The interim CIO of the HSE, Jane Carolan, warns that Ireland is behind international norms and needs to move away from paper to electronic health records.
Prior to becoming interim CIO of the Health Service Executive (HSE), Jane Carolan was national director for Health Business Services, the shared services entity that provides back-office support to the HSE, including procurement, estates, finance and HR shared services.
A member of the HSE Leadership Team, Carolan also previously held the position of head of planning and corporate performance for the HSE, and has a great interest in strategy development and execution.
‘I think, at every single step, there are digital opportunities’
– JANE CAROLAN
A chartered physiotherapist by profession and a graduate of Trinity College Dublin (BSc physio), Carolan also holds an MBA from Smurfit Business School in University College Dublin (UCD), a BA in public management from the Institute of Public Administration, a diploma in corporate governance from UCD, and a BA in Spanish and French from The Open University.
Carolan has more than 20 years’ experience in senior management roles within the health system and stepped into the role of interim CIO of the HSE following the departure of Richard Corbridge to become chief digital and information officer at Leeds Teaching Hospitals NHS Trust.
In the aftermath of Richard Corbridge’s departure, what would you say the biggest legacy of his time as CIO of HSE has been?
Richard was the first CIO of the HSE and he brought a breath of fresh air and a whole pile of energy flowing through the system, which woke everybody up. I personally think, as a peer who was watching Richard from a little bit of a distance, he actually showed us what was possible.
Richard opened a book and showed us what was in that book. We had become quite traditional in the past, and Richard coming to the HSE was at a time when the possibility of digital in healthcare was really gaining momentum. He brought an energy to this place that I would like to continue and grow.
He developed the Knowledge and Information Plan, which is really the plan from which we want to approach everything. He got that plan in place so, for me, it is about implementing that plan.
The plan covers lots of areas, like the building blocks for a digital infrastructure from which we can launch a whole pile of new stuff that is possible.
Data has untapped wealth for understanding our health services better.
What are the priorities the HSE needs to make in terms of tech in the year ahead?
We need to stabilise, because we are kind of swamped with ideas in many ways.
Our whole core infrastructure needs to be made more solid and ready for the 21st-century digital opportunities that are there.
The Electronic Health Record (EHR) is really important to us and, along with the Individual Health Identifier (IHI), these are the two linchpins that we need to get right.
Richard got them ready and they are launching, but there are a few more years of implementing ahead.
The IHI is where the individual patient has an identifier so we can link them through our services and our systems. Without that, digital cannot work properly.
Everyone is familiar with the paper-based health file when you turn up at a hospital, and the problems of losing it, not finding it, pieces going missing – it’s an awkward system to work through.
But that’s not the norm internationally; most hospitals have gotten rid of those at this point and we’ve been slow to go there.
The Maternal and Newborn Clinical Management System – which was started at Cork University Hospital about a year-and-a-half ago after a huge amount of planning – has been a phenomenal success. They got rid of all the paper records and everything is now linked from a digital perspective and it’s so safe. Never mind how easy it is to find, retrieve and use, but getting lab tests and everything going straight into your record is so much safer for the patient.
That’s one thing Richard started and, since he’s left, both Holles Street and – just before Christmas – the Rotunda went live with their digital health records.
That’s exciting and we need to keep moving. We have gotten permission on the national EHR, and the first implementation of that is going to be the new Children’s Hospital, and that’s going to be a huge piece of work for the next few years to try and get that ready.
What is the scale of the problem the HSE faces, and how much of a cure to the problem does IT represent?
I think IT is a huge untapped wealth of possibilities, and it ranges across things, from actually replacing what we do in an automated way right through to doing things totally different. And by totally different, you are talking about things like virtual care, keeping people in their homes and linking up. We see lots of pilots internationally on that and so that’s very possible.
But, if you go right back to the basics, waiting lists are a big issue for us. I talked about the IHI; we have multiple people on multiple waiting lists and so we don’t even know our numbers correctly because lots of people will put themselves on separate waiting lists just to keep their options open. I don’t blame them with the waiting lists being what they are, so we are looking at technology to help us understand our waiting lists better.
The whole data mining area could lead to a much slicker way of doing things. That’s about outpatients, emergency departments – it’s all of that.
It’s really about replacing what we are doing in an automated way, using the data to give us a much better understanding right through to doing things totally differently. I think, at every single step, there are digital opportunities.
What are the big trends you are aware of that could make a difference?
If you look at the Apple Watch, for example, that brings us back to patient empowerment, which is absolutely the way forward. We have a bit to go on that but the idea that you can monitor your own health, link it up and, if we have an EHR, you can have access to that and connect what your device is telling you into your EHR so your doctor will have all the information. There’s a huge amount of empowerment and that’s happening around the world. It’s not science fiction any more.
So, we need to do something in the short, medium and long term to go there. That kind of technology wows me because I’m a physiotherapist. In terms of chronic disease management, there are huge possibilities.
There are lots of start-ups, particularly in Ireland, who are coming up with really good products that can help particularly with patient empowerment where patients work in partnership with healthcare professionals – to me, that is a big possibility.
Going back to basics, everything in a hospital is now technologically enabled. Compared with when I first worked in a hospital 20 years ago, they are such different places now. Every year, something new arrives that connects what a doctor or nurse is doing, making patient care much safer.
We have an open door here. Tech companies are coming here all the time and there’s hardly a day that goes by that I don’t meet a tech company that wants to show me their products.
Genomics is a big one and we support it through our Lighthouse projects, such as an epilepsy programme looking at genomics that has enormous potential to improve and target healthcare in a way we haven’t seen before. And that could save a lot of money by being able to drill right down into what an individual patient’s absolute needs are instead of a broad sweep, which we often do.
There are so many opportunities, but one of our problems is how to prioritise those and start on them.
Under eHealth Ireland, the HSE has been more open to innovation and collaboration with Irish-based start-ups. Will that continue?
Absolutely. It has to continue because this is a partnership. We need them and they need us.
We probably need them more than they need us in many ways because we are a health service. We are not into developing all of the new technologies ourselves; we need the private sector, the start-ups, the big internationals, all of them to come to us with solutions to some of our challenges.
Over the last few years, they have really become partners with us as opposed to people trying to sell us things, and we can jointly solve the problems.
We would be very open to talking about what we see are our challenges – short, medium and long term – posing questions to them etc.
In terms of an open data policy, all of our data is published and available, free to everybody. People internationally have said to me “Are you mad? You could sell that.” But why would we sell it when, actually, it belongs to the people of Ireland? And so, we have put it out there and, whether it is the colleges or the start-ups, we ask them, can they do anything with this data that can help us to help healthcare?
We have big companies and little companies and the colleges looking at our data and coming up with solutions. And that’s about partnership.
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