Ireland’s Health Service Executive (HSE) has published its Digital Health Roadmap, setting out a vision to create better health outcomes through a digitally enabled environment around six core principles: the patient as an empowered partner; workforce and workplace; digitally enabled and connected care; data-driven services; digital health ecosystem and innovation; and secure foundations and digital enablers.
HSE notes that an annual digital health budget of between four percent and six percent of the overall healthcare expenditure is being sought to deliver the initiatives outlined in the roadmap; as such the roadmap serves as the business case for this funding.
The strategy highlights a need to reimagine how transformation is delivered, noting challenges from existing processes and structures including large programmes running in parallel and consuming the same resources, increased technological complexity, implementations that are not fully completed and lack of focus on patient workflows. The required change will see “strong emphasis on reusability and alignment”, built on the concept of platform-based architecture – leveraging pre-existing platform components and services to speed up solution development, reduce costs and develop a solid foundation.
HSE goes on to explore each of the six principles in more depth, starting with the patient as an empowered partner and highlighting two particular programmes designed to support in this area. The QUIT programme aims to help people stop smoking by offering services such as counselling, medication support and online resources; and the Text About It programme offers mental health support including a confidential text messaging platform. Other initiatives include remote monitoring and appointment scheduling and management; the national shared care record to consolidate data from different systems and provide a cohesive view of a patient’s history; and the telehealth programme, offering improved accessibility to services and streamlined workflows.
On the second principle, workforce and workplace, HSE pledges to invest further in staffing and infrastructure to enhance the permanent capacity of health and social care services and expand the range of services available in the community. This includes plans to develop a platform offering “seamless access to comprehensive health information” including diagnostics and clinical tools, with reliable and secure connectivity designed for resilience and adaptability.
Focus will also be placed on enhancing digital literacy within the workforce and improving employee experience by providing fit-for-purpose digital tools and resources. These will include an application and digital wallet allowing the workforce to access information, education and learning resources, annual leave requests, occupational health management and interactions with the wider team; simplified processes for new, moving and leaving staff; and work environments designed to help workers “effortlessly transition between different settings while retaining access to the resources they require”. Additionally, HSE commits to prioritising mental and physical health for employees with utilisation of digital tools to tackle stress and reduce burnout, and also highlights plans for continuous skills development and evaluation to support staff in adapting to new ways of working.
On the principle of digitally enabled and connected care, HSE notes plans to integrate information and systems into single digital longitudinal health records, with the vision to have a single comprehensive EHR for every individual. EHRs will “serve as the central tool for managing all patient-related health and social care documentation and will interface with the overall digital platform, allowing for the assessment, analysis and use of all health-related data”. HSE acknowledges that the approach to introducing EHRs “will be complex, as we are not starting from a green field setting”, with multiple systems already existing across the healthcare landscape; however, the strategy highlights how collaboration with partners to define critical national standards for data sharing and use will help to establish a national procurement framework and a shortlist for successful enterprise-level EHR vendors.
It is expected that a consolidated number of EHR systems will be regionally deployed for data sharing within and between regions; the digital solutions present within primary care will be supported and developed; and private hospital systems will develop interfaces to enable bidirectional flow of clinical information.
Specific high-level initiatives in this space include development of a shared care record with comprehensive data integration and modern standards-based APIs; a collection of digital tools designed to support population health management, such as screening services, disease registries and population health analytics; and electronic observations and vital signs monitoring to support diagnostics.
Another key plan is the “comprehensive standardised data capture and digitisation of health care records, that will quickly deliver value, speed up digitisation within the healthcare system, and prepare essential groundwork for the introduction of EHRs”. Activities in this area include digitising existing paper records, developing an eForms platform to facilitate data exchange and standardising terminology to ensure consistent representation of clinical information.
Moving onto the fourth principle of data-driven services, HSE emphasises how real-time monitoring of data will highlight capacity challenges as they arise and support informed decision-making as a result, with data on patient flow and length of stay or treatment used to ensure appropriate resource management. In particular, HSE points to the Integrated Information Service, the main data analytics service for the wider health sector in Ireland, and highlights the implementation of a health performance visualisation platform designed to provide data flows and analytics capacity to examine activity and blockages across the hospital network.
With regards to the digital health ecosystem and innovation, HSE notes the establishment of the Health Innovation Hub Ireland, supporting the adoption of new technologies and processes across the system, and highlights the potential of AI to improve diagnostics, support precision medicine, enhance patient monitoring, aid data quality and assist in drug discovery and development. A strategy built around AI is set to be developed, and HSE also shares plans to explore AI therapists (chatbots), robotic process automation and blockchain technology for health data management.
Collaboration with partners such as universities, innovators and academic health networks will “play a crucial role in supporting innovation,” HSE states, bringing together expertise, resources and diverse perspectives to drive advancements.
Around the final principle, secure foundations and digital enablers, HSE highlights the need to establish effective governance, foster a supportive culture and create a secure and resilient infrastructure, which can be “achieved by integrating architecture, service design, cyber security, agile delivery, and data engineering into our health service”. This principle is the “anchor of this comprehensive transformation”, HSE states, and to ensure success the system requires key foundational elements including strong leadership and governance and comprehensive change management support.
Work will go into establishing clear legal frameworks and regulations to govern digital initiatives, where appropriate, along with establishing decision-making authorities and structures to promote accountability and transparency. Other planned actions include developing a platform to support healthcare system-wide federated identity and access management between healthcare organisations; introducing architecture practices to restructure the digital and operational aspects of the care system to support interoperability; and incorporating agile delivery methodologies to keep a focus on responsive and user-driven solutions.
With regards to staff, HSE also plans to develop a workforce strategy to address recruitment, retention and performance management; conduct a comprehensive assessment of existing digital skills and knowledge across the workforce; and offer cross-disciplinary training such as workshops, webinars and mentorship programmes to support the workforce in digital upskilling.
The strategy also places specific focus on integration, interoperability and data engineering in this area, noting plans to establish a “national data coordination framework for seamless healthcare information management”; to build a unified set of data management standards; and to build data engineering and integration capabilities across the system.
In terms of timings, HSE shares “immediate actions required”, including the establishment of a governance framework; a dedicated transformation team; and data, standards and interoperability requirements “to serve as a critical foundation”.
Going on to look at year one and two of this roadmap, priority actions will include developing a patient portal, HSE App and HSELive Contact Centre; focusing on remote care monitoring, digital therapy, ensuring reliable secure connectivity and modernising the workplace and productivity tools; developing the shared care record, diagnostics and medication management; and focusing on population health management, EHR procurement and delivery and national clinical information systems. Other actions include exploring patient journey analytics, healthcare data analytics and scheduling, rostering and resource management; legislation and governance; patient identity management; integration, interoperability and data engineering; and the ICT cyber programme.
Focuses for year three and four of the plan include developing a mobile ecosystem for the frontline; medical device integration; integrated referral management; healthcare research; healthcare worker identify and access management; crisis response healthcare; and a 24/7 support function.
Looking ahead to the future from year five onwards, HSE will be focusing on developing a patient feedback platform and open health AI framework; public facing engagement and learning programmes; an employee feedback platform; AI in healthcare; and launch of the first EHR.
To access HSE’s digital health strategic implementation roadmap in full, please click here.
Ireland in the spotlight
In July, HTN reported on the publication of Ireland’s Health Information Bill 2024, designed to provide patients with increased access to their own information and providing a “clear legal basis” to establish a Digital Health Record across Ireland.
Earlier in the year we interviewed Aislinn Gannon, general manager for digital health at HSE.
And we explored HSE’s telehealth roadmap for 2024-2027 here.
