All terrain technology

27 Jun 2003

The Southern Health Board (SHB) has in recent years earned itself a reputation for being at the cutting edge of technology for delivering health services. “It’s a case of necessity being the mother of invention,” says Ursula O’Sullivan, the board’s IT and EU projects manager. “When you are dealing with the geographical terrain of Cork and Kerry, it encourages you to be innovative in how you apply technology to support the delivery of services.”

The SHB region covers 47,000sq miles and is home to 564,000 inhabitants. Many of them live in urban areas but a great many live in rural areas in a region that varies from mountainous to rugged. In addition, Cork University Hospital is the National Maritime Evacuation Centre and is responsible for the well-being of mariners in Irish waters.

The health board employs 16,000 people — 6,000 of whom work in the field — and has 250 locations in the region.

Speaking at a recent seminar on mobile applications at the Commission for Communications Regulation, O’Sullivan listed 10 goals of Health eSHB, the board’s ICT (information and communications technology) strategy: integration of patient-based services; new ways of delivering services and information; manage information as an asset; manage creation of knowledge; optimise use of resources; create an effective organisation; achieve an electronic health record; e-enable clinical systems; e-enable administrative systems; and develop an enabling technology architecture.

But the Health eSHB is only one building block in an overall m-health (mobile health) strategy that combines e-government and healthcare. A core element of m-health is a single patient record. “Everything we are doing now is geared towards one single integrated patient record that obviously, because it has to be integrated, has to be electronic,” she says.

Although the SHB moved ahead on its own, O’Sullivan is confident that there will be no compatibility problems. “In relation to people moving around Ireland, the health boards agreed we needed one national health record and it was put out to tender. By coincidence, the people awarded the tender early this year were the same people who built our Patient Information Management System,” she adds.

As for individuals moving from country to country, the SHB has that covered as well. “We are continuously benchmarked by Cap Gemini Ernst & Young on behalf of the European Commission and we have continuously exceeded the minimum requirements that are currently in force. There is an electronic health services entitlement card being introduced in June of next year, replacing the E111 and E128 forms, and all of the datasets for that card are clearly laid out,” explains O’Sullivan.

High-speed communications — mobile and fixed — also play a key role in m-health and in some cases will be necessary. “For some services, broadband will be absolutely essential,” says O’Sullivan. “There is no way you can deliver X-ray diagnostics or X-ray images over a 9.6Kbps [kilobits per second] GSM link. For instance, if a GP goes on a visit to Cape Clear Island, he’s not going to be taking the luxuries of Skibbereen hospital with him.

“Public health nurses making home visits in remote areas also have to do without the luxuries of a fully equipped health centre. But with a suitably equipped wireless device, she can deliver a service just as if she had one. She would have real-time access to the patient’s record and can then see if any new lab results have come in. She can also make appointments online and can see the availability of everybody in the care team.”

Another new initiative is to help children in hospital keep up with their schoolwork. The SHB has installed a broadband connection to 55 schools in the region and hopes to have this up to 100 by the end of the year. Children in hospital can then take part in lessons via a videoconferencing link.

O’Sullivan is constantly thinking of new ways of exploiting the synergies created by mobile technology and the integrated health record. A passing remark by one of the other presenters at the seminar catches her attention. She thinks that Network365’s wallet approach to identity could be exploited by diabetics that have to have their blood tested regularly. Using such a system, they could test their own blood and send the result by SMS to a central server. The wallet could identify them and make sure that the data is entered into the correct record and, if there is an anomaly, the patient can be notified by text message.

But there’s a problem. “I could do that now,” says O’Sullivan. “But we need to get a mobile to fixed-line SMS service. The operators say they have, but you need a specific set of phones and it won’t run into a VPN [virtual private network], because a five-digit number implies premium rate SMS, but the Government VPN runs on five digits.”

Knowing O’Sullivan, she’ll probably come up with a solution.

By David Stewart