New eHealth Strategy for Ireland

Individual health identifiers are to be introduced for service users and providers under the Government’s new eHealth strategy.  Maureen Browne reports.

eHealth

The Health Identifiers Bill 2013, which has been published as part of Ireland’s new eHealth Strategy, provides the legal basis for Individual Health Identifiers for health service users and unique identifiers for health service providers.

The new identifiers will be used across the health service, in both the public and private sectors.

Priority areas for initial development include ePrescribing, online referrals and scheduling, Telehealth – particularly relating to the management of chronic disease – and the development of summary patient records.

A dedicated branded entity called ‘eHealth Ireland’ is to be established, initially in the HSE to implement and manage the strategy. It will be headed by a Chief Information Officer for the health service who will be recruited through an open competition. Over time, as the HSE is dismantled, this new organisation will be formed as an independent entity within a new institutional framework for shared services for the health sector as a whole.

Priority areas for initial development include ePrescribing, online referrals and scheduling, Telehealth and the development of summary patient records.

It is envisaged the Individual Health Identifiers will ensure patients have all the relevant information needed to allow the management of their own health and their interaction with the health system. Patients will be recognised when they access the system and can quickly see relevant health details. Patients can access their own health records and maintain a health diary.

Health service providers will be required to identify patients and clients who present for service by requesting their Individual Health Identifier or, failing that, identifying particulars (such as name, date of birth etc.) which will enable them to search the register of Individual Health Identifiers. The Bill provides that health service providers must associate the Individual Health Identifier with records they create. However, a health service provider cannot refuse a service solely because an individual cannot, or refuses to, provide his or her Individual Health Identifier.

No clinical information will be held in the Individual Health Identifier Register.
The Bill contains offences and penalties for misuse of the Individual Health Identifier and access to the Individual Health Identifier Register is controlled and limited with supporting criminal sanctions.

A National Individual Health Identifier Register will be established containing the Identifier and other identifying particulars relating to the individual. An Individual Health Identifier or IHI will be a number which in itself will contain no personal data whatsoever. No clinical information whatsoever may be contained in the IHI Register.

The Bill includes provisions for the establishment of identifiers for organisations providing health services as well as identifiers for professionals and other staff.

Access to the National IHI Register will be restricted to health service providers and other entities under the Bill. The Bill provides that measures must be put in place to help ensure that the National IHI Register is accessed only for relevant purposes and by people who are permitted to access it. There are offences and penalties set out in the Bill on inappropriate access.

Health service providers – health professionals, organisations and some employees – will also have a unique identifier. Providers will have to use their identifier on their patient records and in relevant communications. This will clearly identify the person and organisation involved at each stage of care.  There will be a National Register of Health Services Providers Identifiers containing the identifier, name, business address and other relevant details. The Health Services Provider Register will be publicly accessible.

The Bill includes provisions for the establishment of identifiers for organisations providing health services as well as identifiers for professionals and other staff.

The Bill compels health professional regulatory bodies, such as the Medical Council and Nursing and Midwifery Board of Ireland, to provide information to the Minister on registered professionals. It is intended to re-use the number assigned by these regulatory bodies in the Register of Professionals provided for in the Bill.

Assigning identifiers and establishing and maintaining the related registers are functions of the Minister for Health under the Bill. However, for operational reasons, the Bill allows for the possible delegation of these functions to the HSE. . It is envisaged that the HSE /PCRS (Primary Care Reimbursement Service) will operate the Individual Health Identifier Register on behalf of the Minister.

The Individual Health Identifier will rely heavily and be closely linked to the Public Service Identity dataset and the SAFE* Public Service Card infrastructure operated by the Department of Social Protection.