Health Information and Communications Technology ICT in Ireland

1
Health Information and Communications
Technology (ICT) in Ireland

• Presentation to CEN TC251 Strategy Conference
  Brussels 11th-12th December 2000
• by
• Chris Costello, Systems Unit, Department of
  Health Children, DublinTC251 Mirror Group
  Chairperson

2
Eight Regions
Eastern Regional Health Authority (35
population) Midland Health Board Mid-Western
Health Board North Eastern Health Board North
Western Health Board South Eastern Health
Board Southern Health Board Western Health Board
3.62m people (1996)
3
Regional Authorities Responsible for ...

• Primary Care
• 37 approx. of citizens have free services
• Acute Hospital Care
• Community Services
• Health Promotion
• Seamless Care Service Integration are therefore
  key objectives

4
Big Issues

• Waiting Lists
• Staff retention
• Controlling costs predicting measuring impact
  of additional spending
• Ensuring quality
• Co-ordination of services
• Provision of services at most appropriate
  location - many remote areas

5
ICT Funding

• Department of Health and Children provides
  funding to the regional authorities for capital
  ICT investment
• In support of agreed ICT strategies focusing on
  business priorities
• Regions generally top-up this investment
• Regions are responsible for selection of
  solutions
• Co-operation strongly encouraged
• Running costs are met by the regions from revenue
  budgets

6
ICT Funding continued

• ICT Funding now provided under the National
  Development Plan (NDP) 2000-2006
• Significant Increase over previous levels
• Authorities pressing the case for further
  investment
• Recognition at the highest levels of the
  increasingly important role of ICT as an enabler
  in achieving business priorities

7
Traditional Health ICT Market in Ireland

• Focus on Hospital Information Systems
• Core systems generally supplied by a single
  supplier with departmental systems from same or
  other specialist suppliers
• Interfacing rather than true integration
• Market dominated by a number of suppliers -
  mainly U.S. or U.K. based
• SMS
• HBOC (formally Gerber-Alley or ATT Istel)
• Keane (formally Ferranti)
• Home grown systems in three regions some
  hospitals

8
Health ICT Current Position

• Virtually all acute hospitals have at least
  administrative support
• Most larger hospitals have HIS
• Departmental systems common e.g. Laboratory
  Radiology
• Order Communications in major hospitals
• A small number of more modern systems
• Integrated best-of-breed solutions
• PACS integrated with HIS and RIS

9
Health ICT Trends

• Replacement of older hospital systems
• Integrated solution with core from a single
  supplier
• Co-operation between regions likely to be a
  small number of suppliers
• National projects
• Enterprise management - SAP National Human
  Resources initiative Cancer screening
• Increasing focus on integrated solutions covering
  all aspects of responsibility
• Requirement for Electronic Health Record
• eEurope eGovernment eCommerce eHealth .
• High bandwidth telecommunications infrastructure

10
NDP Capital Health Funding
Total 2.54 bEuro (2.0 bIR) Specific ICT
183.85 bEuro (144.79 mIRs)
11
Health Spending Priorities (NDP Plan)

• Provide facilities for persons with an
  intellectual disability
• Develop a range of facilities for the elderly
• Address major unmet needs for the mentally ill
  and the physically disabled
• Provide a comprehensive, quality and accessible
  acute hospital infrastructure
• Address child care needs
• Remedy deficiencies in the network of health
  centres

Maximise the potential of information and
communication technology (ICT) in the health care
sector.
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Planned Impact of Health ICT Investment (NDP Plan)

• The investment in ICT will have a significant
  impact in providing for
• Better management information for planning and
  more effective decision making
• More efficient processes in service delivery and
  administration
• Faster multifaceted communication with resultant
  services integration
• Provision of more information to the public
• Delivery of services at the most appropriate
  locations with access to various centres of
  excellence via tele-medicine as required.

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Capital ICT Funding provided by Department (mEuro)
Year 2000
2001- subject to increase for inflation
14
Public Health Spending (bEuro)
15
Capital ICT Funding from Department as of
Public Health Spending
Year 2000
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Issues in Achieving ICT Objectives

• Tradition little sharing of information
• Single client identifier Personal Public
  Services Number
• Data protection legislation
• Security standards required
• Delivering on Governments Information Society
  Action Plan
• eBroker Citizen portal
• National Health Strategy Strategy for Health
  Information

17
Issues in Achieving ICT Objectives continued

• Requirement for an electronic health record
• European direction on priorities / required
  legislation
• Lack of standards or clear direction for the
  future
• Market not responding
• Pressure to deliver working solutions

18
Monitoring Indicators being drawn up - Many
Issues (Health ICT in particular ?)

• Less quantifiable than other programmes and
  sectors e.g. roads railways housing energy
  output
• An enabler rather than a pure output
• Multi-dimensional admin. doctors nurses etc.
• Defining the baseline position - relative to
  what?
• A moving target in terms of what is achievable

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Approach on Indicators

• Indicators being devised in conjunction with
  health authorities which will (hopefully)
• Reflect the impact of ICT in supporting service
  delivery
• Give high marks for high quality solutions
• Take account of the changing nature of the
  objective over time
• Show progress v an agreed baseline
• Take account of the remaining work to be done
  mid-term and at NDP conclusion gt Make the case
  for further investment

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Standards

• Little in place in the way of formal standards
• DICOM in imaging
• G.P. messaging partly based on TC251/EEG9
  standard
• Interest from authorities pressure to deliver
  solutions
• Industry lack of commitment to-date
• Policy is to seek and implement wherever possible
  and practicable
• Recognised that standards will be very important
  in supporting future requirements
• Still unclear about the process and way forward

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Some Personal Thoughts ...

• Standards need to be implemented by industry
• With a little help from their friends across
  Europe ?
• Standards should be global in so far as possible
  - U.S. product will always be a strong influence
  in Western Europe
• E.U. has a strong role to play
• eEurope, Health Online addresses only some issues
• Governments must collectively provide stronger
  encouragement
• High Level Committee on Health ?
• Do we wait for the push to come from the citizen?

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Questions ?