Healthcare is too important to stay the same
Healthtech report
Sponsored by
healthtech report
Healthcare is too important to stay the same
Minister for Health Stephen Donnelly TD: Leveraging digital health gains Minister Stephen Donnelly TD reflects on the acceleration of digital health solutions during the pandemic, the challenges of the cyberattack on the HSE and how the digital health gains from the pandemic can be leveraged to deliver on Sláintecare’s vision of integrated care. The impact of Covid-19 was unprecedented for health services internationally, with devastating impacts for many individuals and families. This tremendous challenge required immediate responses. In many cases, this triggered a need to develop, at pace, innovative digital solutions which created the opportunity to demonstrate the value of investing in technology to support change. In preparation for the vaccination programme, a national Covid Vaccination System (CoVax) was developed from scratch to enable people to register for the vaccine. The system supported vaccination roll-out and data capture required to build vaccination records and creation of digital covid certificates, required under EU regulations. Earlier in the pandemic the Covid Care Tracker was developed to support the management of patients from testing through to contact tracing. Innovations such as the Covid Tracker App were developed and secured unprecedented uptake by 112
citizens. The app was developed in close collaboration with other countries and leveraged the skills and knowledge of teams working across government departments, the Office of the Government CIO, the HSE, and indigenous Irish tech companies. The Covid-19 Data Hub, which complemented contact tracing, was also developed to collate data and facilitate modelling and reporting on the spread of Covid-19. Therefore, the use of digital solutions, and the value of data, was clearly demonstrated. We were also able to harness existing platforms to support health services during the pandemic. The use of eReferrals was expanded to enable GPs and assessment centres to order Covid tests electronically. Regulations were introduced to facilitate paperless prescribing, thereby reducing visits to GP practices for routine repeat prescriptions. Similarly, teleconsultations and remote monitoring of patients became common.
Healthcare is too important to stay the same
The pandemic also saw collaboration between agencies on the national vaccination programme and the implementation of EU Digital Covid Certificates (EU DCC). The Department of Health led out on policy development for EU DCC’s and established a service centre to facilitate citizen engagement which made use of innovative digital channels to enhance customer service. We must continue to progress digital health, leveraging these gains to support Sláintecare’s vision of providing universal access to integrated care for everyone in Ireland. Integrated care for patients as they transition across the various care settings will lead to safer, efficient, and effective healthcare.
healthtech report
The CONTI cyberattack: One year on The CONTI Ransomware attack on the HSE of 14th May 2021 resulted in almost all ICT systems, applications, and communications networks which support the delivery of health and social care services, being taken offline. Healthcare is a target for cybercrime, worldwide, due to the high value of health data and the criticality of health services. One year on, much progress has been made in remediating the damage, through increasing investment in cyber resilience. Improvements in foundational infrastructure, the implementation of recommendations from the PwC report, enhanced monitoring and cyber security operations have all contributed to improving the performance and responsiveness of ICT systems within the health service. However, the global challenge for all organisations, not just healthcare organisations, is in recruiting very scarce cyber security talent.
“We are also focused on developing a Digital Healthcare Strategy to deliver better health outcomes enabled by seamless, safe, secure and connected digital health services and technologies.” Minister for Health Stephen Donnelly TD
The road ahead Covid-19 has also highlighted our strengths, including our capacity to deploy innovative digital solutions at pace and the resilience, professionalism, courage and innovative spirit of our healthcare workers. The pandemic taught us, out of necessity, how to bring some of our health services to the patient. We leveraged technology and recognised the importance of managed access to health and care data to do this. Looking ahead, the next decade will see ageing populations and an increased burden of chronic illness. We now need to plan an adequate response to the population’s care needs. Sláintecare sets out the vision for integrated care models that aim to generate health and social care efficiencies through the defragmentation of care, promotion of collaboration and continuity of care across settings. We must adopt patient-centred models and prioritise preventive models. This means reforming how care is currently organised and provided to ensure quality and sustainability. The National Digital Strategy Harnessing Digital: The Digital Ireland Framework provides an overarching framework to digitalisation across the economy and society, including healthcare. Aligned to this national strategy, we have invested and will continue to invest in cyber resilience. My department is bringing forward the Health Information Bill to ensure that Ireland has a fit for purpose national health information system that enhances patient care and treatment and supports better planning and delivery of health services. We are also focused on developing a Digital Healthcare Strategy to deliver better health outcomes enabled by seamless, safe, secure and connected digital health services and technologies. Our vision will be anchored in key themes such as digitally empowered and engaged patients, digitally secure foundations, digital enablement of workforce and workplace and connected data-driven services and insights. We have now begun to engage our many stakeholders to bring forward this vision to harness digital, eHealth and modern technologies to allow for a paradigm shift in how we deliver healthcare and wellbeing services in the future. 113
Healthcare is too important to stay the same
healthtech report
Closing the gap: Trends in digital transformation strategy
How are more digitally advanced health systems looking to close the gap between the ‘haves’ and ‘have nots’ for care providers in their networks? eolas asks Cerner’s VP of International Business Development Amanda Green, and Cerner Ireland Country Manager, David Clancy, for
Advertorial
insights from their international client base.
114
What have you seen as the major shifts health systems strategy as they look to procure enablers such as electronic patient records and health information exchange products?
it’s been the somewhere in between,
Amanda Green
ambition can lead to poor value, or
We’ve seen it all in the past 15 years, from building out small departmental electronic patient records or solutions, to national programmes looking to digitise entire countries. More recently though
short-term throwaway investments, while
with a shift towards procurements across health networks.
And why is that? Amanda Green Transforming healthcare isn’t easy and clients have learned what works well, and how to leverage that. It’s perhaps a generalisation but having too small an
going too large can lead to no return at all. Instead, health systems are increasingly looking to build on their successes to date.
Healthcare is too important to stay the same
How does this manifest in real terms? Amanda Green
healthtech report
Take the UK for example. When hospital groups in the NHS seek funding for digital programmes, they are strongly encouraged to learn and borrow from success stories in their region, especially where they are sharing patient care and clinicians. They place a greater emphasis on what’s worked well and who has delivered it. The hospitals that have delivered the success, and the teams that have become the experts, become one of the first ports of call when new sites look for investment. David Clancy Not everyone likes learning from their neighbours, though. Amanda Green This is less and less tolerated. Funding bodies will pointedly ask hospitals or other applicants if they have visited local success stories, and if not, why not. For Cerner’s part, if a prospective new client shows reluctance to engage with the successes on their doorstep, then it’s not a good sign that we are the right partners. David Clancy That’s not surprising given that the major success stories we read about improving health outcomes and reducing costs have collaboration as a key theme. Amanda Green
For hospitals that do not have a modern digital infrastructure, funding bodies are encouraging them to piggy-back on what has been delivered in their region. For
Does this mean companies like Cerner have to offer different solutions? Amanda Green Yes, it’s an enhanced product mix, with our own products and integrating with what is already there. You have the traditional clinical EPR infrastructure, but on top of that place a greater emphasis on sharing information outside of the hospital campus. Clients want to spend less time on the acute hospital EPR so they take what’s already proven in their region. This gives them more time to focus on the patient journey and involving other care venues in their project, like GPs and other community care for example. David Clancy And patients, of course. It’s been exciting locally to recently start conversations with clients on where and how to incorporate the patient feedback into their care, regardless of where they are. This was far further down the agenda only a couple of years ago even though the technology existed. We can move forward with these digitally mature
clients at pace as they have the EPR fundamentals sorted, and don’t want to start from scratch again.
What does this mean for Ireland do you think? David Clancy The appetite and need for digitalenabled change are there, and It’s positive to see the HSE conducting market soundings for certain related products and services, for example the community electronic patient record programmes and shared care record programmes. These must succeed, and to Amanda’s earlier points, perhaps a regional or group approach would be the most efficient and effective approach to these programmes. Amanda Green Yes, especially if you have a strong ‘anchor’ in the region with experience of digital deployment, which allows other paper-heavy healthcare providers level up far more quicky than if starting from a blank sheet. David Clancy
Advertorial
Exactly. Funding bodies are increasingly asking not just how you are going to improve outcomes for your own site, but for the community that you serve. As a result, we’re seeing a shift from single site procurements, to ‘hub and spoke’ models, with regional healthcare providers with existing relationships coming together to improve healthcare delivery and investing in line with that model. It’s working too. For example, in northern England, the Great Northern Care Record programme brought together several acute hospitals, over 400 GP practices, and 200 community care providers to connect existing venues of care and collect and share relevant care information for a patient population of 3.6 million people.
example, in the NHS, Imperial College Trust in London joined forces with Chelsea and Westminster to share an instance of Cerner’s EHR, with both London North West University Trust and the Hillingdon Hospitals Trust additionally joining in 2021. The four organisations serve 2.4 million people and can now provide seamless care for patients and for caregivers as they move between facilities in the region.
Almost anything is better than paper!
E: david.clancy@cerner.com W: www.cerner.com/ie Twitter: @CernerIrl
115
healthtech report
Healthcare is too important to stay the same
Martin Curley: ‘Confidence, courage, and conviction’ Ciarán Galway sits down with the HSE’s Head of Digital Transformation and Open Innovation, Martin Curley, who was recently named as one of the world’s top 10 health influential leaders, to discuss Ireland’s digital progress, supranormal returns on innovation, and constructing an unprecedented healthcare system. Hitherto, Ireland has been digital health laggard. Despite being a top 12 economy, with the top 10 MedTech companies, top 10 pharma companies, and top 10 tech companies, Ireland is ranked 80th – one place behind Georgia and one place ahead of Ukraine – in the CEOWORLD Magazine Health Care Index, which rates healthcare systems relative to factors that contribute to overall health. However, launched in February 2022 and aligned with the EU Digital Compass, Harnessing Digital: The Digital Ireland Framework, the new national digital strategy, aims to ensure “widespread access and use of inclusive digital public services”, with 90 per cent of public services to be consumed online by 2030. Likewise, the EU Digital Compass indicates that “the ability for European citizens to access, and control access to, their electronic health records (EHR) across the EU should be greatly improved by 2030”. If implemented, Ireland would be the first country to introduce an interoperable EHR that is patient centric. “It is about confidence, courage, and conviction. Currently, we are testing it in multiple living labs. We can save and improve many lives if we just decide to do it,” Curley asserts, adding: “The components exist. There is an emergent architecture that must now be tested. Not only can we transform our own health but there is a potential to sell these solutions internationally. Indeed, if we were to adopt a stretch goal, we could potentially double the GDP impact of digital health over a five- or six-year period.” 116
Healthcare is too important to stay the same
“This is going to be a radical and dramatic change. Ireland can deliver, but it will require confidence, courage, and conviction.” Martin Curley, Head of Digital Transformation and healthtech report
Open Innovation, HSE Laggard to leader Emphasising recent progress, the HSE’s Head of Digital Transformation and Open Innovation specifically refers to the introduction of automated respiratory rate measurement as a standard of care for respiratory patients across 23 hospitals, with a new living lab within the community set to be announced. Similarly, while it had been a laggard in telehealth, the latest OECD research now ranks Ireland fifth in the world. “We have been able to leap ahead,” remarks Curley, adding: “We are now deploying vital signs automation into 20 hospital wards, putting us into a leadership position.” Meanwhile, heart failure is the single greatest cause of mortality in the world. Indeed, the one-year mortality rate after heart failure diagnosis is 20 per cent. In response, the Digital Transformation and Open Innovation team has built a capability maturity framework to examine each of breakthrough technologies available in an attempt to reduce the risk of cardiovascular disease. “In terms of cardiovascular, working with Ken McDonald and Matt Barrett, we have put together a capability maturity framework for cardiovascular and are poised to jump from laggard to leader,” he projects. If successful, this capability maturity framework will then be applied to respiratory disease and diabetes. Led by Centric Health and Roche Diagnostics Partner, the Heartcare at Home Living Lab has delivered a 10X reduction in hospitalisation rate, almost continuous care, high levels of patient satisfaction, and safety all at a price point which is about 2.5X cheaper than the current service. In introducing radical technology, Curley insists, there are three stages. “First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident,” he says, paraphrasing a statement on truth, often misattributed to German philosopher Arthur Schopenhauer. “I really think we can transform the healthcare of everyone in Ireland making it affordable and accessible to everybody,” he adds.
10X technologies To achieve this, the Digital Transformation team recommends the implementation of a series of ten 10X innovations. Amid a proliferation of 10X technologies, in an industry as information intensive as healthcare, allied with exponential innovation methodology – or Open Innovation 2.0 – there are super normal or 10X returns. Indeed, this explanation is now known as Curley’s Law. “The idea of this new law is that we are seeing 10X returns across our quadruple aim. This means improvements in quality of care; quality of life; cost reduction; and the clinician/patient experience,” Curley explains. “This is timely because incremental innovation is no longer good enough. Systems are failing and demands are increasing. However, if we can deploy these exponential solutions, the point of care is going to move from the hospital to the home and when you have technologies like this… you get a remarkable pattern. “What we are observing with the vital signs automation solution, for example, is that it is not only detecting patients deteriorating earlier, but it is increasing productivity by taking the cognitive load off the nurses, reducing the average length of
4 117
Healthcare is too important to stay the same
hospitalisation, increasing acute capacity at 1/100 the cost of building new capacity, and the returns are spectacular. The internal rate of return is 1,100 per cent and the payback period is under 8 weeks.”
Wellness management
healthtech report
According to McKinsey and Company, the single greatest opportunity for healthcare improvement is lifestyle. Consequently, a swing to wellness management and protection is the very first of the series of 10X innovations recommended by Curley and his team. “We put together a remarkable living lab [Health Elevator] in conjunction with Careplus Pharmacies, within which we undertook rapid health assessments in 10 minutes. We then provisioned patients with personal electronic health records and within 24 hours they had a plain English report indicating whether they were healthy or unhealthy. “We have also been working with some vendors, but initially with Fitbit, to provision them with a subscription to Fitbit Premium. The overarching principle is that we can scan people, provide them with a personal electronic health record, and then give them devices and tools to help them stay healthier. We believe that we can perform that rapid health assessment for the price of a cup of coffee, per patient, per year.” Simultaneously, Curley believes that the HSE can provide the electronic health record for the price of a cup of coffee, per patient, per year. “We now have a real solution which is about to be introduced to a living lab of 500 patients across six CarePlus pharmacies. We think this could become the centre of the architecture for our new digital health system. Indeed, we are building a digital health platform onto which we are integrating many of Irish vendors, as well as several UK vendors also. “We believe a full preventative, proactive and personalised solution for wellness management and maintenance including digital therapeutics can be provided to Irish citizens for about the cost of a PCR, delivering at least 10X the value,” he explains.
Barriers While there has been an explosion in digital health solutions, several barriers continue to hinder Ireland’s digital health journey. The first, identified by Curley, is education. “We recognise that digital health is changing at such a rate that we must provide continuous information. Therefore, education is key,” he comments. Consequently, the Digital Transformation team established a MSc in digital health
“Two years into what is a digital health decade, we are trying to architect and engineer a healthcare system that has never existed before.” 118
Healthcare is too important to stay the same
transformation, delivered by the University of Limerick in conjunction with the seven other Irish Universities, and accelerated the Digital Futures in Healthcare Diploma in collaboration with Dell.
“Already, we are starting to see big bang adoption because the benefits are so great that organisations and individuals are adopting it. Once you show the solution people get behind it.”
Open Innovation 2.0 Reflecting on the development of overarching digital health strategies and referencing his own experience in liaising with agencies, patient associations, clinicians, the Irish College of General Practitioners, the Health Information and Quality Authority, and the unions, Curley stresses the importance of collaboration between stakeholders from across the quadruple helix. “With Open Innovation 2.0, the whole idea is you have intensive networking in trusted relationships towards a shared vision, which is Ireland’s Digital Health Strategy and Action Plan – Stay Left, Shift Left, 10X – then we talk about shared value and the value is better wellbeing, better welfare, and wealth. “The economy of mutuality means moving away from the primacy of shareholder value to value for everybody in the ecosystem. The beauty of Open Innovation 2.0 is that it defined by shared value and working together to create that shared value.”
Previously, there was a predominant clinical focus on system design. In January 2022, however, the Irish Digital Health Leadership Steering Group approved the 10 key principles underpinning the Ireland Digital Health Transformation Strategy, the first of which is the leapfrog principle. The objective of the Digital Health Transformation Strategy is a transformation from a European digital health laggard to a European digital health leader by 2025, meaning that Ireland will leapfrog from having a primarily paper-, presence-, and acutecentred healthcare system to one that is digital-, patient-, and home/communitycentred. This will require assertive leadership and clinical governance. “What we are doing in Ireland is a brilliant example of what Harvard Business Review calls a ‘high-impact coalition’. We are undertaking a major societal programme that no one agency can deliver on its own and everybody aligns around that. Open Innovation 2.0 advocates for these grand coalitions and we have built this steering group to oversee, create the momentum and eliminate the barriers,” Curley asserts. “To our knowledge, this has not been done anywhere else in the world. It is going to be a serious heavy lift, but it is going to deliver a breakthrough and Ireland could be a global exemplar. We have a great shot at a genuine revolution that will transform healthcare.”
Catalytic impact
Impact
Characterised as a ‘big bang disruption’, the adoption curve for disruptive technologies accelerated during the Covid crisis. In a period of two months, the Digital Transformation team delivered 10 new disruptive innovations.
Application of the Open Innovation 2.0 paradigm is set to have a significant impact on patients and clinicians alike. “We are moving to an accountable care ecosystem,” Curley outlines, “By taking the right actions for the right reasons, there is equitable value creation. For example, by involving patients in system design and in our living labs, as well as
“By the end of the first week of Covid arriving in Ireland, we were remotely monitoring Covid-19 patients. During the first weekend, we were undertaking respiratory monitoring of Covid patients in Beaumont Hospital with Professor Richard Costello, finding that we could get up to 12-hours’ notice of a patient desaturating.
“Most notable was the introduction of the ability to send prescriptions electronically. Several people have described this as the biggest digital innovation in Irish healthcare in 20 years. It took five people with a plan. On day one, 100 prescriptions were sent. On day two, between 800 and 900 were sent. And on day three, it was 20,000.
healthtech report
Next to education, culture is the single most significant challenge to digital transformation in healthcare. “People feel threatened,” Curley asserts, “because this is going to be a radical and dramatic change. Ireland can deliver, but it will require confidence, courage, and conviction. We just need political decisiveness to say we are going to do it.
collaborating with companies and clinicians, we develop the solutions that give the best outcomes, the best quality of life, and the lowest cost. This is win, win, win.”
“Other innovations include the adoption of video enabled care by hospitals and GPs. It was a massive catalyst we now have 2025 capability in 2022. But we still have a lot more to do. With confidence, courage, and conviction, we can do this.”
Health 4.0 Defining the Health 4.0 concept, the HSE Head of Digital Transformation and Open Innovation explains that it is simply the principles of Industry 4.0 applied to healthcare. “The one addition is you have the empowered patient at the centre, taking responsibility for their healthcare,” he adds. Stay Left, Shift Left identifies at least six paradigms that are in simultaneous flux, transitioning from the clinician to the patient, and from reactive to proactive healthcare. Outlining his vision for the future of healthcare in Ireland, Curley believes that individuals and organisations across the quadruple helix are beginning to acknowledge the substantive digital health developments in Ireland. “In Ireland and among our international partners, we have a unique collective of companies motivated around personal contribution to drive change. It is about taking responsibility, showing leadership, and delivering but it requires a collective effort. We have around 200 organisations in the ecosystem, with whom we have very high trust relationships. “Two years into what is a digital health decade, we are trying to architect and engineer a healthcare system that has never existed before. I would be really hopeful that in just a handful of years, many more people will be living longer, we will be saving more lives, and patients will experience less hospitalisation. That is my sole motivation,” he concludes. 119
Healthcare is too important to stay the same
healthtech report
Moving quicky to population health management: A repeatable case study for Ireland
As Ireland considers its strategy to implement Regional Health Areas, Community Healthcare Networks and achieve Sláintecare’s goals, this case study looks at how care providers across North London partnered with Cerner to provide better care for their 1.7 million population. Advertorial
North Central London Integrated Care System (NCL ICS) brings together a partnership of local health and care organisations and local councils to join up the provision of care and implement ways to improve health outcomes for residents, tackling the inequalities that currently exist. Following the publication of the NHS Long Term Plan in January 2019, North London Partners (NLP) was formed from the community of providers within the ICS, with a mission to drive integration of health and social care. This would enable population health management (PHM) across all the 120
health and care providers within the five boroughs and the 1.68 million people of north central London. Cerner was selected as the technology partner to assist NLP in the goal of moving away from the traditional focus on reactive care to a proactive model of care.
NLP’s background in population health NLP is using the Cerner suite of population health management tools to
Healthcare is too important to stay the same
help bring together and normalise data from multiple systems across the network to create an integrated, longitudinal health and care record for each of NLP’s patients. This data is being used to develop new case-finding tools, analytics and registries to identify unwarranted variation and drive goldstandard care. These tools provide insights to frontline health and care professionals, and care teams at all levels of the system, with the information subsequently used for effective targeting of interventions for individuals and populations. Currently, there are more than 1,800 health and care professionals from across north London set up as users, with more than 500 already using the analytics tool available within the platform.
The planning, collaboration and relationships already in place in support of the partnership had the benefit of enabling a more rapid and agile response once the Covid-19 pandemic hit. While the wider national effort in meeting the Covid-19 challenge focused on reaction and response to treating the infected with critical care capacity, NLP also sought to establish a proactive community-based response. In planning for this, NLP defined its priorities as: Providing rapid discharge for those requiring adult social care at a far greater scale and pace than ever before. Rapid two-hourly discharge turnarounds were enabled through sharing patient-level hospital data with GPs and social care workers.
•
Protecting and supporting large numbers of people who were shielding across local authorities and NHS teams (this equated to about 45,000 people). The tools helped identify them and assist with getting professional support and food packages out to the vulnerable categories at a geographical level. GP practices, community and mental health providers were given access to filterable lists of registered individuals based upon the shielded lists generated by NHS Digital.
•
Protecting frontline staff who were going into people’s homes where they had suspected or confirmed Covid-19. GPs, social care workers,
•
Ensuring that teams were systematically and rapidly notified when their patients/clients had been admitted to hospital or had sadly died, to help frontline health and care teams most effectively plan and deliver care.
This level of patient information was augmented by the OneLondon shared care record programme where Cerner health information exchange (HIE) technology was implemented to connect HIEs across London, including north central London’s exchange. This programme provides real-time access to the healthcare data of London’s nine million citizens, from multiple health information systems used in acute, community, mental health, and primary care. Data is patient-matched and presented back to the care provider as a single and comprehensive snapshot of each individual’s journey through the system.
Integrated care as business as usual Beyond the Covid-19 initial response, work commenced with the onboarding of data across NLP, enabling care teams to focus on key population health priorities for their individual patients, clients and the wider communities they care. This included the development of flu and Covid vaccination analytics using HealtheIntent® to proactively support GP practices, PCNs, boroughs and the wider system in driving vaccination uptake, particularly among the most at-
risk groups within the eligible cohorts, with a focus on equity across different communities. Additional whole-life registries that have been designed and implemented include health checks for adults with serious mental illness, care quality for those living with and beyond cancer, learning disabilities, and dementia. This will facilitate further collaboration and new working practices between organisations within the NCL health economy to support population health improvements. Population health management will remain at the heart of integrated care systems and regional population health systems far into the future. The ability to gain clearer insights into how people live, work and play within a place or neighbourhood, how this shapes health and wellbeing, and what can be done to improve outcomes will be core to the success of ICSs. It is this insight that helps to shape the services and support of the future. Integrating care in Ireland: Cerner has worldwide experience of partnering with clients to deliver integrated care systems. We look forward to engaging with the acute, community and wider care providers – both public and private – over the coming years.
Advertorial
•
and wider community health and care teams working within community trusts were provided with a list of at-risk patients within their populations.
healthtech report
Adapting and accelerating through the pandemic
“Population health management will remain at the heart of integrated care systems and regional population health systems far into the future. The ability to gain clearer insights into how people live, work and play within a place or neighbourhood, how this shapes health and wellbeing, and what can be done to improve outcomes will be core to the success of ICSs.”
E: david.clancy@cerner.com W: www.cerner.com/ie Twitter: @CernerIrl
121
Healthcare is too important to stay the same
Post-pandemic eHealth The Covid-19 pandemic provided the catalyst for the rapid introduction of many new health technology features, but a greater role of health information systems and data infrastructures is required to enable responsiveness to increased healthcare use and expenditures.
healthtech report
While the establishment of eHealth Ireland has led to many improvements, significant gaps in health information systems and data infrastructure requires considerable investment and further advancements, an ESRI study has found. Examining the developments in healthcare information systems in Ireland and internationally, the ESRI research outlines the key tools of individual health identifiers (IHIs) and electronic health records (EHRs) as policy ambitions yet to be implemented at a national scale, but which are “key goals of the Irish healthcare system”. The research estimates that in 2021, less than 0.8 per cent of the public health budget was spent on eHealth and health technologies, lower than most peer countries, despite the recognisable benefit of an advent of new health technology in dealing with Covid-19. While Covid highlighted deficiencies in the Irish health data landscape, mainly for decision-making to provide rapid responses at the onset of the pandemic, it also served to hasten the increased
adoption of some pre-existing eHealth tools such as e-prescribing and ereferrals. Additionally, it has spurred the advent of new technologies, including the cloudbased lake platform to collect and collate Covid-19 data, and the Covid Care Tracker, which became vital features of the pandemic response. Highlighting that an individual health identifier (IHI) was rolled out through national programmes such as the Covid vaccination programme, the ESRI study says: “Further building upon and strengthening these improvements and successes will be required to continue to navigate the course of the pandemic and to meet the healthcare challenges of the post-pandemic era.” In comparing a range of international eHealth evidence in other countries, the ESRI pinpoints Scotland as a useful template for developing Ireland’s health information system within the public health system. The study highlights that Scotland’s Community Health Index (CHI), a mandated unique patient identifier, is the “fulcrum” for health information system development.
“The available evidence indicates that an integrated national electronic health record is a key enabler of the collection, secure storage and confidential communication of health information from disparate settings within a health system,” the report states. However, it adds that while big data, electronic health records and individual health indicators are important, of equal importance to a modern health information system is interoperability, enabling the different systems across the health system to communicate and integrate with each other. The study summarised six policy recommendations, outlined below. Highlighting the pandemic’s role in identifying gaps in Ireland’s health information systems, increasing adoption of existing eHealth technologies, and fostering new technology innovations, the research concludes: “Further building upon and strengthening these improvements and successes will be required to continue to navigate the course of the pandemic and to meet the healthcare challenges of the post-pandemic era.”
Policy recommendations 1
Develop a modern HIS based on national IHIs and EHRs that spans services and the public and private systems.
2
A robust, structured and rigorous health data infrastructure that captures data from public and private providers to allow for resource, capacity and workforce planning.
3
122
Continue investment in current and capital funding needed for HIS in Ireland. Replacement of antiquated healthcare technologies with devices that afford appropriate modern capabilities and functions.
4
Ensure privacy protections for data subjects and cybersecurity provisions. This process should be transparent and well communicated to the public.
5
Support digital health literacy and capability among older people, those in rural areas, and those in lower socioeconomic groups.
6
Train the healthcare workforce in the use of new technologies and eHealth.
Improving patient safety by ‘designing-in’ traceability standards healthtech report
identify a recalled batch – BKO123 – does the human eye see this as a zero or the letter O when manually recording the data in the first instance?
Safer, more efficient care starts with a simple scan
The learnings from Covid and other implementations are demonstrating the importance of laying the foundations for unique identification and traceability to ensure safer, more efficient care, writes Siobhain Duggan, Director of Innovation and Healthcare, GS1 Ireland. Safer systems: Designing-in traceability standards
The pandemic has accelerated the development and adoption of ehealth technologies and there are several excellent examples of innovation and collaboration where teams from multiple organisations came together to design a solution to a problem. We experienced this ourselves at GS1 Ireland when we collaborated with the HSE’s National Immunisation Office to implement TrackVax, enabling the tracking of the Covid-19 vaccine in the central vaccination clinics (CVCs).
When unique identifiers and structured data are in use then it is much easier to link systems as there are common data fields in both systems. For example, a clinician scans a patient barcode: when standards are used the system will recognise “I am a patient” and add the patient identifier into the correct field in the system. This ensures that the data is captured accurately and there is no risk that a staff (or other) identifier is put into a patient field or vice versa.
As healthcare systems and processes are being digitised, it is key that data standards are ‘designed-in’ from the start. At its heart GS1 is about unique identification, encoding barcodes with structured, standardised data and using this to enable traceability. These three ingredients are fundamental to designing ehealth solutions that are safe, future proofed, and interoperable.
About GS1 Ireland GS1 is the international standards and licensing organisation for globally unique identification and barcoding that enables the traceability of every product, person, place, asset and more. GS1 supports more than two million public and private sector organisations worldwide.
For more information please contact: Siobhain Duggan Director of Innovation and Healthcare T: 01 208 0660 E: healthcare@gs1ie.org W: www.gs1ie.org/healthcare
Advertorial
Digital transformation: The need for interoperability
Removing paper-based systems and processes, and using a simple scan of GS1 standard barcodes to cross check and capture patient data reduces, the risk of medical error, the time to carry out administrative tasks, and returns time to front line staff to concentrate on patient care. Regulations for the standardised identification of medical devices and pharmaceuticals are in place and there is a real opportunity now to standardise and design-in traceability standards in our healthcare systems.
Real-time, accurate, meaningful data Systems with traceability standards ‘designed-in’ have much better data quality as the barcode scan captures all the data real-time at multiple stages. A barcode scan is much more reliable; data entry errors can cause unintended consequences when later interrogating data. For example, when trying to 123
Healthcare is too important to stay the same
A guide to Health 4.0 healthtech report
Health 4.0 is a new concept that springs from Industry 4.0, the fourth industrial revolution. The concept is based on the use of smart machines collating and analysing large amounts of data in order to make decisions without human involvement. “Health 4.0 is really the principles of Industry 4.0 applied to healthcare, but with one addition; the empowered patient is very much at the centre, taking co-responsibility for their healthcare,” Martin Curley, Director of the Digital Transformation and Open Innovation at the Health Service Executive tells eolas.
data, Internet of Things, wireless internet, 5G, cryptography, augmented reality, etc) to improve healthcare and create new and innovative visions for the healthcare sector whereby patients are given better, more value-added and cost-effective healthcare that has improved in terms of both efficacy and efficiency.
“Rather than Healthcare 4.0, it is Health 4.0. As one of our top 10 principles… What we identify in our Stay Left, Shift Left paper is at least six paradigms that are changing at the same time, from the clinician to the patient, from reactive healthcare to proactive healthcare, from curing to preventative etcetera.”
While healthcare is one of the sectors in which Industry 4.0 is expected to achieve some of its more notable results, the industry is already more computerised than in previous decades, with technologies such as x-rays and magnetic resonance imaging being replaced by computed tomography and ultrasound scans, along with electronic medical data.
Stay Left, Shift Left commits to moving Ireland “towards a healthcare system where the primary improvements in life expectancy and health outcomes will be driven by digital technology and data driven care and innovation” through Health 4.0. Health 4.0 refers to the use of Industry 4.0 technologies (cloud computing, big
124
The Covid-19 pandemic has also reemphasised the need for the deliverance of healthcare within local communities, and this is one of the innovations offered by Health 4.0. Telehealth systems now allow for remote patient monitoring, with
providers now beginning to provide software and solutions that connect patients and doctors and record the patient’s medical data at the same time, such as wearable devices. Such technologies and more basic ones like laptops and smartphones also allow for the remote delivery of health services such as patient education and involvement and real-time telehealth appointments as a partial replacement for in-person doctor-patient visits. Advances in digital healthcare technologies such as artificial intelligence, virtual reality, 3D printing, robots and nanotechnology are changing healthcare and the sector. Positive examples have been seen elsewhere, with a recently developed AI-powered algorithm for breast cancer shown to outperform human radiologists in identifying the disease by 11.5 per cent when tested in the UK and the US, again showing the potential for improvement in healthcare brought by Health 4.0.
Pexip: Powering the best-in-class telehealth solutions with patients, with no need to buy additional hardware or tools.” The video platform integrates with existing workflows and tools, so it fits seamlessly into daily schedules. This means that providers can also join using the technologies they already have such as telehealth carts, video conferencing systems, Skype for Business, Microsoft Teams, or Google Meet.
is helping to transform the way care is given through its unique approach to simple and interoperable video solutions for healthcare organisations. “Demand for telehealth solutions has increased considerably over recent years, due the pandemic, in particular for telehealth consultations,” explains Leighton Hughes, Managing Director, Pexip UK and Ireland. “During this time healthcare sector has experienced great success through the implementation of integrated video solutions to enhance their existing services, tools, and workflows as well as improving user experience.”
Easy for patients
With a firm focus on data security and data sovereignty, Pexip’s innovative technology is enabling healthcare organisations in Ireland and further afield, to extend the reach of their practice and by providing secure, easyto-join telehealth visits for patients from any device or location.
Simple for providers
With Pexip, patients can easily join video meetings from the device of their choice, without the need to download any software or plugins. Pexip Health provides a user-friendly, seamless experience for patients, putting their care at the forefront. Patients can meet their caregivers from the comfort of their homes, using the devices they already own.
“Healthcare organisations rely on Pexip’s secure video platform to deliver a broad spectrum of virtual care services,” says Hughes. “Through Pexip’s APIs, caregivers can use the technologies they already own to meet
Scalable and secure Pexip’s reliable, easy to use platform offers a private, cloud-based telehealth solution which helps to address security compliance issues and provide reassurance to providers and users. The customisable user interface means that patients benefit from added peace of mind that they are in the right place with the providers’ branding featured on the platform. In addition, Pexip Health is scalable by design and easy to manage today and in the future. There is no doubt that Pexip’s flexibility, powerful interoperability, robust integrations, and customisation options mean that health organisations can easily extend their care from hospital to home and transform patient experiences.
Advertorial
Pexip Health’s virtual care solution enables healthcare providers to
healthtech report
Trusted global video conferencing provider Pexip
Hughes adds: “Pexip’s native integration with Epic EHR and other APIs pairs with other electronic health records including Cerner, Allscripts, eClinicalWorks and Practice Fusion. Implementations include the Western Health Trust in Northern Ireland, where face-to-face diabetes appointments have been reduced by 32 per cent. Pexip is also encouraging intra-departmental collaboration on complex cases through Multi-Disciplinary Teams (MDTs) who are using the video platform as a way to connect specialists across multiple hospital sites and broad geographic areas, as in the case with Hampshire Hospitals Foundation Trust’s orthopaedic MDTs.”
extend the reach of their practice by providing secure, easy-to-join telehealth visits for patients from any device or location. This in turn helps to achieve the quadruple aim: •
Improved clinical experience;
•
Improved patient experience;
•
Better outcomes; and
•
Lower costs.
E: james.irving@pexip.com W: www.pexip.com/healthcare
125
healthtech report
Healthcare is too important to stay the same
Digital health transformation principles Implemented by the HSE’s Digital Transformation team, Ireland’s Digital Health Transformation Strategy is underpinned by 10 key principles. Incorporating health, enterprise, and sustainability, it is supported by all four elements (government, industry, academia, and citizens/patients) of the quadruple helix working towards the shared Stay Left, Shift Left vision.
1. Leapfrog: Laggard to leader
2. Stay Left, Shift Left
The objective of the Digital Health
Closely aligned with Sláintecare, Stay Left, Shift Left is the
Transformation Strategy is a transformation
HSE’s digital health innovation strategy. Stay Left is defined
from a European digital health laggard to a
by keeping people well and managing chronic conditions
European digital health leader by 2025. This
from home, and Shift Left by the movement of patients out
requires a leap from a primarily paper-,
of acute setting, to a community setting, and, ultimately, a
presence-, and acute-centred healthcare
home setting. The innovation strategy seeks to identify digital
system to one that is digital-, patient-, and
interventions which deliver quadruple improvements. These
home/community-centred. This will require
are: improved care and outcomes, reduced cost or better
assertive leadership and clinical
value, improved clinician and patient experiences; and
governance.
improved quality of life for citizens, patients, and staff.
3. Healthcare 4.0: Patient centric The transition towards a healthcare system which delivers improvements in life expectancy and health outcomes will be driven by digital technology, data-driven care, and innovation that is enabled by disruptive technologies. As such, citizens will take greater co-responsibility for their health, as informed by real-time health data. Simultaneously, care networking, care anywhere, and personalised care will contribute to this transformation.
126
Healthcare is too important to stay the same
4. Open Innovation 2.0: Citizen Allied with engagement across the quadruple helix, digital technologies will drive structural improvement in the healthcare system. Patient centricity will be central to this process.
healthtech report
5. 10X: Radical innovation Digital technologies will be harnessed to deliver a 10X acceleration in outcomes, speed, cost, and capacity. In pursuit of a digital first culture, an exponential mindset can capitalise on exponential technologies.
6. Digital transformation model
7. Value-based Healthcare
The digital transformation model comprises five pillars:
Moving away from a healthcare outputs-based
inform; inspire; ideate; iterate; and implement. When
model to one that is outcomes-based via a value-
combined, these can create a virtuous circle of progress. HSE
based healthcare lens will improve patient
Digital Transformation is leveraging the WHO Digital Health
experience, clinician effectiveness, and system
Investment model for the management and sequencing of
efficiency. The new model will deliver risk/gain share
digital health investments. As such, governance and decision-
and pay for outcomes.
making will become more clinician led.
8. Dynamic capabilities and capability maturity frameworks Dynamic capabilities determine the ability of organisations and ecosystems to integrate, develop, and reconfigure both internal and external resources in order to respond to and proactively engage with rapidly changing health and economic contexts. Ultimately, dynamic capabilities aim to generate abnormal efficiency, effectiveness, and return on investment. HSE Digital Transformation has also committed to the development of a national Digital Health and Wellness Capability Framework. This framework will provide a roadmap and a measurement tool to track progress, in order to facilitate successive evolutionary leaps to improve capability and outcomes.
9. Enterprise and sustainability
10. Design thinking and design
The Digital Health Transformation Strategy also incorporates
Through the use of design thinking – a non-
enterprise and sustainability. A focus on digital health as a
linear process to understand problems and
national enterprise growth area can simultaneously capitalise on
create innovative solutions – the Digital
existing assets and resources, while creating new opportunities
Health Transformation Strategy
for scalability and export. Meanwhile, the use of digital to
conceptualises challenges and solutions.
virtualise, automate, and dematerialise healthcare will establish a
Furthermore, HSE Digital Transformation’s
more sustainable health system, while telehealth and remote
Open Innovation 2.0 expands on design
monitoring will contribute to decarbonisation. A proportion of
science research as an archetype to enable
economic savings could then be reinvested in further
the rapid testing of new digital solutions.
digitalisation.
127