I thank the committee for the invitation to attend this committee meeting. I am joined by my colleague, Yvonne Goff, who is the HSE's chief clinical information officer, a role recognised globally as key to enabling the delivery of digital solutions in health and to maintaining a clinical focus in the delivery of digital solutions for how we put forward what we do. The work being done in Ireland around clinical engagement has been recognised by the European Union, the World Health Organization and the NHS as having world class clinical engagement and leadership in many of its digital projects. This is a crucial foundation to the digital journey we are on today.
I will first clarify the concept of eHealth Ireland in relation to the Health Service Executive. It is a function created out of the eHealth Ireland strategy of 2013. This document was provided to the committee previously by the Department of Health in an earlier submission. Today, eHealth Ireland is a function within the HSE tasked with bringing about a change to the way in which health care is delivered in Ireland through the use of digital solutions. The documentation that has been provided to the committee ahead of this meeting will give it a comprehensive view of what and where the delivery for the eHealth Ireland programme has got to over the last 18 months. These documents include: Ireland's eHealth, a progress document that sets out key successes that have been achieved and provides a summary of the focus for the next 12 months, highlighting priority areas throughout the health system, and the Knowledge and Information Strategy, a plan formulated and agreed across all stakeholders in March 2015. This document sets out an organisational design which created a national programme delivering digital benefits into health throughout Ireland. In addition, there is a pack of ten slides which give the committee some pictures to explain some of the things we will go through as part of this opening statement.
The development of the knowledge and information plan is not simply another health-based strategy. Its agreement and implementation has enabled us to move forward at a rate not seen before in digital health in Ireland. It has enabled us to consider what digital means to health care specifically in Ireland, learning from other jurisdictions such as the USA, the NHS in the UK, Northern Ireland, Estonia and Australia, where success has been achieved in some arenas and where significant lessons have been learnt in others. The delivery of digital solutions supporting health care is described in the knowledge and information plan. It has enabled the HSE to put in place a national team to deliver solutions to the whole health system. It removes a previous focus on acute hospital solutions and places at the heart of health care delivery the ability to centre what we do with digital on the health system, not the health care definitions and boundaries but putting the patient at the centre of everything we do.
Digital solutions deployed to the health care system are immune to organisational structure and change. They are put in place to empower the patient to choose where they want to be treated and to neutralise the current boundaries of health care. Effectively, digital solutions can be seen as a catalyst to the delivery of integrated and personalised care. "No more IT projects" is the mantra of eHealth Ireland. This may seem somewhat strange but it is a key lesson learnt from previous attempts to deliver large digital solutions in health in Ireland. What do we mean by "No more IT projects"? We mean everything that digital can do, whether it is a new financial management system or an electronic health record for community functions around Ireland, has to be more about the business change than the technology. Digital solution should not change the way people work. We need to do that through development of business change facilitated by digital.
The knowledge and information plan defines the resources, both financial and human, needed to do this and a timeline to enable it.
All targets set in the plan in the spring of 2015 have thus far been met, which is a credit to the eHealth Ireland team and its collaboration with the Department of Health. The success of 2015 has released a small amount of additional funding to the HSE in this area after over a decade of what is considered to be under-investment.
Building on a change that has seen some success provides Ireland with a unique opportunity to apply lessons learned from elsewhere and move forward safe in the knowledge that others have proven the direction Ireland can take. Now is not just a safer time to invest in digital solutions for health, but an essential time. The integration of care, the removal of false boundaries and placing care delivery around the patient can only be achieved with digital solutions.
I would like to provide the committee with an overview of the current resources available to the HSE to take forward this digital agenda. We have a very lean team in comparison to other Government Departments and health care systems. There is one IT person supporting every 236 people in the HSE today. Other Departments such as the Revenue Commissioners have one IT person supporting every 11 resources. In other areas, such as social welfare and agriculture, there is one IT person for every 17 resources to support their complex agendas.
The current average EU health care budget spend on digital solutions is just over 3%. The HSE has around 1% of its budget allocated to this agenda. In 2016, we secured permission to add further resources to the team, around 49 new people. This has been progressing through the year as we start to bring those people on board and into the team.
The HSE has created a function that can work in an agile manner. It does not require funding linked to EU norms. However, it will necessitate a steady programme of investment that, over time, enables it to become a function that drives business change and supports digital delivery in health. I ask the committee to give consideration to how digital solutions can be implemented in health care over the next decade. In order to truly realise benefits, the system needs to be equipped with business change capabilities and the ability to apply funding from IT to business change.
Clinical leadership of digital projects today is the key enabler of the of the work eHealth Ireland is doing. More than 200 clinicians across 45 disciplines now have the additional role of clinical information officer. This resource is there to ensure that projects that used to be focused on the delivery of IT are now there to focus on the delivery of patient and clinical benefit. The vision can overcome many operational issues in the creation of integrated care. Digital is the catalyst for the delivery of an empowered patient who expects and rightly assumes that care is integrated.
In 2015, the Minister's office asked us to consider how we could learn through real Irish digital projects within our current budget. We chose three radically different chronic disease areas to focus on: epilepsy, bipolar disorder and haemophilia. These areas became known as lighthouse projects. Haemophilia now has a patient solution that allows illness to be managed, controlled and audited digitally. The supply chain of that treatment can now be managed at home with the patient's mobile phone. The solution also allows patients to have access to their records and will this year enable secure communication with their clinicians. The Irish Haemophilia Society has considered the savings in this programme and puts the figure at around €10 million a year in drug cost savings.
A second lighthouse project is epilepsy. Ireland has begun its first genomics sequencing programme in partnership with the Royal College of Surgeons in Ireland. Through seeking for the genome of suspected epilepsy patients we can provide efficient and safe care to a cohort of patients; fatalities could be avoided and the cost of treatment has come down dramatically. There are as many as 130 epilepsy-related deaths in Ireland each year, 90 of which are considered to be undiagnosed children. The cost of finding the correct medicines for those patients is approximately €5 million year. Investment in this project has made and can continue to make treatment available for 40,000 epilepsy sufferers in Ireland. Treatment can now be personalised and contextualised to their type of epilepsy.
The final lighthouse project is in the area of bipolar disorder, which affects 1% of the Irish population. The ability to treat complex mental health issues through the use of digital solutions is yet to be fully explored globally. Ireland has been able to invest and we consider bipolar disorder as an area to concentrate on. Delivering a solution for the recording and communicating of the patient's disorder directly to the clinician is the first step for this calendar year.
I would like to describe a number of national solutions that have been the focus of our attention over 2016. These are projects that can become the foundational elements of the future of a digital fabric of Ireland. In the coming weeks, the individual health identifier will be connected to the first local health system, joining up information and supporting integrated care. The technology infrastructure to support the individual health identifier, which was legislated for in 2014 by the Health Identifiers Act, is now live. The complete population and building of the process to support this within health are under way. The Department of Health continues to work with the Department of Social Protection to get agreement on the linkage between datasets, all of which is made clear in legislation. This will allow us to populate many of our current and new information systems with the IHI, ensuring that patient information across a range of systems can be safely connected. The HSE is ready to place the individual health identifier on all electronic referrals as soon as the Department has completed this negotiation.
The implementation of electronic referrals in every hospital in Ireland is now complete. More than 40% of GPs used the service in August 2016, with 10,733 referrals being handled by this digital service during that month. This means that a patient can see the arrival of his or her referral in the hospital while he or she still with his or her GP. This solution removes the need for a paper referral and for the GP practice to post the referral, where the referral can touch an estimated 11 hands in its movement through the health system. This digital process enables an increase in efficiency, security and traceability, and allows us a significant opportunity to modernise the referral process. This will clearly have an impact on waiting lists across the system and will create a significant cost reduction with the removal of paper referrals. The referral project is now moving to the next stage, with the ability for patients to see their referrals digitally and to make changes to the time and date of their appointments. Due to the success of e-referral, we can now move to consider how e-pharmacy and electronic prescribing can also be added, and a focus will be applied to that in the coming months.
There are three other key projects that are a priority to the end of 2016 and that will begin to deliver benefits before the end of this year. The first national digital health record solution will be the maternity and newborn clinical management system, MNCMS. This will be deployed in Ireland's maternity hospitals over the next 18 months. The first hospital will be Cork, in late October, and Kerry, in late November this year. Moving one of Europe's busiest maternity hospitals from a largely paper-based administrative system to one which is almost paper-free and supports clinical practice is a major task, but one that is on track and is clinically led. Delivery in this area will allow Ireland's maternity services to ensure national integrated care is safely and efficiently delivered into the next decade.
Ireland will move to a single digital lab system, known as MedLIS. This will allow information to be shared securely across the areas of care that have a legitimate reason to access this type of information. Electronic ordering, tests and results and sharing between acute, primary and community care settings will reduce the burden of testing and retesting. This will have a significant financial saving as well as being more convenient and, in some cases, safer for the patient.
Another priority is the connectivity of delivery staff to digital solutions. The connection of the 47,000 health staff who today have no access to any digital solution for their work is a key enabler for eHealth Ireland to put in place. The priority areas include the implementation of 10,000 new physical devices into community and primary care, areas that are currently largely paper-based. This is crucial to the success of all digital projects.
Ireland is the first EU member state to avail of the Health Cloud First policy. This technical term simply means that the clinical resources of Ireland can access their system safely, securely and from anywhere. They can do this happy in the knowledge that information remains within Ireland and is protected to a high globally recognised standard. One of the next areas that can avail of this is the cancer care solution, known as MOCIS. Currently, cancer care is delivered largely on paper and does not have a digital solution to support it. Early in 2017, MOCIS will also begin its journey to go live.
Before closing, I would like to speak about the opportunities of the future. I hope what has been made clear today is the opportunity of the present, the building blocks that are being put in place and structures set up to facilitate the ten-year journey ahead of us. The concept of an electronic health record Ireland is not new. However, Ireland now has a well-structured and HSE-approved route to deliver an electronic health record.
This programme of work will span ten years and will put in place a set of solutions built around the individual health identifier, which will be deployed in a modular fashion to the benefit of the whole health care system. It is in this area that Ireland can come to the concept of digitally connected health care systems and leapfrog other jurisdictions. The concept of an electronic health record described in the business case is not one of a single, monolithic Irish Government database, but rather involves connectivity, integration and transformation and clinically led implementation with the person at the centre. This is a ten-year journey that the electronic health record programme will put in place. It is not an immediate large investment, but rather a commitment to incrementally evaluate the success of digital over a ten-year period and continue to add to the investment as benefits can be seen and success is clear.
It is crucial for Ireland that this solution is not a big bang but an evolution of today's systems, set in stone as we move to 2020. By 2020, clinicians will be able to access digital information about patients appropriately, and by 2025 we will see a digital fabric throughout the health system including a system that is also accessible and in the hands of the people of Ireland. It is important to reiterate this is not a single one year investment; it is a continuously assessed multi-year investment over the lifetime of the programme.
I thank committee members for their attention and interest in these key areas. The success of the past 18 months can be built upon with support, investment and enthusiasm. We believe we can truly change the way in which the health system can work together by enabling eHealth Ireland as a digital catalyst. I and my colleague will endeavour to answer any questions committee members may have.