Using eHealth interventions to drive the Shift Left Strategy

The Shift Left Strategy, which was aimed at providing the highest quality of life at the lowest possible cost, involved finding and sequencing eHealth interventions to drive and improve quality of life and reduce the cost of care, Prof. Martin Curley, Chief Information Officer, GSE and CO, eHealth Ireland, told the Conference.

Prof. Martin Curley
Prof. Martin Curley

This meant shifting left from acute care to primary/community care, to home care, to preventive care. The objective was better outcomes, improved patient experience, improved clinician experience, lower costs and economic growth, with efficiencies reinvested.

The costs of care could range from one dollar a day for independent healthy living through managing chronic disease in primary care and community care to residential care to acute care, where costs could be 10,000 dollars a day in an ICU.

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Prof. Curley was speaking on “Stay Left, Shift Left – Digital Innovation Strategy for Sláintecare.

Sláintecare was a ten-year plan to transform health and social care services, in Ireland.
Its aims included delivering strategic ehealth programmes, engaging health workers and patients in transforming our services, integrating care, enabling a seamless patient journey between community and acute services, moving to a timely service, increasing capacity and the ability to plan and manage changing needs, providing the majority of care in the community and promoting health to prevent illness.

The European Investment Bank had provided a €225 million loan for the rollout of ehealth in Ireland. This would allow us to implement former HSE CIO, Richard Corbridge’s knowledge and information plan.

Data was an enabler of health service improvement, of advances in medical science, of population health and well- being and better clinical trials.

The Individual Health Identifier Programme was a key enabler that allowed information to be shared about a patient. It meant moving from paper records locked in organisations to a digital patient record shared across care settings.

Other healthcare providers would access and contribute to the National Record through the integration capability.

Prof. Curley said that in the first quarter of 2018, the Department of Health confirmed capital funding for the acute Electronic Health Record (EHR) programme.

At this stage, the acute business case peer review had been completed, the acute EHR supplier briefing had been held and attended by over 60 organisations, a shared record business case had been completed and approved by the project board and a community business case was in production.

The EHR was the foundation stone of the National Primary Care Management System which supported the safe and timely care of patient managed by primary care staff in the community.

It addressed core patient and service management needs, built on the current infrastructure, was a driver to increase IT capability for staff and systems and was a relatively fast deployment with fewer resources (i.e. quick wins).

He said data was an enabler of health service improvement, it was an enabler of advances in medical science, of population health and well- being and better clinical trials.
“I think a major accomplishment has been Project Oak, which has now gone live in St. James’s Hospital, Dublin. It is really a lighthouse, showing where others could go.”

St. James’s has gone digital with a new electronic patient record (EPR). All inpatient records are now accessible via an electronic system rather than on paper, with details of patients’ medication and prescriptions, allergies, health conditions, treatments and social care information all in one place. It has been called Project Oak because of the amount of paper it will save.

Prof. Curley said a number of other exciting projects were already under way. The MN-CMS proof of concept had been agreed to provide antenatal visits and discharge summaries to GPs.

The ePrescribing Mallow project covered 175,000 GMS ePrescription in three GP practices and nine pharmacies since January 2017.

We are arguably at a point in time that we need ehealth service data czar.

A draft single page repeat GMS script had been agreed with the PCRS, the GMS returns process for pharmacist had been simplified, there was real time visibility of GMS prescriptions by PCRS, validation of paper prescription against an electronic copy and extensive work had been done on drug files to identify the coding which was currently available to support both generic and product based ePrescribing.

The next steps were to establish governance with clinical leadership, communicate with all stakeholders, work with relevant parties to facilitate coding of meds and instructions, completion of privacy impact assessment, a standards-based approach, robust secure clinical data repository and robust business continuity, legal requirements, and tests, pilots, training, communication and implementation ay Left, Shift Left.

Prof. Curley said Ireland could potentially move from being an ehealth European laggard to a leader over five to six 6 years.

“We are arguably at a point in time that we need ehealth service data czar. This is something that will be critically important as we move to digitise the health services.”
He quoted Vinod Khosla, co-founder of Sun Microsystems, and the founder of Khosla Ventures, who said “In the next ten years Data Science will do more for medicine than all of the biological sciences combined.”