Can Health Care Really be Like Uber?

All the examples and analogies much used by politicians the globe over come to mind when trying to describe why we need a digital fabric to support health care delivery in Ireland. Nowadays, Uber is the watch word for digitisation and disruption of a market place. Airbnb is wheeled out as another clear example of a change inspired by a disruption; can health care really be changed in a similar way? Of course it can, write Richard Corbridge and Maria O’laughlin.

Richard Corbridge
Richard Corbridge

The programme of work EHealth Ireland received a special commendation at this year’s HMI Leaders Award.

Localisation of a problem and then a unique, specific response to that problem is how we believe the Irish health care system can be revolutionised through an application of digital solutions. The Health Management Institute of Ireland asked us to write a piece for the journal that would describe the journey that eHealth Ireland is on and the approach it is taking to getting to that now famous ‘destination in mind’.

One of the keys we have tried to use for the delivery of eHealth in Ireland is the engagement of the population, clinicians, patients, technology leaders and yes, even politicians. Every viewpoint we believe needs to be heard and a suitable outcome to the view described needs to be considered. The concept that some mythical centre of the Health Service Executive has all the answers and can fix the health system from the inside out is flawed. However, management no matter how much derided by the media is needed to create a change, to lead a change that is described by the system.

What was your best learning experience at school? For a huge amount of people it would be when you were allowed to be creative, to work in groups, to learn from each other. It is our ambition that digital will be the foundation of a ‘learning health system’, one that facilitates that much loved ‘group work’ scenario.

The IHI central function is now live, it has the demographic information allowed in the health identifiers act and a unique number for every patient in Ireland, the next steps in 2016 are the connectivity of systems.

To learn the system needs information, inspiration and insight. Let us consider how the eHealth Ireland projects and the engagement around them can deliver these three ‘I’s. The whole programme would be too unwieldly to discuss so lets take three examples and apply the ‘I’ to each of them.

The Individual Health Identifier (IHI) – One of the solutions that enables the building of the digital fabric is the IHI. The ability for patients throughout the system to be uniquely identified, the ability for the digital system to be able to audit who has accessed information about patients and the ability to locate information about a patient throughout the system where a legitimate relationship allows for it. That first ‘I’ is perhaps clear here, the IHI delivers the key to accessing information, without it information remains local, impenetrable data that can never drive change and certainly will not enable a learning health care system. The IHI changes the outlook for integrated care, it makes it inspirational, it allows a patient to begin to understand what integrated means. A caring, sharing health system; perhaps the best definition of a reformed health system for all of us to hold on to whether we are managers, clinicians or patients receiving the care that is the goal of the system. The IHI central function is now live, it has the demographic information allowed in the health identifiers act and a unique number for every patient in Ireland, the next steps in 2016 are the connectivity of systems. The patient information systems, the GP systems and all new systems will be an early focus as will the eReferral.

A Digital Identity It is 2016, let us not forget that when we say the next statement, in 2016 over 47,000 people delivering health care in Ireland today have no ‘digital identity’, they have no way to log on to a digital solution safely and uniquely and use technology to deliver care. They use a ring binder and a Bic pen! At the same time in other parts of the globe we have clinicians and scientists exclaiming that solutions like an Electronic Health Record (EHR) are more impactful on health care then the stethoscope! Simply providing a digital identity to the remaining resources delivering health care will be inspirational, we now empower our resource to use technology, we have changed the culture of technology delivery to ensure that a member of the team can do what they need to do with technology, whether that is interaction with colleagues or patients or access to key information.

In 2016 over 47,000 people delivering health care in Ireland today have no ‘digital identity’

Inspirational initiatives like the ‘eHealth Moments’ call to action are changing how people involved in healthcare use technology. eHealth moments is an initiative driven by staff, to begin sharing stories and comments, allowing a video to be used as an introduction to every member of the team so that at last a distributed workforce can virtually meet each other, know a little bit about each other and begin to build or build on relationships. This is a facility for them to recognise and acknowledge each others’ achievements, share knowledge and support each other.

In a similar way a number of cancer treatment centres have begun to use video technology as a way of reassuring new patients coming into care. What is the biggest cause of a missed appointment, it certainly isn’t forgetfulness when considering care for cancer, it is fear. A trial run from a number of centres in Ireland has seen Snapchat used on the evening before a patient’s appointment, a 30 second video introducing the team, face to face to the patient means that when the nerves are at their worst and the risk of turning on a heel and not attending strikes the patient feels just that tiny bit more comfortable and knows who they are talking to, this takes the ‘Hello my name is’ initiative and applies it to the delivery of care before the first face to face meeting, a simple yet brilliant idea.

The success of the eReferral – Has changed the way digital is perceived by the public of Ireland currently recieivng care. No longer does a patient need to worry that the referral has got to the hospital or not, before they leave the GP they can see the referral has arrived. No more letters, stamps, signatures and delay. Perhaps most significantly though will be the next stages of eReferral, the impact this solution can have on the waiting list challenges in Ireland is one now being considered. eReferral provides a platform of insight that can be built upon. It is designed to open up the process to the patient. Globally health is perhaps the last service industry that has yet to really ask the ‘customer’ if they want to have a digital relationship with the service. Imagine a patient being asked if they would like to give health their email address so that the referral letter can be copied to them, so they can see the details, the reference numbers and the responses by virtue of the referral being digital.

These three solutions described here are just examples of the work that has been done. eHealth Ireland is a lean initiative, just over 250 people are involved in putting in place a digital fabric for Ireland. Engagement, passion and belief are key descriptors of the team trying to make this happen for the population of Ireland. It is only through engagement with each and every organisation though that these solutions can be deployed and really make the difference they are designed to bring to the health system. After all, this is a business change programme led by clinicians, not an IT programme led by technologists.

  • Richard Corbridge, Chief Information Officer, HSE
  • Maria O’Loughlin, eHealth Ireland Engagement Lead