Transforming Ireland's healthcare into a digital leader DIGITAL REPORT 2021
IN ASSOCIATION WITH:
HEALTH SERVICE EXECUTIVE
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HEALTH SERVICE EXECUTIVE
TRANSFORMING
IRELAND'S HEALTHCARE INTO A
WRITTEN BY: LEILA HAWKINS
PRODUCED BY: JAMES BERRY
DIGITAL LEADER hse.ie
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HEALTH SERVICE EXECUTIVE
HEALTH SERVICE EXECUTIVE
Martin Curley of the Health Service Executive tells us how Ireland is set to become a digital healthcare leader
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Martin Curley Health Service Executive
artin Curley is the Director of Digital Transformation and Innovation for Ireland's Health Service Executive, also known as the HSE. His team have ambitious plans for the country's healthcare to significantly transform so that Ireland becomes a digital leader that other healthcare systems can follow. "Healthcare is around 10 years behind other industries in terms of digital technology, and Ireland is behind the rest of the OECD countries," Curley explains. "We're trying to transform Ireland to go from being a digital laggard to a digital leader in five years." Curley leads a small team of people he describes as catalysts whose goal is to use digital technologies to innovate and transform the healthcare system. "Our ambition is that by 2025, we will be one of the leaders in Europe for digital health, we will have significantly transformed the HSE and our health service for our citizens, our clinicians, and indeed, for business staff." The HSE's digital innovation strategy, which they launched in 2018, is called Stay Left, Shift Left and extended the concept of "Shift Left" which was first introduced by Intel Corporation's Doug Busch and Andy Grove. It is an approach to using solutions to make people's health better. "It's very aligned with Ireland's National Health Policy called Sláintecare," Curley explains. "Essentially, we're looking for digital hse.ie
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IMPROVING PATIENT OUTCOMES by #MakingEveryBreathCount PMD Solutions was founded to fill the fundamental clinical need to measure patients’ rate of breathing, which if amiss, is a significant indicator of early deterioration. RespiraSense is a solution for avoiding preventable respiratory failure. A novel wearable device that measures respiratory rate in a continuous and motion tolerant way. PMD Solution’s creation of RespiraSense has revolutionised the early diagnosis and intervention of medical events, by #MakingEveryBreathCount.
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PMD Solutions and its Vision for Respiratory Care
Myles Murray (PMD Solutions) and Martin Curley (HSE) discuss their partnership and PMD Solutions’ vision for Respiratory Care. Respiratory Rate is the earliest sign of deterioration says Myles Murray, CEO at PMD Solutions. The reason for this is that your breathing is driven by how healthy you are. An infection or fluid building up in the lungs from Pneumonia or COVID requires your lungs to work harder in order to stabilise the body. Respiratory rate is wellestablished globally as the earliest and most sensitive indicator of deterioration, Murray adds. However, the challenge has been to measure this sentinel vital signs accurately.” Adding to Murray’s comments, Martin Curley, Director, Digital Transformation and Open Innovation, at HSE, says that “there has been very little innovation in actually measuring respiration rate.
It’s very subjective. We found that in almost 80% of the cases, the subjective measurement by the nurse were different. And this isn’t because they are bad nurses. It’s because it’s inherently difficult to measure. So the ability in a general ward to measure respiration rate really is a game-changer.”
PMD Solutions and HSE Reflecting on the genesis of this partnership, Murray starts off by explaining that RespiraSense was launched as part of the COVID response in Beaumont Hospital. “Within a few weeks they saw enormous value from the technology, and because of that success, RespiraSense were very kindly introduced to the Digital Transformation team at the HSE.” Taking just three months to deploy nationally as a de facto standard of care in respiratory compromised patients, Curley reflects on a recent meeting: “one of the more senior clinical engineers in the network commented at one of our meetings that she was amazed at how fast this could be rolled out. She said “normally, a new programme like this would take two to three years in the HSE, and it took three months.”
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interventions or solutions that in the first case help keep people well or help them manage their conditions in their homes. That's the "Stay Left'' part.`` "Shift Left is about moving patients as quickly as possible from an acute to a community to a home setting. Every time we make a digital intervention, or an innovation intervention, we're looking for four characteristics, sometimes called the quadruple aim: improvements in the quality of care, in quality of life, reduction in costs, and improvement in the clinician/patient experience." He adds that Stay Left Shift Left is a way to state the direction of HSE's innovation strategy. "Thankfully, we've been able to mobilise the ecosystem that works with us - large multinational companies as well as smaller SMEs - to help find solutions that help us Stay Left Shift Left." HSE's digital transformation journey started in early 2019, and Curley explains 8
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“ We propose a healthcare system that is mainly home and communitybased, is proactive, predictive, mobile and cloud-enabled, as well as opensource where possible” MARTIN CURLEY
DIRECTOR OF THE DIGITAL ACADEMY AND OPEN INNOVATION, HEALTH SERVICE EXECUTIVE
HEALTH SERVICE EXECUTIVE
MARTIN CURLEY TITLE: DIRECTOR OF THE DIGITAL ACADEMY AND OPEN INNOVATION
2005
INDUSTRY: HEALTHCARE LOCATION: IRELAND
Year founded
130,000 Number of employees
€20.6bn spend
that it had to begin slowly. "Our first efforts were to create a digital academy to start building digital capability and capacity in the Irish health service. Working with eight Irish universities, we co-designed and launched a Masters in Digital Health Transformation. We used a paradigm called design science research, where instead of students writing a 30,000-word dissertation, they actually have to develop and deliver a digital change project." This approach has had remarkable success, as in the first year, 18 out of the 20 projects delivered were found to be viable and are either fully implemented or in development. Given that Ireland lags behind OECD countries in terms of digitalising, Curley and his team developed a Leap Frog strategy to move the healthcare system forwards. "Many countries have installed monolithic electronic health records into their hospitals
EXECUTIVE BIO
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Martin Curley is Director of the Digital Academy and Open Innovation at the Health Service Executive (HSE), helping enable the digital transformation of Ireland’s health service. Most recently Martin was Chief Information Officer (CIO) at the HSE. Prior to joining the HSE Martin was Senior Vice President and group head for Global Digital Practice at Mastercard. Previously Martin was Vice President at Intel Corporation and Director/GM of Intel Labs Europe, Intel’s network of more than 50 research labs which he help grow across the European region. He also served as a senior principal engineer at Intel Labs Europe leading Intel’s research and innovation engagement with the European Commission and the broader European Union research ecosystem. Prior to this Curley was Global Director of IT Innovation and Director of IT Strategy and Technology at Intel. Earlier in his Intel career, he held a number of senior positions for Intel in the United States and Europe. He also worked in research and management positions at GE in Ireland and Philips in the Netherlands.
riMedik
R E D E F I Care NING CARE Redefining
HEALTH SERVICE EXECUTIVE
Transforming Healthcare Transforming Care Through Innovative in the HSE Through Innovative Technology Patnerships Technology Partnerships
Improving Vital Patient Care Worldwide Dr Róisín Molloy (TriMedika) and Professor Martin Curley (Health Service Executive) discuss how TRITEMP™ thermometer has helped drive the digital innovation agenda in Ireland. Developing devices that really make a difference for patients. Working in the medical industry for 25 years, Dr Róisín Molloy, CEO at TriMedika, could see areas where technology wasn’t keeping up with patient need. “We set up TriMedika to provide the most accurate clinical devices for hospitals, and this is where we see ourselves as being different.” A particular area that Dr Molloy explains hasn’t seen much development is thermometry. “There has been no development for 15 years. Yet it is one of the routine diagnostics that we use around the world, so we set about making the TRITEMP™ non-contact thermometer.“ “The key things that came from talking to doctors, nurses and healthcare workers within the HSE, were obviously the savings on cost and time for the healthcare workers at the hospital, but also to manage infections, and we were keen to build the future for thermometry.” TriMedika and its Partnership with the HSE. For the last four years, TriMedika has been selling into the HSE, now in over 200 locations
in Ireland, as well as hospitals in over 20 countries. “We have been working with the HSE team to really understand their needs and their pain points, as well as looking at research to make thermometers better and develop them so that they are better for nurses and hospital teams. The HSE is a very forwardthinking organisation”, says Dr Molloy. Adding to Dr Molloy’s comments, Professor Martin Curley, HSE Director of Transformation/ Maynooth University, says, “It has been tremendous to partner with TriMedika. The ambition of the HSE is to move Ireland from being a digital health laggard to a European digital leader in the years ahead. To do that, we need to partner with the best and the brightest, both here and abroad.” “We have an overarching strategy, which we call ‘stay left, shift left’. Stay left is about using technology to keep people well in their home, or if you happen to have a chronic condition you can be managed best of all from home. Shift left is about moving patients as quickly as possible from an acute to a community, to a home setting. Every time we make these digital interventions, we’re trying to achieve the quadruple aim: lower cost, improved quality of care, improved quality of life and improved clinician experience. TriMedika delivers on all of these.” “The TRITEMP™ is a superior thermometer because it is non-contact, thus helping with infection control - very important during the COVID-19 pandemic. It’s going to be an essential tool for preventing Hospital Acquired Infections. It’s also more sustainable with no consumables making it about a fifth of the total cost of ownership of conventional thermometers.”
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over the last 15 years or so," Curley says. "Ireland didn't do that, even though that was the intention. What we propose instead is moving to a healthcare system that, instead of being paper-based and presence-based around acute hospitals, is mainly home and community-based, is proactive, predictive, mobile and cloud-enabled, leveraging opensource where possible.” Curley says there is a real opportunity for Ireland to lead in this space. "We have this really unique point in time where we have all these disruptive technologies available in the cloud-like machine learning and the Internet of Things, that enable us to do things that weren't possible five years ago." One example of this is remote monitoring via pulse oximeters and apps, which they deployed during the pandemic. This led to an innovative platform for remote respiratory management developed in a 'Living Lab', which today has 850 patients with chronic respiratory conditions being monitored remotely while they're at home. "A Living Lab is where a technology or solution is actually tested in context, in a clinical setting and quickly co-designed in an agile way. We have four phases of innovation: exploration, proof of concept if that's successful we move to demonstrator, proving the business value and clinical efficacy of a solution, and lastly, broad adoption," Curley explains. "We try to develop a consistent innovation pathway, a place where good ideas and embryonic solutions can be generated and evaluated, and if we feel there's significant value, we can deploy these in a living lab." Members of the government, industry, academia and patients or citizens themselves participate in these labs, with the benefit of utilising patients as 12
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co-innovators in the process, rather than treating them as research objects. "We're getting really good results," Curley says. "We're able to speed up projects, and we're usually hitting all four elements of our quadruple aim - reduced costs, improved care, improved quality of life, and improved clinician experience." The Digital Transformation and Innovation team has set up over thirty
HEALTH SERVICE EXECUTIVE
living labs across Ireland, for example a virtual rehab lab in Drogheda, an emergency general surgery living lab in Letterkenny hospital, and a distributed heart care at home lab working with patients with heart failure conditions. This lab, set up in conjunction with Centric Health and Roche is in the demonstrator phase. The early results are very promising - in a cohort of one hundred patients who
“ We think using this new digitalbased, home-based approach to healthcare can be transformation” MARTIN CURLEY
DIRECTOR OF THE DIGITAL ACADEMY AND OPEN INNOVATION, HEALTH SERVICE EXECUTIVE hse.ie
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HEALTH SERVICE EXECUTIVE
“ We're trying to transform Ireland to go from being a digital laggard to a digital leader in five years” MARTIN CURLEY
DIRECTOR OF THE DIGITAL ACADEMY AND OPEN INNOVATION, HEALTH SERVICE EXECUTIVE
Telemedicine video on the move RedZinc constantly innovates in wearable video solutions for on-the-move video communications for the healthcare industry. LEARN MORE
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are being monitored remotely, thirty two early interventions have been made which have avoided the need for a hospitalisation. In the near future, HSE hopes to roll out a solution called Vital Signs Automation, which will automate the process of collecting the observations nurses do to monitor vital signs. "This will also automatically compute something called an early warning score, which detects whether a patient is deteriorating so that an intervention can be made. We're testing it in a Living Lab in Cavan General Hospital, and the nurses really love it - it's transforming their role. It's eliminating much of the paperwork they have to do and giving them back more time for caring.” Another solution called RespiraSense has also proven to be very effective, in this case for patients with COVID-19. RespiraSense wirelessly transmits a person's respiration rates while they're lying in bed, using innovative piezoelectric technology and advanced processing algorithms. "Historically, it has
been very difficult to actually measure the respiration rate of a patient; nurses monitor it subjectively. In a trial in one of our Living Labs, we found that 80% of nurses reported respiration rates were incorrect, so we were making care decisions based on information that wasn't quite right." RespiraSense, which was co-introduced with PMD Solutions, gives accurate rates as well as a 12- hour notice if a patient is going to deteriorate, which has helped move people to the ICU quickly when needed. "Typically, it enables shorter lengths of stay and better results for the patient," Curley says. It helps identify to clinicians which patients might need more care in a busy ward. PMD Solutions also helped them integrate RespiraSense into the vital signs solution, enabling all vital signs, including blood pressure, pulse oximetry, and respiration rates, to be automatically recorded. "We think this is a global first, that we could be the first hospital hse.ie
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system in the world that has automated respiration rates as the standard of care in our non-ICU wards." Another key partner is Irish software-asa-service company RedZinc. HSE worked with RedZinc on a new video conferencing solution for St. James's Hospital, Ireland's largest teaching hospital and HSE’s mental health division. "It works very simply. The consultant that needs to speak to a patient sends them a text, the patient clicks on the text, and it immediately opens a secure two-way video conferencing solution. At the start of the COVID-19 pandemic we had the solution in place in a matter of weeks before we started to see some of the more mainstream solutions become adopted." 16
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He attributes the speed at which they've been able to innovate to their partner ecosystem, which includes large companies, universities, policymakers and SMEs. The stakeholders work with an approach called Open Innovation 2.0. "Open Innovation has been around for a while," Curley explains. "It was popularised in 2003 by Henry Chesbrough. I had the privilege of working with the European Commission and leading a group focused on Open Innovation over the last nine years or so. We were tracking what was happening with Open Innovation and recognised a new paradigm has emerged: Open Innovation 2.0.” "Where Open Innovation is a collaboration between two parties, Open Innovation 2.0 is a multi-party collaboration with many actors from different areas all coalesced around
HEALTH SERVICE EXECUTIVE
a shared vision. Through working together based on a shared vision, we're able to deliver far greater impacts than we could if we just innovated on our own. We've worked with a pipeline of around 15 different SMEs to co-innovate solutions in the last year alone." One company that mobilised really quickly was Trimedica, which created the TRITEMP thermometer. This uses infrared technology to measure the temperature of a patient and requires no contact - it can even be used while a patient is sleeping without needing to wake them up. "This was also very important in terms of COVID-19 when we knew very little about the disease. The limited contact between the clinician and the patient reduces the risk of COVID-19 spreading, so it's very beneficial."
Curley adds that another benefit that is often an afterthought is the total cost of medical equipment or medical devices, which in the case of TRITEMP is around a fifth of a conventional device because it doesn't have disposable parts. "It's a very sustainable solution. Once we identified this solution, TRITEMP had shipped hundreds of these devices to us within a couple of days, and they were deployed immediately by public health nurses going out to people's homes and in our hospitals." The overarching aim of building HSE's digital capacity to transform healthcare is to improve the lives of patients, as well as those of the clinicians. "Ultimately, if we're successful, Ireland will be a really healthy society. The focus of the healthcare system will move from recovering from illness to maintaining wellness. We'll use techniques like social prescribing rather than always prescribing pills as the solution. It will be a proactive, predictive system and is based primarily in the home and community - we will still have acute hospitals, but they will be highly digitised. "We think using this new digital-based, home-based approach to healthcare can be transformational," Curley adds. "Every healthcare system in the world is struggling and has budget and service challenges. We think we can provide a design pattern for other health systems to copy. Most importantly, we hope patient experiences and outcomes will be better, clinician experiences and outcomes will be better, and people will live longer and more fulfilling lives."
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