“A hospital is a unique and challenging environment, especially from an ICT perspective given the scale and breadth of services the hospital provides but also what is required to support that service provision,” said David Wall, director of ICT at Tallaght Hospital.
David Wall took on the role of director of ICT for Tallaght Hospital last year. Prior to that, he was the head of ICT and information governance lead at Temple Street University Hospital.
A graduate of University of South Wales, Trinity College Dublin (TCD) and University College Dublin, Wall oversaw the implementation of ICT solutions for the two children’s hospital groups at Tallaght and Connolly Hospitals.
Tallaght Hospital is one of Ireland’s largest acute teaching hospitals, providing child, adult, psychiatric and age-related healthcare on one site. The hospital has 495 adult beds and 67 paediatric beds with 2,600 people on staff. The hospital is a provider of local, regional and national specialities. It is also a national urology centre, the second-largest provider of dialysis services in the country and a regional orthopaedic trauma centre.
Tallaght Hospital is one of two main teaching hospitals of TCD, specialising in the training and professional development of staff in areas such as nursing, health and social care, emergency medicine and surgery, amongst many others. It is part of the Dublin Midlands Hospital Group which serves a population of over 1.2m across seven counties.
A new satellite centre is to be built at Tallaght Hospital as part of the National Children’s Hospital project. This will be a key element of an integrated clinical network for paediatric services nationally.
The hospital’s emergency departments catered for 44,640 adult attendances and 31,934 paediatric attendances in 2014. A further 263,929 patients were treated through the hospital’s outpatient clinics in 2014. The hospital’s operations are supported by a community of 200 general practitioners in surrounding communities.
What is the breadth and scope of the technology roll-out across your organisation?
A hospital is a unique and challenging environment, especially from an ICT perspective given the scale and breadth of services the hospital provides but also what is required to support that service provision.
The hospital has implemented a number of innovative ICT-enabled solutions: from self-service check-in kiosks for those attending as outpatients, online booking of blood tests and online bill payment to the most recent telemedicine solution known within the hospital as Lucy. Lucy allows for remote ward rounds and assessing patients in the acute medical assessment unit. By using this technology, the efficiency of the unit has increased and makes specialists available around the clock as they can see and speak with the patient from their mobile device via the screen when time is of the essence.
The recent deployment of a hospital-wide Wi-Fi network has allowed the hospital not only to provide a mobile access for hospital staff and a public Wi-Fi service for patients and visitors, but is also being used to track cardiology patients via mobile telemetry. This particular initiative will improve patient care and bed utilisation within the hospital.
What are the main points of Tallaght Hospital’s IT strategy?
Currently, the hospital doesn’t have an IT strategy. As I am only in the job a little over a year, the focus has been on reviewing the existing ICT set-up.
The hospital is planning to undertake the development of an e-health strategy that will be supported by an ICT roadmap. The e-health strategy will be key to deciding how ICT and support and enable patient care and hospital services over the next three to five years.
In terms of managing budgets, what are your key thoughts on how heads of technology should achieve their goals?
Managing budgets in the health service is always a challenge as hospitals are funded on an annual basis so it makes multi-year planning difficult. That said, CIOs need to engage and build relationships with fellow C-level executives and, in particular, the business owners and sponsors.
A CIO will need to ensure a sufficient revenue budget to ensure the ‘lights are kept on’ – ongoing ICT infrastructure investment and staff development as well as a capital investment programme in new innovations and solutions. I have always found that partnering with clinicians and fellow executives to clearly demonstrate the proposed benefits to patient care has had positive results.
How complex is the infrastructure?
Extremely complex. The hospital campus is approximately 30 acres in size and we are constantly developing new services and expanding our physical footprint. So much so that the hospital is expanding with an off-campus employee resource centre and plans to move some clinical specialities into the wider Tallaght community, requiring links back to the hospital.
Supporting these developments is one of the key objectives for ICT. There is also the planned construction of one of the urgent care centres as part of the new children’s hospital to be considered.
The hospital has an ageing ICT infrastructure, however, with the assistance of the office of the CIO at the HSE, it is undertaking a major ICT infrastructure investment programme over the next three years to improve the resilience of these services. This will include an upgrade of the hospital’s network, implementation of a new back-up solution which will provide the platform for improved disaster recovery.
Rationalisation of our server farm will be achieved by virtualisation. We are keen to reduce the desktop overhead further with the roll-out of virtual desktop technology along with single sign-on to reduce log-on time and improve user experience. Given the hospital provides services on a 24/7/365 basis, downtime is not an option, so the challenge is ensuring the minimum disruption to patients and staff.
Do you have a large in-house IT team, or do you look to strategically outsource where possible?
There are approximately 26 staff in the ICT department across four teams: ICT service desk, ICT infrastructure services, health analytics, and innovation and project delivery.
We are not an IT support company but do need to retain governance of and responsibility for the ICT service we provide. With that in mind, we work with our support partners and vendors to allow us to focus on the strategic elements of ICT, while ensuring the transactional ICT function runs as it should. The innovation and project delivery team works with our partners in identifying and delivering ICT-enabled solutions to support the business.
What are some of the main responsibilities of your own role?
In my role, I have responsibility for ICT, information governance, medical records and telephony. From an ICT perspective, the goal is the 70-30 split (70pc strategic and 30pc operational).
Given I am only a year into the role in Tallaght Hospital (but not new to health informatics), my first year has been focused on reviewing the current ICT service and putting in place a platform for future growth and ICT service delivery. With that done, the majority of my focus will be on how ICT can add value to the hospital and support the delivery of patient care and services.
What are the big trends and challenges in your sector?
Like many healthcare organisations, Tallaght Hospital is reliant on paper medical records and is drowning in paper. The national e-health strategy has already identified the need for an electronic patient record. The cost of producing, moving and retaining this growing mountain of paper is significant, not to mention the time clinical staff spend wading through it. ICT can provide a solution to this and transitioning to an electronic patient record and becoming a paper-light hospital is a priority.
Our population is living longer and chronic disease in on the increase. Predicting how this will affect the hospital is critical as is the planning for future services. So, moving from operational reporting to predictive analytics and applying business intelligence will be one our focus areas.
We are now in the era of the digital patient. People are used to using online services for air travel and shopping, so why not healthcare? The hospital has already implemented electronic referrals for GPs, sends patient results back to GP via Healthlink, and provides online booking for blood tests. However, we need to take it to the next level and not only interact with our service users online but make it easier for them to access the services they need.
Telehealth and home monitoring is another trend. People would much rather recuperate at home and not be in a hospital in the first place, which is better for their wellbeing. It is also more cost effective. Being able to monitor patients from their home with the assurance that, if they need to contact the hospital, we’re there; or, if their condition deteriorates, we not only know about it but are already reacting. Expanding the use of telehealth and home monitoring will be central to our e-health strategy.
When a patient leaves Tallaght Hospital they may move to a step-down facility or require follow-up care in the community. However, that healthcare staff may not always have knowledge of the care they received while in the hospital. This can lead to delays. We have to improve how we share information with our healthcare partners in the wider community. Part of the national e-health programme is looking to address this.
As CIOs and the health informatics professionals in general, we need to take a more innovative approach to how we do business. Moving ICT to the role of value-add partner as opposed to someone who keeps the lights on. While this is important, ICT has much more to offer and can support and enable business transformation in healthcare.
What metrics or measurement tools do you use?
None at the moment. We’re currently discussing what metrics to introduce.
Whatever we do introduce has to be meaningful to the business and not just to ICT. 99pc server up-time might sound great to ICT but means very little to our clinical staff. ICT are here to support them and their service and our metrics will need to reflect that.
Are there any areas you have identified where IT can improve?
Cybersecurity and ransomware attacks are on the increase. Talking to colleagues, several have suffered from attacks over the last year. In America, particularly, hospitals and healthcare organisations have had to pay to get files unlocked. So health informatics needs to focus on what it is good at and partner with expert companies that can ensure our environment is secure and protected.
As hospitals become more reliant on ICT for the delivery of service business continuity, disaster recovery is an area for improvement. Investment in this area needs to improve as to ensure services are maintained on a 24/7/365 basis.
What other projects do you have lined up for the year?
Improving our service-user experience and engaging with our digital patients will be key focus areas. The hospital is planning to introduce a patient engagement app for our patients, visitors and service users which will provide information on the hospital and the services we offer, improve way-finding but also allow users to provide feedback. In time, it is hoped to provide condition-specific information to our long-term patients and allow them to interact with the hospital via the app.
The hospital is actively participating in the national e-health programme. Two programmes of note are Bloodtrack and Medlis. Bloodtrack lets clinical staff using mobile devices at the bedside for tracking and issuing of blood transfusions. Medlis (the national lab system) will see a single national lab system introduced in Ireland for all hospitals. A feature of Medlis will see clinical staff using mobile devices to support patient care.