Healthcare, in any country of the world, is a labyrinth of services and interactions that present an enormous challenge to ICT companies offering the promise of greater efficiency through sophisticated computer management systems.
“The Irish healthcare system is quite complex and multi-layered,” said Peter Henshaw, press officer at the Department of Health and Children. “At one level there are general practitioners, community nurses, social workers and community hospitals, then you have regional hospitals and tertiary referral centres that specialise in particular illnesses.
“Within these layers there is a complicated level of interaction. If you pick someone with an illness they would interact with a lot of different healthcare professionals, including doctors, nurses, physiotherapists, speech therapists, social worker, community welfare people and so on. It gets slightly more complex when you consider that some services are available privately.”
He continued: “For instance, I could go to my GP tomorrow on a private basis as do 60pc of the population. I might then be referred to hospital on a public basis if I don’t have VHI coverage for that same illness. So that’s the backdrop. To put IT systems into that and to make it work effectively is a complex issue.”
According to Henshaw, one UK expert has calculated that the UK’s National Health Service has the potential to generate 200 million transactions or messages per week. “If our population is 10pc of that of UK, we can assume that our healthcare system has the potential to generate 20 million messages per week.”
He agreed that the health service has not stretched out information technology to the general public to the same degree as other sectors, such as banking. However, he pointed out that the service is reasonably well computerised for administrative tasks such as payroll, financial systems and medical cards. Also at a basic patient administration level, most GPs have at least one PC in their practice.
“We haven’t, however, got much in the way of electronic health records,” he said. “That’s an area we are trying to move into.”
Although Henshaw stressed that Ireland is not really behind the rest of the world, a recent EU benchmarking exercise (June 2002) placed Ireland ninth when it came to the number of medical practices with internet access. Only 57pc were wired for the web compared to 97pc in Sweden and the UK.
Before the end of the year the Government will publish its National Health Information Strategy, a report that is expected to highlight the contribution that information and communications technology (ICT) can make to the quality of patient care and satisfaction in Ireland.
It will be followed by an ICT strategy document that will provide a more detailed action plan for the way ahead.
The exchange of information across all levels of the health service is considered a priority enabling doctors, public health nurses and other health professionals both inside and outside hospitals to sing from the same hymn sheet.
According to Dr Tom Jones, vice-president and chief medical officer of Oracle Corporation, a keynote speaker at recent conference in Dublin on the topic of electronic health records, the sector is ripe for reaping the benefits of the electronic age.
“The genesis of the electronic health record happened about eight to 10 years ago,” Jones said. “It had to do with the notion that the paper record was perfect as long as there was only one doctor and one patient. But as medicine became more complicated and people moved around more, the idea that the patient would see only one doctor for life disappeared.
“As patient care became entrusted more and more to teams, the paper record became impossible because it often wasn’t available. That meant the clinician treating the patient at a particular time could miss critical pieces of information and this led to all sorts of horror stories in the press,” he continued.
This has ramifications on well-worn misconceptions of the medical profession. “As medicine becomes more complicated it is impossible to hold on to the conceit that one doctor knows everything,” said Jones. “The doctor will need to access things he or she might not remember or never have known at all, so the idea of artificial medical intelligence came into being. This wasn’t possible with paper records. The only way of handling this was to create a virtual, logical representation of the patient.”
A third factor, according to Dr Jones, was the changing relationship between the medical profession and the citizen. The notion of the patient as a passive receiver of medical care is being replaced by the concept of the patient as an active participant in the healthcare system. This raises questions of who owns the patient data and who can access it.
There are several high profile projects already under way, in addition to the National Health Information Strategy. Among them is the PPARS (Payroll Personnel and Rostering System). Headquartered in Sligo, the PPARS was conceived when the health boards came together to replace the old separate personnel systems with a new centralised one, explained Damien McCallion of the North Western Health Board.
“There are some 80,000 people working in the health service in Ireland,” he said, “and just under 70pc of our total budget deals with people costs. It was felt that a whole strategic approach to managing people would have to be taken. And modernisation of human resources would require a system that would allow the service to move forward.”
Such a system, he said, would cover basic things such as tracking absenteeism while removing some of the paper processes from the system rather than adding to them.
“If you imagine a hospital with complex hours, rosters and so on, it generates a lot of paper,” McCallion explained. “One of the key aspects of minimising paper is to capture information close to the source and feed it through scheduling, patient caseloads, payment, absenteeism so that people on the front line are not buried in the administrative process needed to support payroll and management.”
According to McCallion, five health boards originally defined the requirements by looking not only at their own needs but also at what was going on in the private sector. Once the requirements had been defined, the health boards went through the process of choosing a vendor and selected SAP as being the most suitable product.
During the implementation of the first phase, much of the work focused on development of common processes and standards. All of the participating boards worked collectively. Relevant personnel were seconded to the projects head office in Sligo, as McCallion put it, to minimise duplication and maximise expertise.
The second phase, which is currently in the tender process to select a consultant, will focus on payroll, time management and employee self service, where employees will be able to look at their payslips online via an intranet. This phase is scheduled to go online over the next two to five years.