Dáil Éireann Debate, Tuesday - 23 January 2024
591. Deputy Cathal Crowe asked the Minister for Health for an updated on the implementation of Electronic Health Records in Ireland; and if he will clarify why Ireland is so far behind its European counterparts in this regard. [2491/24]
View answerWhilst it is true to say Ireland is still behind many of its peers in relation to the use of electronic health records (EHRs), actions are now being taken to address this deficit.
In addition to the delivery of EHRs into specific hospitals like St James Hospital in Dublin, three of our largest maternity hospitals, the national rehabilitation and national forensics hospitals, all GP practices now use electronic health records to manage patient data. Furthermore, the evidence we have seen from most other countries that have a national EHR, suggests that these patient records are delivered by collating data from existing, local or regional systems, and combining this data into a singular view that is accessible by healthcare professionals and increasingly, by patients themselves.
The evidence further suggests that clinicians in these countries mostly use local IT systems to manage data about the patients they are treating, and use the national or regional records to understand more about their patient if or when they were treated by clinicians elsewhere.
This is positive for Ireland because it means that we can build on the existing investments we have made in EHR systems (and other clinical systems) to date, and take a stepwise approach to delivering national and regional electronic health records, to overcome the deficit in how we compare to international peer countries to date.
Furthermore, most countries we have engaged with also highlight the opportunities that exist by deploying EHR systems now, rather than when they started their journey, which in some cases was over 10 years ago. These include the opportunity to deploy newer technology, access more mature and better proven solutions than those that were available in the past, and to leverage mobile technology, cloud based solutions and more digitally literate staff and patients. Indeed, during recent engagements with other countries, many of their technical teams commented on the challenges of being tied to older technology and legacy solutions.
To that end, whilst we will continue to invest in major EHR systems deployments across a number of care settings, such as the one at the new National Children’s Hospital - which will be the most extensive and capable EHR in Ireland to date - we will also invest in other capabilities such as the technical platforms and standards that enable us to collate data from existing systems. For instance, the HSE are in currently in the market to procure a technology platform to deliver a National Shared Care Record, which is a form of electronic health record that is similar to what many other European countries have delivered, and importantly allows us to join data from across existing systems to present a single view to clinicians and patients. It is anticipated this procurement will complete in 2024. Design, configuration, build and testing will all take time, but we anticipate initial deployments in 2026/27, delivering a national capability to allow both clinician and patients access medical records and in time more comprehensive health records as we deploy future EHRs.
However, these forms of national electronic health records are only as good as the data that can be derived from the source systems. For this reason, in parallel with the national shared record, we must continue to invest in core clinical systems and accelerate investment in the large enterprise EHR systems, like the one at Childrens Health Ireland.
The decision in 2018 not to proceed with large scale investment in this area and only to proceed with CHI at the time, was based on availability of funding and the capacity of the health system to take on such a large scale and complex programme of work.
Since 2018, the Government has consistently invested in digital health to build the capability and capacity of the ICT team extensively. Combined with the companies that specialise in supporting health services in the deployment and optimisation of enterprise level EHR systems (some of whom already work with CHI and others who work with the health service in Northern Ireland), we believe we can now address the challenge of capability.
As we invest further in digital and commit to electronic health records, we must be mindful of the devastating impact that the criminally motivated cyber-attack had on the Health Service in 2021. It is therefore equally important that we continue to invest in building cyber resilience, to ensure we have secure technology foundations, and the ability to protect data and keep it safe.
It is acknowledged that while there is a need to invest in EHRs with some urgency, there is still the challenge of funding this in order to make the desired progress. We estimate that a strategy based on a regional deployment of EHRs is likely to cost between €200m and €300m for each of the new 6 regional health areas. This will be considered by Government in the context of ongoing deliberations regarding additional funding to be made available in the upcoming review of the National Development Plan.
In the meantime, the HSE are examining ways in which Ireland can meet its EU obligations under the ‘EU Digital Decade’ Policy, whereby all EU citizens should be able to access their own digital health record by 2030. commission.europa.eu/strategy-and-policy/priorities-2019-2024/europe-fit-digital-age/europes-digital-decade-digital-targets-2030_en
We plan to do this by looking at combining data derived from GP systems, the reimbursement service and existing hospital level data where available, and by leveraging the shared care record technology platform to deliver this to citizens through a secure portal and patient app. This is completely aligned with how many other EU member states have delivered this capability.
In summary, a ‘stepwise’ approach to the delivery of electronic health records is typical when compared to many other countries. It also facilitates a good balance between making progress whilst managing risk, for what are quite complex programmes.
It should be noted that those countries that are recognised as leaders in digital health have been working in this area consistently for over 20 years. By way of context, Denmark, often cited as a Digital Health leader, was coding clinical diagnosis and procedures long before EHR systems become available. This coding enabled Denmark to manage the health of their entire population very effectively and made the transition to digital health systems more straightforward. Estonia, another country that is considered a leader in digital health, had already built its national infrastructure before EHR systems were deployed, so the health service there was able to ‘tap into’ that capability when it came time to deliver their national electronic health record system.
Finally, by maintaining a consistent focus and investing strategically in digital health, Ireland will, in the coming years, considerably improve its status when compared to other EU member states.
