The man tasked with healing Ireland’s broken healthcare system from a digital perspective is Richard Corbridge, an accomplished innovator who has streamlined systems at the NHS and who was ranked among the top 100 CIOs in the UK. As CIO of the Health Service Executive (HSE), can he transform healthcare in Ireland for the better?
If you don’t have to experience the anguish of suffering chronic delays and inefficiencies in the Irish healthcare system as a patient or relative of a sick person, there is also the anguish from a taxpayer’s perspective of the gigantic money pit it has become, swallowing up to €15bn a year without any sign of improvement.
The heart of the problem isn’t just capacity and availability of beds, doctors or nurses, it is organisation and the bloated paper-based bureaucracy that Ireland’s network of hospitals and clinics has become through under-investment in IT.
All that may be about to change if a young and industrious new CIO called Richard Corbridge has his way in terms of initiatives like creating a new Electronic Healthcare Record (EHR) for every citizen of Ireland, the introduction of electronic referrals by GPs directly to hospitals and pioneering new IT initiatives to map genome sequencing that could save the lives of up to 100 Irish-born children every year.
‘This isn’t a technology project. One of my biggest lessons learned from working anywhere in health technology is that if you turn it into a technology project it will not succeed. This is about clinical engagement and patient-leading projects’
– RICHARD CORBRIDGE, HSE
Corbridge is seen as a rising star on the CIO landscape and is leading the digital transformation of the Health Service Executive (HSE), Ireland’s equivalent to the UK’s NHS. He is also the CEO of eHealth Ireland, a vehicle established to accelerate innovation created in the process of transforming the HSE.
Prior to joining the HSE in December 2014, he was CIO of the NHS’s National Institute for Health Research Clinical Research Network where he garnered a reputation for implementing bold new strategies that yielded sterling results.
Last week, Corbridge announced a public consultation to get the public’s feedback on the EHR, especially from a data privacy perspective. This is significant because other countries trying to introduce similar systems didn’t engage with the public.
In the latest budget for the HSE, out today (16 December), it is estimated that €720m of next year’s funding will be needed to maintain existing services, while there is a provision of €100m for the development of new services.
Ireland could catch up with the NHS by 2020
Corbridge explained that the Individual Health Identifier (IHI)– a unique number assigned to individuals using health and social care services in Ireland – is the first step on a journey to making information flow much easier across all the services.
“The IHI went live as a proof-of-concept in the second week of September. All that means is we have tested the fact that we can uniquely identify every person in Ireland and we can share that into systems as they come online.”
In the first quarter of 2016, Corbridge said that the plan is to build this into an industrial-scale system that can work with different platforms. The trial will involve 35 GPs and the LauraLynn Children’s Hospice in Dublin.
“That means those systems can start to share information about patients and uniquely identify those patients.
“The IHI is a building block to identify who you are and where you live, the next stage is the Electronic Health Record itself and in December we went live with the public consultation to ask people how they would like to see an electronic record handled, how they would like to see consent handled, what are the privacy issues and how do they want their health information to be looked after.”
Corbridge said that as CEO of eHealth Ireland the idea is to take innovations created during the transformation of the health system and turn them into technology-enabled solutions.
“EHealth Ireland is a new function and it is not clear what we are going to make yet. That gives us a brilliant opportunity as clinicians, as patients and as technologists to come together and work out what a digital fabric for health delivery in Ireland looks like.”
He said the plan is to create an ecosystem that will encourage start-ups, for example, to connect with the health system to trial products and gain insights.
One of the earliest innovations to emerge from eHealth Ireland is HealthLink, which enables GPs to do electronic referrals directly to hospitals while the patient is in the doctor’s surgery.
“We envisage this will be a solution that connects every GP to every hospital in Ireland. By Christmas, 50pc of hospitals in Ireland will be able to accept electronic referrals,” claimed Corbridge. “The next time you are at your GP as a patient, ask for your referral to be done electronically and you will find that before you leave the GP’s practice your referral will have landed in the hospital.
“The confidence this brings you as a patient, hopefully, is huge, because you know your appointment is being looked after by the hospital and is no longer sitting in the post box in an envelope. It is in the hospital for people to deal with.”
‘Ireland could skip two of those cycles because it can learn from the lessons and mistakes of the UK and other countries and get to the point that by 2020 we have caught up with what the NHS delivers’
– RICHARD CORBRIDGE, HSE
If Corbridge has his way, the digital transformation of the HSE will bring Ireland’s healthcare infrastructure up to par with that of the UK’s NHS by 2020.
He said that often the time difference between technology and innovation in healthcare is 15 years. “If you break that into three five-year cycles, Ireland could skip two of those cycles because it can learn from the lessons and mistakes of the UK and other countries and get to the point that by 2020 we have caught up with what the NHS delivers.
“That will be a phenomenal place for the healthcare system to be in: where we can talk about real information digitally available to clinicians and to patients.”
Having been aware of IT projects in the past that have been costly failures, not only because of the technology but often because of executives in the HSE’s unwillingness to change or have their personal fiefdoms disrupted, I ask Corbridge a pointed question: What is harder to change, people or processes?
“This isn’t a technology project,” he said. “One of my biggest lessons learned from working anywhere in health technology is that if you turn it into a technology project it will not succeed. This is about clinical engagement and patient-leading projects.
“I am the CIO of the HSE and yet I stand up and say I don’t want to have IT projects.
“Projects should be clinically led. We have just finished the clinical evaluation of the maternity and newborn system, which goes live in the first three hospitals next year. This was clinically-led and the result was that trainee nurses in Cork stopped me in the hospital and said they can’t wait for the system. It does what the clinician needs it to do to support their work.
“It is not like IT has just unwrapped a box and left it on a desk. It is the clinicians themselves who have made it look and feel like the clinical journey.”
In this time of Apple Watches featuring medical applications, not to mention the Google-backed 23andMe biotech company focused on genomics, I ask Corbridge how innovation aimed at unblocking bureaucratic bottlenecks will keep pace with the breakneck speed of medical development.
“It is huge. Technology has moved so far so quickly. Personalised healthcare is a huge topic and how do we actually make sure that the clinical journey is centred around you, the patient, through the information and the systems that are there.
“The internet of things could deliver so much more into the patient’s home, keeping patients out of hospital and allowing us to look in and see what’s happening.”
One of three LightHouse innovation projects for 2016 is the creation of the epilepsy EHR, which will allow patients to update their record straight from their smartphone.
“For a healthcare system that hasn’t really done technology, imagine an epilepsy patient being able to write to their clinician from their mobile phone and add to their record whatever happened that day.
“Perhaps the most exciting piece that we are planning to look at next year is the genomic sequencing of a thousand under-fives to understand the type of epilepsy they have.
“The only way to treat epilepsy of an under-five is to just keep trying the different treatments until you land on the right one.
“But if you sequence the genome and spot the deformed gene you can actually then target the right treatment straight away.”
Not only could this save €5m per year on drugs, but it could save the lives of children.
“It will save 90 lives every year and that for me is hugely exciting, being able to take that piece of technology – not just IT but technology generally – and apply it to a real healthcare system in Ireland and make a difference in one year.”
If Corbridge is right and his vision of catching the HSE up with its UK counterpart NHS by 2020 in technology terms comes to fruition, then we will all be the better for it.