Critical condition for Irish healthcare?

2 Jul 2007

Technology in healthcare is a touchy subject since the PPARS scandal, but some IT projects in the primary care and hospital sectors have potentially wide-ranging benefits for patients.

The dust has barely settled on a closely fought election campaign in which health was either a core issue or a peripheral one, depending on your political sympathies.

Promises of more hospital beds often went hand in hand with assertions that taxpayers’ money wouldn’t go to waste — a thinly veiled reference to failed health sector projects such as Personnel, Payroll and Related Systems (PPARS).

Could that explain why ICT got precious little airtime in the debates? Maybe politicians thought voters might find it too complicated to understand how smarter use of new technology could actually help speed up hospital waiting times and make the health service function more efficiently.

It was arguably an opportunity missed.

Behind the scare headlines, ICT can and does play a role in delivering better healthcare. Some projects have a national reach, whereas others are taking place in small pockets of the health service. What links many of them — and this is just a snapshot — is a drive to remove or reduce paper from the workings of healthcare.

But this isn’t just about making life easier for administrators. There are massive potential benefits for patients such as faster and more informed decision-making by doctors as well as more accurate dispensing of medicines by chemists.

Ireland’s population stands at 4.2 million and it’s estimated that over the next 20-30 years, at least 40pc of that population will be more than 50 years of age. In addition, 20pc of the population currently have a chronic disease. This places even greater demands on the health service — a point acknowledged by Damien McCallion, head of the ICT directorate at the Health Service Executive (HSE).

At a presentation earlier this year to the Institute of Business Analysis and Consulting, he related the issues involved in large-scale change through ICT. As in business, the ‘single view of the customer’ is the aim. “In health we struggle with that — to have information at the point of care, most importantly, the right information about the right patient,” McCallion admitted. Prompted by recent events, the HSE has actively researched successful and failed projects in healthcare at home and abroad to see what it can learn.

For example, the radiology department at St Vincent’s University Hospital in Dublin uses no film or paper in its records. “There are lots of good examples but many are islands and the challenge is to try to make it a more universal system,” said McCallion.

Digital X-ray, or PACS [Picture Archiving and Communications System], is currently in approximately 10 of the country’s 51 hospitals and the benefits are not just the costs saved by reducing film use, but also improved service to patients. “We’re putting together a business case to roll that out to the entire country over the next three years,” said McCallion. Another IT-enabled project is remote consultation, which would remove the need for elderly or infirm people to travel great distances to see specialists.

Since PPARS, building confidence is needed to attract funding. Examples like those above, allied to strong project governance, should mean that technology can be perceived as bringing benefits. “While PPARS was negative, hopefully the positive side is it can be used to highlight the need for ICT,” he said.

One big issue facing the hospital sector is preventable patient mis-identification. According to statistics from the Institute for Haemovigilance in Ireland, around 5pc of patient wristbands in circulation are either incorrectly labelled or missing altogether. The same study found preventable patient mis-identification was a key factor in 43pc of hospital phlebotomy (vein opening) errors.

Barcode patient identification wristbands promise improved patient care and much higher safety levels, or the ‘five rights’ as they’re known — right patient, right medication, right dose, right time and right method of administration. The problem with handwritten wristbands is that they can be misread, easily damaged or even lost.

Previously, nurses had to handwrite all patient wristbands using information from the patient’s medical history, which another doctor would have written by hand. Portiuncula Hospital, a public teaching hospital in Galway, is one of eight hospitals automating their patient identification process with barcodes to cope with issues such as keeping track of blood samples, drug supplies and patient information.

Accurate information is the key benefit, according to Barry Long, sales manager with Zetes, a technology provider working with the hospitals on the project. “It identifies the caregiver, identifies the correct medication or action and identifies the patient, and it’s done in an auditable fashion.”

In addition, using barcode patient wristbands would allow hospitals to comply with the EU Blood Directive, new legislation designed to ensure traceability of all blood products at every stage from donor to transfusion lab to patient. “Positive patient identification is a requirement. The only way you can comply with that is through an electronic identifier,” says Long.

The 2D datamatrix barcode used at Portiuncula contains the patient’s name, date of birth, sex and hospital number. All wards have label printers for issuing wristbands and the total IT investment is not large, Long says. He echoes McCallion’s sentiments about relatively small-scale technology projects being used as an example for others.

Backing all of this is a wireless infrastructure, which means the data goes on to the system in real time rather than in a batch process at the end of a day. By eliminating the manual process, the hospital saves time for medical staff, allowing them to focus on other aspects of their jobs. “We need to get them to see the patient care improvements by doing this. For nurses, it’s not extra work,” says Long.

“Blood tracking is a door opener for us. If we can prove it, we can really show that mobile computing has a place in Irish hospitals and can benefit the HSE. Wireless networking will give the means to do other things and remove paperwork at the bedside,” he adds. The technology doesn’t have to be restricted to areas such as blood allocation or medication — it could have applications in hospital administration such as cleaning wards or delivering meals to patients.

Turning to primary care, one of the most far-reaching health projects is the result of a merger between two software companies. Medicom and Systems Solutions came together earlier this year, combining the leading technology providers to general practitioners (GPs) and pharmacies respectively.

Now the company, renamed Helix Health, is piloting an electronic prescription system that could significantly reduce errors in administering medication to the public.

To put this in context, Prime Time investigated this issue in 2003 and found a significant level of preventable medication error in the Irish health system. Most starkly of all, it found up to 2,000 preventable deaths due to the wrong medicine being prescribed.

With the proposed technology, doctors wouldn’t need to upgrade their existing IT system. They would simply add a piece of software developed by Helix Health that sits between the patient management system and the printer and adds a 2D barcode to the printout.

“We’ve managed to develop a middle ground for electronic prescriptions using paper as the carrier,” explains Howard Beggs, chief executive of Helix Health. “The huge benefit is that it speeds up the patient journey and, more importantly, it eliminates any transcription error; it will only dispense exactly what was prescribed. It adds a huge layer of patient safety to the process,” he maintains.

Instead of the usual wait for the prescription to be filled, pharmacists can use the time saved to advise the patient in more detail.

Since the merger, Helix Health manages almost 60pc of the computerised primary care centres and 70pc of community pharmacies. It has also formed a strategic alliance with another IT provider, Health Ireland Partners, giving the project a reach into around 90pc of Irish GPs using computers. A pilot scheme for this initiative will be established at the end of this month, involving six pharmacies and six medical centres, with a review in August.

The project also offers potential benefits to taxpayers. Every year around €2bn of the HSE’s budget is allocated towards drug reimbursement. This operates by giving refunds to pharmacies based on the medicines dispensed. Beggs believes a more accurate system that details what was prescribed and dispensed holds the potential for “multimillion euro saving”.

Another possible application would be to make this data available through the web, so that it would be possible to see how many asthma inhalers were prescribed during the summer in a particular area.

Beggs dubs this project “” and says it could look something like Google Maps and be searchable by one of 30,000 drug types. No patient data would need to be revealed, he emphasises.

“It’s completely anonymous and you don’t go down to individual town levels, only electoral regions.” Such a project is possible because data relating to 88pc of the medicines being prescribed throughout the country is currently sent in real time to a central server called MedNET. “The infrastructure already exists,” says Beggs. “A project of this scale will need buy-in from stakeholders at all levels.”

Retaining paper in the system avoids the need for legislation to be changed to recognise electronic prescriptions. “The prescription can still be signed by the doctor in ink and the full paper-based audit trail is there,” Beggs says. “To get to the ultimate holy grail of paperless prescriptions, we’re years away, but we don’t have to wait that long for a lot of the benefits.”

Case study: Is this Ireland’s first paperless hospital?

Nestled between the Liffey valley and the N4 in west Dublin is the Hermitage Medical Clinic, a €120m 101-bed hospital providing medical, surgical and advanced radiotherapy care.

The facility is one of several privately funded hospitals that recently opened in Ireland and it offers full cardiological and clinical laboratory services.

The Hermitage management team has set the goal of making the hospital’s operation entirely paperless, investing more than €4.2m in IT.

From the moment a patient arrives, an electronic record is created, stored centrally and made available in real time to medical and administrative staff throughout the hospital, from the patient’s bedside to operating theatres.

“With this system, the information pretty much can’t get lost,” says CEO Eamonn Fitzgerald. “The information is available in real time so decisions can be made in real time as opposed to calling the record up from the archives. You’re bringing all the information to the point of care, to the caregiver and the recipient.”

The information is secure at all times. “Nobody can access this information without authority and the appropriate passwords,” says Fitzgerald.

Patients also get to take advantage of the technology. Each hospital bed comes with a €3,500 flat-screen PC on an extendable arm, which has a TV, phone, radio and wireless internet access. Patients activate the PC using a swipe card.

Doctors and nurses have a different version of this card that allows them to call up the patient’s record on the screen. “The doctor doesn’t have to bring paper with him,” says Mike Gogola, chief information officer at Hermitage. “It’s the equivalent of having the patient record in hard copy by the bedside.”

Interestingly, the Hermitage has avoided using consultants, preferring to train its own staff on the technology. “If you bring in consultants to do a rollout, all the intellectual capital leaves; that’s why you have to do it from the ground up,” Gogola reasons. Every department in the hospital has nominated ‘super users’ who can pass on knowledge and skills on using the system to colleagues.

The system will also have a way of capturing the knowledge that a doctor may have about a surgical process, so that the expertise relating to ‘care episodes’, as they are called, can be accessed by others.

By Gordon Smith

Pictured – Eamonn Fitzgerald and Mike Gogola, chief executive and chief information officer at new hospital, the Hermitage Medical Clinic, Dublin