“A huge trend for health will be the adoption of IoT,” said Richard Corbridge, CIO of the Health Service Executive.
Christmas 2016 was notable for the bed shortages, overcrowding and delays that clogged the Irish medical system.
The health system in Ireland is regarded as a gigantic money pit that swallows up to €15bn a year, with no let-up for taxpayers.
A bloated paper-based bureaucracy and underinvestment in IT are seen as serious parts of the problem.
Tasked with using technology to cure these problems, Richard Corbridge is at the coalface of driving new services to bring about much-needed change.
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 delivered results.
Richard, it has been a year since we first spoke. Can you give me an overview of the breadth and scope of the technology roll-out across the HSE and what improvements have been made since then?
The change in 2016 has been vast. We have completed the implementation of key infrastructure in a number of areas:
- the delivery of electronic referral into every hospital in Ireland
- the technology to release the Individual Health Identifier in 2017
- the ability to record the sequenced genome in the Electronic Health Record (EHR) for epilepsy
- the first truly digital hospital is now happily delivering ‘digital babies’ in Cork
- a cloud-first policy and process
- the first digital prescriptions have been sent
- the pilot for eDischarge notes is underway
- the process to connect 47,000 healthcare workers to cloud services is now in place
- over 10,000 new devices have been implemented into the healthcare system
All of this has been achieved without impact upon running the services that are live already, and certainly is not an exhaustive list – although it certainly is an exhausting list!
Specifically around eHealth Ireland, how has the strategy of Lighthouse Projects worked out?
The Lighthouse Projects have been successful in very different ways.
The Epilepsy Lighthouse Project gave us an area of focus earlier in the year; the infrastructure to now sequence the genome and also to record this for clinicians to use in the delivery of care is now in place; the ability for a patient to use a portal to view and add to care information will be live in quarter one of next year; and prototyping and testing has gone extremely well.
The Haemophilia Lighthouse Project allowed a clinical design focus to be applied to the development of new technology, which has now gone to market and is about to be awarded.
The Bipolar Disorder Lighthouse Project gave an opportunity to deliver solutions via a hackathon, bringing cutting-edge technology, chatbots and AI to the fore with clinical-centred design – a brilliant outcome here.
How involved are local medtech start-ups in the eHealth/HSE roll-out?
In 2016, eHealth Ireland launched three different initiatives focused on the local medtech and start-up community – all have brought great rewards to what we term the digital fabric of Ireland. eHealth Connect is a monthly meeting in a different county of Ireland, where local SMEs and start-ups with ideas for implementation can pitch these into the strategic programmes team. If there is a fit, an investment of €25,000 can be made by the team to ensure a pilot can take place.
We also worked with the NDRC to run HealthTech in 2016. This pre-accelerator programme took 11 ideas from inception to teams built, and in some cases, solutions being deployed – a great experience for all the team involved.
Finally, there is the QIC (Quality Innovation Corridor): a programme conceived to enable a clinician with a digital answer to a problem to get support to deliver the answer.
‘Achieving goals in my role is about the journey and the story; we need to take huge groups of people on a journey to the implementation of an eHealth digital fabric’
What are the main points of your company’s IT strategy going into 2017?
Key for eHealth Ireland in 2017 will be progress towards the EHR. Whether this is via maternity hospitals and units in Ireland moving quickly in the wake of the success in Cork, or the next stages of the business case approval process, we are in a desperate need to have connected health in Ireland; and perhaps the best way to achieve this is through a digital health record.
The business case has been approved by the HSE and is now with the minister’s office, Department of Health and government officials. The eHealth Ireland function will, in 2017, continue to build towards an EHR, but there will come a time when difficult investment decisions are required for us to continue on the defined path.
We have a patient portal prototype, which as been met with a great deal of enthusiasm. However, a full EHR for the country requires good governance, resources with skill and experience, and a mobility to implement with the healthcare professionals of Ireland perhaps not seen before.
In terms of managing IT budgets, what are your key thoughts on how CIOs/heads of technology should achieve their goals?
Achieving goals in my role is about the journey and the story; we need to take huge groups of people on a journey to the implementation of an eHealth digital fabric. The public, the patients and the clinicians are all major stakeholders of what we are trying to do – this drives the priority of people engagement for us. I believe that storytelling – selling the sizzle and the sausage – are important when it comes to health.
We are one of the few public sector health programmes globally that has met every one of its targets within budget, and to a benefit release plan that is ambitious but releases benefit to all types of stakeholders. The team are proud of this and intend to keep this as a way to attract additional funding decisions next year. Our director general points out to us that success delivers expectation; we have started to heighten the expectation.
‘Digital in health, until recently, was never planned or designed – it evolved as part of the organisational structure’
How complex is the infrastructure, are you taking steps to simplify it?
Excessively complex. Digital in health, until recently, was never planned or designed – it evolved as part of the organisational structure. We have pushed hard to remove the technology from the physical boundaries of Ireland’s health system and with this in itself, we start to remove the complexity significantly.
With new team structures in place, digital can be supported in Ireland in a more effective and clinically led way. We now have a single national helpdesk function for example, and in Q1, will have a single Major Incident and on-call capability in place. The actual technology side will take longer to simplify but that will be one of the significant benefits of moving to cloud. Security and capacity are ‘baked in’ to the solutions we are now adopting at a national level.
Do you have a large in-house IT team, or do you look to strategically outsource where possible?
We have a good mix of both today. Decisions have been taken to build internally and test capability over the next two years. However, we then do have the cloud-first principles for infrastructure elements of what we are here to do, which enables us to concentrate on the in-house areas we are best at.
With the size of team we have – very small – we need to concentrate on doing what is best for the health system internally and look for partnerships externally to give us the most opportunity to deliver, particularly when it comes to innovation and change.
What are the big trends and challenges in your sector, and how do you plan to use IT to address them?
A huge trend for health will be the adoption of IoT [internet of things]. Being able to bring the advantages of sensors and the information they collect directly into EHR-type solutions will be huge. We have seen this in maternity in the last few weeks, with sensors in the hospital being able to pass information on babies directly to clinicians without the 20-minute check-and-record round – this frees up clinical time to be with patients and removes so much reliance on manual recording. We can see this type of technology bringing phenomenal benefit in other areas.
The move to wearables and how that information can be ingested into clinical information is huge – the Bipolar Disorder Lighthouse Project tests this ability for Ireland.
In the future, AI will bring huge benefit. For now, we need to use the super compute power behind AI to help with elements like genome sequencing; however, there will come a time – and in the next single figure years I suggest – that AI will start to really deliver direct and significant rewards to the way in which care is provided.
What metrics or measurement tools do you use to gauge how well IT is performing in the healthcare space?
Key metrics for us are still the traditional break/fix and helpdesk calls, and this, I believe, is wrong. We have moved to a world where we talk about no more IT projects, how we are here to deliver business change and yet, we measure the traditional IT metrics.
In 2017, we will change this and begin to measure our engagement levels, the release of benefits into the system and how we have impacted on the delivery of healthcare. After all, if we are to truly put the patient at the centre of what we are doing, we really should have the improvement we make on patient care as a metric for IT success.
‘We need to constantly evaluate are we doing the right job, not just the job we set out to do’
Are there any areas you’ve identified where IT can improve, and what are they?
What we do should be about constant improvement. The single biggest area for improvement for us to focus on in 2017 is how to make the most of the resources we have. There are 288 people who work in digital in health – that’s a very low number to support the whole healthcare system.
The commitment of the team to deliver successfully is beyond any I have seen in 20 years of working in IT and therefore, I must find ways as a digital leader to help the team achieve the most with such a small resource. We need to constantly evaluate are we doing the right job, not just the job we set out to do.
The delivery of solutions into the health system needs to be as much driven by local innovation as it is by national projects. Finding the right balance for ‘command and control’ is difficult, as some of the best innovations and deliverables will always come from locally identified need. With our Design Authority in place, I believe we have a unique opportunity to get this right.
What other projects do you have lined up for the year ahead, and what will they contribute to the business?
The year ahead has a catalogue of projects in a similar way to 2016 had. We will see:
- the Individual Health Identifier being used in health systems
- e-prescriptions and the removal of legacy hardware from GP practices countrywide
- maternity EHR launched in more hospitals
- a contract for a cancer care EHR awarded
- endoscopy specialist referrals launched
- the national ambulance computer-aided dispatch completed
- the contract for a single cloud vendor put in place
- digital identity for all staff completed
- a national audiology system implemented
- Information Governance CBT [cognitive behavioural therapy] implemented
- the response to the digital waiting list challenge
… all of this in quarter one!
For eHealth Ireland, the intent is to continue to build, to react to changes and to support patient care with what has become our ‘trademark’ phrase: a digital fabric.