The eHealth of the nation
“To lose one parent may be regarded as a misfortune; to lose both looks like carelessness.” So said Oscar Wilde in 1895. The phrase jumped to mind as the Government recently lost its second Government-wide Chief Information Officer in less than two years.
It took four long years for the actual establishment of the Office of the Government Chief Information Officer at the Department of Public Expenditure and Reform in 2013.
The establishment of the Office followed the appointment of Bill McCluggage as Government Chief Information Officer in June 2013. He resigned within six months, citing “personal reasons” for his departure. Michael McGrath was subsequently recruited and appointed, and he resigned this month after just 14 months in post. The Department of Public Expenditure and Reform says he is pursuing other career opportunities.
When the Office was launched, Minister Brendan Howlin said it was “an important development in Government’s ongoing commitment to maximising the potential benefits of ICT in improving the efficiency and effectiveness of public service delivery”. The resignations of two people appointed to head the Office indicates an absence of any real commitment within the Government to utilise IT to support the public sector reform agenda and to improve the public service.
However, there have been some positive developments in the area of IT in health. The recent appointment of Richard Corbridge as Chief Information Officer (CIO) in the HSE throws some much-needed and long-awaited light on what has been a long, gloomy winter for use of technology and information systems in the health sector.
Corbridge was previously CIO of the National Institute for Health Research in the NHS in England. Specifically, he spearheaded the Clinical Research Network, which is responsible for providing information systems and business intelligence to 10,000 research-related staff in the NHS. He was recently ranked as the fifth-most influential CIO in the UK.
The appointment follows the publication in 2013 of the eHealth Strategy for Ireland and the Government-wide National Digital Strategy for Ireland. Last year, legislation was passed to allow individual health identifiers (IHIs), which will be able to track and facilitate the public’s use of the health system. This year will see the introduction of the first system-wide IHIs and electronic patient records, with their full roll-out within five years. The Health Information Bill is on the Oireachtas schedule for 2015, some 14 years after it was first promised, although it is still just at the Heads of Bill stage. Under Corbridge, a detailed strategy for ‘Knowledge and Information’ — in effect, a high-level implementation plan for eHealth — will be published shortly.
There are, however, some advantages to coming so late to IT developments in the health sector. We can learn from the mistakes made by other countries and indeed, ourselves in the past. Central to this is that technology and information systems must become core to everyday health and social care delivery. For that to happen effectively, it is crucial that both staff and citizens see the benefits and are active participants in those processes.
Introducing effective knowledge and information systems in health requires resourcing, and building on small successes to date.
Writing on this matter in the journal eHealth, Law & Policy, Corbridge points out how Ireland has significantly underinvested in IT. The average investment in information systems across Europe is between 2-3 per cent of the health budget; in Ireland in 2013, it was 0.85 per cent. Budget 2015 earmarked €55 million — a 30 per cent increase — for much-needed IT capital infrastructure developments.
The European Commission has endorsed the need for an emphasis on eHealth in its recent country-specific recommendations to Ireland. Specifically, it stated that “effectively rolling out e-health tools, activity-based funding and improved prescription practices have significant potential to increase cost-effectiveness”.
The most recent reorganisation of HSE structures – this time into hospital groups and community health organisations – will once again cause more disruption to service organisation in the near future. But their embryonic form may provide an opportunity to dovetail with IT and eHealth developments which result in improved access, experience and outcomes for the public from health services.
Progress is stunted at a national level in developing and utilising information systems, knowledge and structures to enable public sector reform. However, the arrival of Corbridge as HSE CIO, combined with the small, initial financial and apparent political commitment to making eHealth happen across the Irish health system, provides a great opportunity to improve public health and assist in ensuring a safe, effective public health system in Ireland.