A new report from Deloitte considers how Ireland can deliver on e-health, with six prescriptions for success.
The Irish health system needs treatment. Though improved ICT is not going to cure all that ails the HSE, it is a core part of its latest strategy led by CIO Richard Corbridge.
Comparatively, Ireland’s health system challenges are not unique. Years of lagging investment in infrastructure now has to reconcile with upcoming population growth and certain increases in healthcare demand.
In particular, if you take Ireland’s population aged over 65 and divide that by those aged 15 to 64, you get what is known as an old-age dependency ratio. In 2011, this was at 17pc, but the Central Statistics Office forecasts that this will rise to at least 28pc in 2031.
According to the HSE, more than 60pc of over-65s in Ireland report having chronic illnesses. Thus, an ageing population will inevitably bring on a rise in chronic disease and greater challenges for healthcare.
How can health digitisation help?
An ambitious plan to reform Ireland’s health service is underway. Part of this is the HSE’s Knowledge and Information Plan, which outlines the measures needed to deliver a robust e-health ecosystem.
The digitisation of healthcare promises efficiency and broader access to information for patients and practitioners, as well as new practices such as e-prescriptions, e-referrals and tele-healthcare services.
By putting new technology to work, remote care and treatment is enabled, which means those at home dealing day-to-day with chronic illnesses may not have to continuously attend clinics and hospitals for treatment.
This is just one example of improvement in a particular case, but it gets to the core of what this digital transformation aims to achieve overall. That is, putting the patient at the centre of healthcare delivery, with an emphasis on preventative care and efficient, equitable access to services along with a devolution of services to primary care facilities.
It’s the modern view of healthcare espoused by design-led thinkers such as Lorna Ross at Mayo Clinic, and many developed countries before Ireland have already put this kind of strategy to work.
By many counts, Ireland is behind on healthcare. But there is an opportunity in this vantage point, in being able to see the challenges that befell those that have gone ahead and how they tackled them, successfully or unsuccessfully.
Follow the leaders
“There are clear advantages to playing catch-up,” said Shane Mohan, a consulting partner at Deloitte who leads the company’s public sector industry group.
“There is an opportunity to deploy matured technology, such as cloud-based services and analytics. In doing so, Ireland should be able to catch up with, or even leapfrog, countries who started to go digital at an earlier stage.”
However, Mohan also warned that Ireland should look carefully before we leapfrog and take on board the lessons learned by others.
“These lessons related not only to technology adoption but also to wider lessons around managing change,” he said. “Whilst our health systems differ considerably, there are numerous universal lessons that can be applied. The advantage these learnings offer cannot be underestimated.”
‘Ireland should be able to catch up with, or even leapfrog, countries who started to go digital at an earlier stage’
– SHANE MOHAN
To that end, Deloitte released a report titled Ireland’s eHealth Transformation: Prescriptions for Success, with recommendations for health digitisation under six key points. This advice stems from the consultancy’s experience in e-health implementation globally, and in particular in the US, the UK and Australia.
The six broad priorities identified by Deloitte for a successful e-health strategy are:
- Treat e-health as a business project, not an IT project
- Manage expectations on going paperless
- Provide easy access to information to support clinical decisions
- Leverage the cloud
- Integrate analytics and reporting up front
- Provide for patient data mobility
Paper-light, not paperless
Each of these recommendations is ambitious even taken alone. For example, take point number two: a teardown of expectations that digitisation equates to a paper-free environment. Creating a paperless healthcare environment is not only challenging and costly, it’s also impractical. According to Deloitte, few hospitals have achieved ‘paperless’ status, citing less than 5pc in the US.
‘According to Deloitte, few hospitals have achieved ‘paperless’ status, citing less than 5pc in the US’
In practice, paper is often the tool of choice for clinicians and so, tools to allow for digitisation is preferred. There may also be patients who opt out of the proposed Electronic Health Record (EHR) for privacy reasons, and wish for their data to be recorded manually.
And that’s just looking at future record-keeping in healthcare. There are also vast amounts of paper records already filed away, and digitising this entire data set is no small feat.
Deloitte suggests that the Irish health system aims for the more achievable goal of a ‘paper-light’ hospital environment at the outset of digitisation.
“Leverage the cloud” reads like a simple enough recommendation. Going digital through cloud services is a cost-efficient and expedient route. But this is tricky in the case of healthcare due to security and privacy considerations.
On the one hand, cloud service providers can afford to invest in security infrastructure that would not typically be cost-effective for a single organisation. On the other, the hospital is ultimately responsible for this data and its security. Thus, Deloitte recommends both a risk-based and defence-in-depth approach to securing healthcare data in cloud environments.
Currently, Ireland’s only regulations around health data privacy are evolving with the Health Information and Patient Safety Bill, while the EU’s new General Data Protection Regulation (GDPR) will come into effect in 2018.
Due to this regulatory ambiguity, Deloitte advises that healthcare operators opt for a hybrid cloud model, storing and processing sensitive data on a private cloud. Thankfully, due to Ireland’s suitability as a data centre location, there are plentiful options available for this set-up.
The last priority on the list is perhaps the greatest challenge. If clinicians want easy access to data, this translates to secure multi-platform access to information across multiple healthcare facilities – even, in some cases, via a personal mobile device. That is a mountainous IT challenge to overcome.
The proposed EHR will begin this climb towards enhanced mobility, but true mobile accessibility will require access to core hospital systems and information sources; storage and display of data in structured and standardised formats; ready access to appropriate devices at the point of care; and user-centric mobile applications – not to mention end-to-end adherence to security policies and standards.
This is, without doubt, a huge undertaking that has proved challenging across a myriad of industries and sectors dealing in projects less critical than the management of a nation’s health.
Among Deloitte’s recommendations toward reaching this god-like achievement is to build mobile device support into the information system from the ground up and not as an afterthought, as well as sufficient focus on data privacy and security of the system.
Pay to play
Irish hospitals are operating at near capacity and it’s apparent that the current health system is not fit enough to keep up with the challenges to come.
According to eHealth Ireland, the HSE body responsible for the IT of the healthcare system, just 0.85pc of Ireland’s healthcare budget is spent on IT, versus an EU average of 2 to 3pc.
“Our public health expenditure has now been restored to pre-crisis levels. One area that continues to suffer from a significant shortage in investment, however, is healthcare IT,” said Mohan.
The HSE’s digitisation plans started when the eHealth Ireland Strategy was published in late 2013, and the evolving Knowledge and Information Plan incorporates advice from the UK, Scotland, Wales, Northern Ireland, the US, Australia and Spain.
Deloitte’s recommendation of incorporating ‘lessons learned’ is evident in this claim, but without significant investment, the effort of this ambitious strategy will not pay off.