services website takes the user directly to a menu of healthcare forms, available to complete online, including the popular E111 document which provides medical coverage for EU citizens while travelling within EU countries.

Although these forms are not very user friendly they are a step in the right direction.

Though the information found on the Eastern Region Health Board’s (ERHA) website (www.erha.ie) in the health information section is comprehensive and covers issues from antenatal care to meningitis, the site is largely brochureware with little else functionally beyond downloading forms. The site has a clean feel to its design – navigation is easy and intuitive, although there is no mention of complying to the W3 standards of accessibility that is required of all government websites.

Another provider of online health services is the Eastern Health Shared Services (EHSS), which was born out of the need to avoid duplication when the Eastern Health Board was split into three sections. The EHSS site (www.ehss.ie) shares some of the functionality, such as forms, with the ERHA site but offers a recruitment section in addition.

Eoin Darcy, project manager for the EHSS, says that the biggest challenge in the provision of healthcare systems is the “extent of the legacy systems” and moving forward the long-term goal would be “to standardise technology across the health boards”.

Perhaps the biggest service the health boards can provide is to enable better communication and access to services for the healthcare professionals themselves, creating a cost saving that could then be passed on to the end user.

Pat Millar, managing director of Clarion Consulting, has worked with the EHSS to develop its IT strategy and assist its project management. Millar points out that the health board is a unique environment. “The healthcare system is unlike private sector companies because it has a vastly more complex operating environment. There is a huge range of systems – patient administration systems, child health system, theatre systems – and it’s also very distributed so a health board could provide services to a geographically diverse population,” says Millar.

There is evidence that some health boards are moving towards the model of improving internal communication. The SHB is working with the medical community to make laboratory results available to doctors on an extranet, which should cut down the time involved in the still largely paper-based process. The project is currently in its pilot stage and will go live in early March.

The SHB has also used technology to provide extended services to the public. It carried out an ‘Ageing with Confidence’ online conference accessed by over 3,500 people. Ursula O’Sullivan, IT/EU projects manager, explained the objectives: “It was to present the findings of six months’ worth of public meetings that the SHB had conducted. It was a complete success and to paraphrase one conference goer it was the best conference she had ever attended.”

The drive to understand the needs of the user also extends to the ERHA, which is undertaking a survey of clients to try to identify further improvements to its website. Fidelma Browne, communications officer in the ERHA, says that the objective of the survey is to find out from clients “their satisfaction rate with the information currently on the site and to identify ways in which the site could be further developed”.

Similarly, the MHB has a feedback facility prominently displayed on its homepage, inviting users to suggest improvements the board could make to the site.

But it’s clear that health board websites are still largely passive with limited functionality and interaction. There also seems to be a lack of formalised strategy across all the boards when it comes to technology, although this is an issue being addressed by the Health Boards Executive (HeBE).

The executive comprises the chief executive officers of the seven health boards, three area health boards and the ERHA. Established to facilitate joint working between boards, the HeBE is conducting a range of projects including developing messaging standards and a delivery framework that will enable improved communication between primary and secondary care.

There is clearly a long way to go before we are able to live the Government’s dream of finding ‘new ways of interacting that challenge the boundaries of what is traditionally possible’. Firstly, let’s get content and functionality on health board websites that will provide a genuinely useful and interactive service to people.

By Gillian Cope