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eHealth in Ireland

Project Oak Launch 5/4/2017

Name

Fergal Marrinan, EHR Programme Manager

Delivering eHealth Ireland | Office of the Chief Information Officer

Background

New entity called ‘eHealth

Ireland’ created as a result of the

‘eHealth Strategy for Ireland’.

The Office of the Chief

Information Officer is the team

responsible for delivering this

strategy, led by:

CIO: Richard Corbridge

CCIO: Yvonne Goff


What is eHealth?

eHealth is the means of ensuring

that the right health information

is provided to the right person at

the right place and time in a

secure, electronic, accessible and

meaningful format for the purpose

of optimising the quality and

efficiency of healthcare delivery.

Some eHealth systems are: Electronic Health Records

ePrescribing

Telehealth and Telemedicine

Automated Pricing, Performance,

Billing and Claims Management.


Why change?

• Our care is mostly reactive, we wait for the

stroke, heart attack…

• We have an ageing population with multiple

chronic diseases and obesity

• Data we receive are intermittent and

fragmented

• Our existing care models are mainly paper-

based

• Resourcing - Lean Teams -1:236, ratio IT

person to HSE Employee


• Clinicians inform both small and large scale implementations

• Creating a well tested model for the national EHR (e.g. Lighthouse

projects)

• Leading to a new paradigm of healthcare delivery

What does this mean?


What is the National Electronic Health Record?

The National EHR

comprises:

What does the National EHR do?

• Transforms patient experience

• Delivers greater patient safety and more

effective care

• Drives efficient delivery of health services

• Makes the wider reform programme

possible:

- Underpins integrated care

- Provides the information for

proactive health and wellbeing

initiatives

- Provides the operational systems to

realise CHO’s and Hospital Groups

- Captures accurate information on

activities that show the true cost of

treating a patient

!The National EHR is a fundamental cornerstone for the delivery of high quality,

comprehensive and accurate information in a timely manner for the provision of

patient centred, effective and efficient care

Pharmacy

GP Systems Private Hospitals


The National EHR Suite

National

Core

Solutions of

Record

Innovative Solutions

National Extended

Solutions

Key capabilities based on minimum viable

solution for all organisations from a single

vendor

Enhanced capability of core solutions are

extended from the core in first instance

unless there is a strong rationale for an

alternative

Emerging and innovative solutions from

the marketplace introduced in a controlled

manner

The implementation of a National Shared Record can progress

in single implementation but solutions for Hospital Groups and

CHOs must be phased given the scale and complexity

National Children’s

Hospital will have a

focused core based on

paediatric requirements.

!


Operational Systems (Core & Extended)

Community Operational Systems Acute Operational Systems


Personas and Scenarios

9

Scenario: Cerebrovascular Accident

Actors: Citizen (Tom McCarthy), Emergency Medical Technician, Registrar, Case Manager, Physiotherapist, Nurse, GP (Dr. Martin)

Tom McCarthy was diagnosed with atrial fibrillation about six months ago. He has been very non-compliant with taking his warfarin. Four hours ago he started to develop some weakness in the left side of his body and face. He chose to ignore it but it has progressed and Tom is starting to become concerned. When Tom’s wife, Sheila, came home she fears he is having a stroke and calls an ambulance.

The ambulance is en route to Tom and Sheila’s home in Tramore, 13km from Waterford Regional Hospital. One of the Emergency Medical Technicians (EMT) in the ambulance has accessed the National Summary Care Record and has been able to review information about Tom. He retrieves Tom’s health profile and reviews his summary medical history, current problem list, allergies and medications.

Tom is taken to Waterford Regional Hospital. After assessment in the Emergency Department there, Tom undergoes a CT scan which suggests a cerebrovascular accident (CVA, or stroke). The General Medicine Registrar on call that evening, Dr. Cheema, assesses Tom in the ED to admit him to hospital. He gets as much history as possible from Tom and Sheila, but this is limited. He examines Tom then reviews the CT images. Dr. Cheema reviews the ED notes in the hospital EHR and accesses Tom’s records. He is able to view Tom’s health profile and see his current and past medical problem list. He can also see the medications which have been prescribed. Dr. Cheema searches for the 15 most recent lab results to get an idea of Tom’s anticoagulation status. After reviewing this information, Dr. Cheema feels Tom has had a stroke secondary to atrial fibrillation with poor anticoagulation. He creates a record of the admitting history and physical in the hospital EHR.

After several weeks in hospital, Tom has recovered to the point where he can be discharged home. On leaving the hospital, Tom is assessed for home care services. The case manager meets with Tom and reviews his recent health events with him. She accesses his records and is able to see the details of his recent hospitalisation. She reviews the medical, nursing, social worker, pharmacy, respiratory therapy, speech therapy, physiotherapy and occupational therapy notes and/or discharge summaries. The case manager does her own assessment of Tom and, together, they formulate a plan of service. She makes a record of her findings and plan in the care record and arranges for the appropriate services to be delivered at Tom’s home.

The home care services arranged for Tom includes physiotherapy. The physiotherapist assigned to work with Tom accesses his records and searches for his last 5 encounters. She drills down into the recent hospitalisation encounter and reads the discharge summary and physiotherapy notes. From this she has a good impression of the history of Tom’s stroke, his deficits from it, the treatment thus far and the ongoing management plan. The physiotherapist assesses Tom in his home. She performs her evaluation and commences treatment with him. At the end of the session she creates a record of the encounter in her Community EHR system.

Six months later, Tom develops a respiratory infection and is readmitted to Waterford Regional Hospital. He is not physically able to return home so is admitted to a long term care facility. He has been residing in a long term care facility for about one year following his stroke. His lung function has continued to deteriorate as a result of chronic obstructive pulmonary disease and, with it, his overall functional abilities. Tom recently developed another respiratory tract infection. He has become very weak and is having greater and greater difficulty breathing. Tom and his family had previously decided with his GP Dr. Martin, that attempts will not be made to resuscitate him should the situation arise. This wish has been recorded in Tom’s Summary Care Record as a patient directive.

Late one night Tom’s condition deteriorates markedly and he passes away. The nurse who was with Tom when he died makes a record of the event in the facility’s electronic records and notifies Dr. Martin. Dr. Martin comes in and pronounces Tom deceased.

Bio:

Tom is a retired 72 year old who spends the majority of his time at home with his wife Sheila. They have a grown up family who live in other parts of the country. Tom is not a major user of technology and prefers more traditional face-to-face interaction.

Health Status:

Tom is not particularly active and while he is good at having check-ups, whenever he’s prescribed medication for any condition, he’s not good at remembering to take it.

Goals:

He wants clinicians to tell him straight up what the outcome is likely to be so he can plan around it.

Frustrations/Fears:

He would not like to ever become a burden on his wife or his family.

Technology: Broadband Access Smartphone/Tablet

High Low Internet Usage

Low High Tech Comfort

Emotional Rational

Organised Disorganised

Extrovert Introvert

Personality

Tom at a glance Age: 72

Location: Waterford

Family Status: Married

Education: College Graduate

Employment Status: Retired


5 Years 10 Years

Cri

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National Solutions

PAS

Replacement

Initial National Shared

Record

Haemophilia

Lighthouse Project

Epilepsy

Lighthouse Project

BiPolar Lighthouse

Project

Portal

(Organisation)

Other Future

Innovation Projects

Order/Comms

Other Future

Innovation Projects

NCH Implementation

eDischarge

Single

Solution Set

Evolving to a single

solution set will require

agility and a governance

approach that supports a

dynamic environment

Other Future

Innovation Projects

National Shared Record Development

MEDLis

MN-CMS

MOCIS

Acute Operational Components – Phased Implementation in HG’s

Community Operational Components – Phased Implementation in CHO’s

NIMIS

National Solutions

ePharmacy

eRefferal

EHR: 10 Year Programme


Maternal & Newborn Clinical Management System

Background

Ireland is the first country to adopt

EHR for its maternity hospitals.

This project stemmed from reports

looking into maternity service

provision in Ireland.

Current Status

The project went live in Dec 2016

in Cork and earlier in March in

Tralee – a phased national roll out

follows during 2017.

Led by CCIO, OoCIO, and the MN-

CMS team.

Cerner appointed as the preferred

vendor.


MN-CMS

Key Benefits

Improved patient care through

better communication and visibility

Improved standards of recording

information through the adoption

of best practice

Better quality data for clinical

audits and research

Informed business intelligence to

guide management decisions

locally and nationally

Image adapted from: http://healthitsecurity.com/

http://healthitsecurity.com/


Cloud First Strategy

Aims

Provide and maintain robust, secure,

accessible, high performance Cloud

architecture for healthcare.

Deliver high performance and scalable

IaaS to any application and disaster

recovery programmes.

Provide robust, affordable and scalable

secure platforms for Test and

Development systems.

All future procurements will be

developed as ‘Cloud First’ solutions.

To future-proof Irish healthcare IT solutions and become a world technology

leader in healthcare.


ePharmacy Programme

Our approach was to meet

with most of the stakeholders

and software vendors.

This allowed us to listen to

their concerns and ideas

while we reviewed the

documentation.

With this we were able to

determine the best way to

progress ePrescribing across

Ireland in a structured,

standardised, coordinated

and safe way.


eHealth Ireland is working to deliver an Electronic Health

Record (EHR)

To understand the benefits of an EHR, three project areas

have been chosen:

Bipolar Disorder

Haemophilia

Epilepsy

We are working with a number of other organisations to

research the implementation of a flexible and reusable EHR.

Through the projects the many positive outcomes and

benefits for patients as well as healthcare professionals

associated with using information technology within health will

be showcased.

Lighthouse Projects


Epilepsy Lighthouse

16

• Nationwide eHealth Project

• Participants– 50 adults with intellectual disability and

epilepsy

– 50 children with epileptic encephalopathy

– Unaffected parents

– Healthcare/service Providers

• National Epilepsy Electronic Patient Record (EPR) Enhancements– Genomics Module

– Patient Reported Outcomes Portal

– Data Analytics Visualisation


Innovation Centre

What is it?

A culmination of a number of

collaborations and health strands

that have been in place over the

last 2 years.

Why?

To encourage people, academics,

clinicians and other stakeholders

to further research and collaborate

on the development of innovative

projects in health.

Inspire the development of future

projects using the Lighthouse

Projects as templates.


HealthTech

Aims

Identify health technology start-ups with a

vision to creating a new future for

healthcare.

What is it?

A pre-accelerator – a partnership initiative

between NDRC and eHealth Ireland.

How does it work?

The programme is an intensive action

learning and mentoring based.

Based on the results of the pre-accelerator,

successful candidates would be eligible to

apply for a place on an NDRC Investment

Programme with the aim of building a

successful start-up.


Who are the council and what do they do?

Established to provide clinical governance for the

delivery of eHealth solutions.

It acts primarily as an advisory group with primary

governance oversight provided by the Office of the CIO

and the eHealth Ireland board.

It can include: Any clinician with an interest in improving care and patient safety

through the use of eHealth solutions.

Information Leaders - who promote and deliver eHealth solutions.

Academics who have involvement in education, research and

development in eHealth success.

Supplier CCIOs - partnerships rather than a customer/vendor setup.

Council of Clinical Information Officers


• Over 260 members

• Bringing together clinicians to guide the

successful delivery of eHealth

• Clinicians are empowered through the

Special Interest Groups to guide

projects

• Engagement throughout the lifecycle of

both national and local projects

• Events, Social Media, Discussion

Forum, Blogging Site

Council of Clinical Information Officers


Collaboration: building relationships, nationally and

internationally with other CCIOs (e.g. Summer School,

Leeds).

Education: promoting Health Informatics training in

undergraduate programmes.

Policy: working with groups to develop policies, for

example supporting the broad adoption of mobile apps in

health.

Clinical Leadership: CCIO members are the Clinical

Leads on the 3 Lighthouse Projects – these focus on

Epilepsy, Haemophilia and Bipolar.

Special Interest Groups: contribute to national policy.

CCIO Developments – 2016/17


Do follow up

[email protected]

@marrinan

22

mailto:[email protected]

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