Dáil Éireann Debate, Tuesday - 11 July 2023
785. Deputy David Cullinane asked the Minister for Health the estimated cost of delivering the use of electronic patient records across the public healthcare system; and if he will make a statement on the matter. [33905/23]
View answerElectronic Patient Records (EPRs), Electronic Medical Records (EMRs) and Electronic health records (EHRs) terms are often used interchangeably and therefore all have very different cost drivers. Our national eHealth strategy 2013 and subsequent input to the committee on the reform of the health service cited budget EHR costs of approximately €875m pre-market engagement and Acute Hospitals only.
Since the eHealth strategy was published in 2013 and the Committee on the Future of Healthcare – Sláintecare Report 2017, we have learned a lot more about the approach taken by other countries and the factors that influence costs. For example, many countries have deployed single-site, single- instance EHRs to individual hospitals only or where countries have adopted an approach on integrating existing electronic health record systems to present a regional based electronic health record. Only a small number of countries are deploying EHRs on a national roll-out basis including Estonia (who leverage their long established national digital identity and infrastructure systems and adapted that to join up their health data) and more recently Northern Ireland (that are deploying a single, enterprise level EHR system across an entire region (all five health and social care trusts).
In terms of EHRs and their deployment across the public healthcare system, what our experience and research has confirmed there are a number of factors that need to be considered, when planning budgets, that contribute to the total cost of EHR implementation. These range from digital maturity, intending setting (e.g. national, regional, hospital or community wide or site specific based), Hardware Purchase Costs, Training of End-Users (as this is a significant transformation in moving from paper based processes to full digitisation), projected user numbers and needed licences, maintenance and optimisation required, and lastly, expertise to guide and manage these often complex technical and change deployments over and above internal staff costs assigned to the project. It should be noted that delivery of complete electronic patient records also requires other areas of investment besides the core EHR system/s, to cover related clinical, non-clinical systems and supporting infrastructure, cyber resilience etc.
Turning to actual cost information we have from recent procurements run more recently. The delivery of the EHR for Children’s hospital, for instance, has three component costs. The EHR main and support vendor costs are in the order of €50m, project team implementation costs on the order of €50m and c. €40m will be invested to build the supporting for ICT infrastructure. This could be used as a benchmark cost to deploy an EHR into a typical model 4 hospital of which there are 10 spread nationally. Applying a significantly lesser cost to the remaining model 3 and model 2 hospitals, would only add to these costs. Separately we would still need to account for the investment required for community EHR’s also as none of these costs include the cost of deployments in the community.
The intended approach for Ireland, as will be codified in Digital Health Strategic Framework and the Health Information Bill, will be that Ireland will deploy Summary Care Records, followed by Shared Care records in parallel to single instance/single site deployment of EHRs in Maternity, National Rehabilitation, National Forensic and some Acute Hospitals and in advance of an intended wider deployment to other Hospital/Community settings in the future. It will also account for the establishment of Regional Health Areas and the deployment of EHRs across same to support the delivery of integrated care. In conclusion and subject to an affordability assessment, scope of deployment, intended settings to be covered and lastly and most importantly, market response will ultimately determine implementation and life-cycle costs.
