An eHealth Strategy for Ireland

1. An eHealth Strategy for Ireland
Kevin Conlon
ICT Unit Department of Health
‘Connected Health : Collaboration & innovation to
engage patients and elevate care’ CCD 1 April 2014

2. eHealth : What does it mean?
Different things in different places
• eHealth is European also known as
• Health IT is a US phrase
• Connected Health by both and the best
• mHealth ehealth without wires?
… not solely about computerisation

3. Definitions of eHealth exist
• What is eHealth
"The combined use of electronic communication and information
technology in the health sector“
World Health Organisation
“eHealth means Information and Communication Technologies tools
and services for health. Whether eHealth tools are used behind the
scenes by healthcare professionals, or directly by patients, they play a
significant role in improving the health of European citizens”
European Commission

4. Societal changes from technology
Where is health care in the digital economy?
• Travel …think Ryanair.com, Trivago, AirBNB
• Media … think RTE player, IrishTimes.com … Twitter ..
Facebook ..You Tube
• Education … think digital school books.. Distance learning
• Retail : think Amazon.com, ebay, pigsback, Brown Thomas
• Registration for nurses doctors is on-line
• Bills, Bookings … think Tolls, Bins, Parking
fines, Banking, Theatre , Revenue, Property Tax car tax
– All done over the Internet … still costs the same !!

5. Where is health care in all this?
Healthcare is well behind the curve
– Why can’t we readily book appointments for
GP’s, hospitals, clinics…..
– See our test results….
– Keep track of immunisations for our kids….
– Prescriptions…. See on line what we are taking.. what we
took 6 months back … or did we take it?
– When we were last at the GP, Specialist etc

6. What are the barriers to e-enablement?
• HealthCare transactions
– Are complex
– About vulnerable people
– Services delivered by multiple professions, multiple providers
over many locations
– Change processes to bring about change are not simple
– Legal issues
– Technology issues
– Legacy issues such as PPARS
– Privacy and confidentiality issues

7. Process Change
• At its simplest eHealth is about
“Access to the right information, in the right place at the right time”
• “Information is the lifeblood of modern medicine, and health information is dedicated
to be circulatory systems. “
– David Blumenthal New England Journal of Medicine 362 2010
• It is fundamentally about process change and reconfiguration
underpinned by ICT
(Hal Woolfe, Kaiser Permanente)
• If we are to benefit from technology we must be prepared for change.

8. Opportunities that eHealth provides
• Impact of eHealth developments on the
healthcare delivery system
• Potential and opportunities to change and help
re-configure healthcare delivery
• New information and systems environment
• Provides a enormous opportunities and
significant challenges

9. eHealth offers new services
• Personal Health Records
GoogleHealth, HealthVault, Have not got traction yet but are not ‘mainstream’
• Health social networks,
Breast cancer.org, PatientsLikeMe, CureTogether, MedHelp very popular widely used
• Consumer personalised medicine
23andMe (Genomics) DirectLabs (Blood & Bio Marker Tests) Genome Sequencing is now nearly a
consumer product
• Quantified self-monitoring
Keas, (Personalised Care Plans) Zumelife (Chronic Care)
• Healthcare Social Media
Blogs - DiabetesMine, HealthMatters, WedMD
Microblogs - Livestrong, Stupid Cancer
Social Networking - Organised Wisdom, PatientsLikeMe, DailyStrength
Podcasts - John Hopkins Medical Podcasts, Mayo Clinic
Social Sharing - Flickr, You Tube, ICYou
Forums - Google Health Groups
• Clinician Social Networks
Sermo, Medscape Physician Connect, Asklepios, MEDTING

10. For clinical resources

11. For patients …..

12. Health Information resourcesUse of Services
61% - American adults looked online for health information (2009)
84% - physicians engage online as part of their clinical workflow
71% - physicians are interested or already use physician social networks
Sources of information used by American adults for health or medical issues information or
assistance:
86% - Ask a health professional - such as a doctor
68% - Ask a friend or family member
57% - Use the internet
54% - Use books or printed material
Impact of online Health Information
60% - Affected a decision about how to treat an illness or condition
56% - Changed their overall approach to maintaining their health or the
health of someone they help take care of
53% - Led them to ask a doctor new questions, or to get a second opinion
from another doctor

13. Potential from Advances in Technologies
 Location-aware technologies enables increased access
and quantity of information – provides greater safety
 Home automation and sensor technologies support
telehealth and mobile health applications
 Virtual doctors/health professional visits
 Easier user access to information and technologies
through voice, touch screen, eReaders, biometrics, etc.
 Focus and investment by large scale companies in
monitoring and telehealth technologies
 Broadband and Internet use among seniors increases
 Significant developments in portals and tools for
caregivers
 Increasing use and development in personal emergency
response systems

14. How Smart can technology get?

15. Some views of the future….

16. eHealth is about Transformation
Person
Community
Primary
Secondary
Tertiary
Individual Self-care
Friends & Family
Community Networks
Professionals as Facilitators
Professionals as Partners
Professionals as Authorities
Transformation
Through
Cost-Effective Use
of Information &
Communication
Technologies
Industrial Age Healthcare Information Age Healthcare
Source: Adapted from Malaysian Telemedicine Blueprint

17. Changing Role of Patients
…from passive to active patients ……

18. Health systems challenges we all know them…..
• Increasing Demand due to:
• Ageing Populations
• Rise of Chronic Diseases
• Already Stretched Services
• Planned Reform of Health Services
• Universal Health Insurance
• Money Follows the Patient
• Formation of Hospital Groups
• Current ICT Issues
• Current Ireland ICT budget 0.85% vs. EU
average 2-3%.
• Lack of understanding of benefits

19. eHealth Strategy for Ireland

20. Ireland eHealth Strategy : Methodology
• Extensive Research
• 8 countries, EU and Non-EU
• Benefits/ROI and Lessons
Learned
• eHealth week in Dublin in
May
• Analysis of EU and WHO Policy
• Re-designing Health for
Europe 2020

21. International Experiences
Summary of Findings...
(Based on 8 countries analysed)
1. Dedicated delivery entity with proper
focus, governance and authority
2. Deploy in phases. Avoid ‘big bang’ approach.
3. Use interoperability standards
4. Strong stakeholder and clinical engagement
from the outset.
5. National Health Identifier is crucial.
6. Strong branding and pubic awareness
7. Skills shortages need to be addressed at all
educational levels

22. eHealth Benefits to Ireland
• Population Wellbeing
• Healthier Citizens
• Empowered and Mobile citizens Patient as Consumer
• Focus on prevention Healthy Ireland
• ‘Keep people out of hospital’ Supporting the clinical Programs and hospital groups
• Health Delivery Service Benefits
• Deliver Higher Quality, Lower Cost models of care
• Easier Access, Higher Transparency Supporting UHI , MFTP
• Move to Patient-Centric system Chronic Disease Management / Tele health/care
• Will enable Planned Reform Program : Supporting Money Follows the Patient
• Economic Development
• Export-driven jobs creation : Some good examples of that in Ireland
• eHealth start-ups :
• Ireland Ideally placed for new ‘Services’ : industry leader in Pharma, ICT hardware and
software and Medical Devices

23. Implementation
• Create ‘eHealth Ireland’ (initially within HSE ICT)
• Fully focussed delivery entity
• Made up of stakeholder organisations
• Health, DJEI, Agencies, Academia etc
• Full Fiscal Oversight
• 4 Key Functions…
• Project Delivery (ePrescribing, Telehealthcare etc)
• Ecosystem
• Patient Empowerment
• Economic Impact Realisation
• Key ‘Enabling Functions’
• Legal and regulatory
• Technical interoperability
• Health identifier
• Branding and Public awareness

24. eHealth Innovation Ecosystem
Build a World Class Innovation Ecosystem
• Collaborative Environment
• Academia
• Industry
• Health Services
• Cross Border
• International Alliances (e.g. EU/US)
• Focus on Commercialisation
• Open-up services to R&D
E.g. Horizon 2020 Funding
• Promote Entrepreneurship
• Start-ups support
• VC funds, incubators…
• Export-led Jobs Creation

25. eHealth Innovation Ecosystem
Models in Catalonia, Northern Ireland, Manchester, New York
….

26. Indicative Timelines

27. 1. Create ‘eHealth Ireland’ and source requisite leadership.
2. Develop full Business Plan
• Input (funding and resources) from Govt depts, agencies, academia and others
• Set up governance structure including board.
• Strongly branded entity eHealth Ireland
• Resource internally where possible.
3. Begin Work on Priority Programs
• Identifier, ePrescribing, Online Referrals and Scheduling, Telehealthcare and others
4. Begin work on ‘Enabling’ Functions
• Legal, Regulatory, Standards, Branding and others.
5. Coordinate with Govt agencies to drive Economic Benefits program.
6 . Health Identifiers Bill 2013 (now in Oireachtas)
• Work with partners to ensure Identifier is deployed in a timely manner.
Key Actions

28. eHealth update
• eHealth strategy finalised and published
• eHealth Ireland entity to be set up
• CIO approval
• Health Identifiers Bill
• APJ 2014
• MoU with NI
• Ecosystem / forum to be set up ……

29. Its only beginning……
American Healthcare is one of the last great industries to remain
largely undisturbed by information technology revolution of the
past few decades
– Vijay Vaitheeswaran, The Economist, November 22, 2010
Medicine has built on a long history of innovation, from the
stethoscope and roentgenogram, to the MRI. Doctors have
embraced each new technology to advance patients care. But
nothing has changed clinical practice more fundamentally
than one recent innovation: the Internet.
Pamela Hartzband and Jerome Groopman , New England Journal of Medicine.

30. Where will we go?
• Implementing eHealth in Ireland is about….
– Bringing improved population wellbeing, health service
efficiencies and economic opportunity through the use of
technology enabled solutions.
Thank you for your time…….