Restructuring healthcare

The Office of the CIO for the HSE has underwent a process of restructuring. Ciarán Galway meets with Richard Corbridge at Dr Steeven’s Hospital to examine the progress made by eHealth Ireland.

Outlining the rationale for his Office’s restructuring, Richard Corbridge highlights that over the last two and a half years of digital delivery across the whole country, his senior management team swelled to 13 people.

This, he determined, was too big a number. “What we’ve done over the last three months is to restructure the Office of CIO, start to consider it more as the eHealth Ireland function and put in place a senior management team of five.”

Aside from Corbridge, this team consists of:

1. Yvonne Goff, “the Chief Clinical Information Officer who takes the lead on engagement with clinicians – making sure what we do is clinically-led, and drives innovation”.

2. Darach Glennon, “who leads on Customer Experience, ensuring what we deliver from a technology perspective is really what is required”.

3. Fran Thompson, “looks after the Enterprise Programmes. All of the strategic programmes that exist across what we’re trying to deliver fall under Fran’s remit to ensure that they are regarded as a whole piece of a bigger programme rather than many separate projects”.

4. Michael Redmond, “is our Chief Operating Officer and looks after the governance of what we’re trying to do and helping to ensure that we have that true centre of excellence in ICT management in place”.

Clinician-led

Corbridge emphasises the precedent set by other jurisdictions as the driver behind the adoption of a clinically-led approach. “If you consider the NHS 10 years ago or observe other countries which are trying to implement digital health now, they failed because they weren’t clinically-led. When IT leads projects and IT solutions are applied to clinicians, then it won’t be viable. If you make it clinically-led then it ensures solutions to clinical questions and it works.”

He elaborates: “It’s really important that all of our projects have at least one clinician present. At the core of what we are trying to deliver we must consider what clinicians need in order to complete their job safely and more efficiently. That’s why Yvonne’s role in that CCIO function is so important.”

Priorities

Conceding that “we are not very good at saying ‘this is our number one priority’”, the CIO asserts: “We need to improve on this in 2017 because we are pulling staff in so many different directions, we sometimes could lose focus if we’re not careful.”

“We’re aware of that as we move into this new way of working, our priorities need to be balanced. Across the five members of the Digital Health Executive, our leadership team, we have the ability to set and manage individual priorities. Yvonne’s priority would be to ensure that an eco-system is clinically focused and exists to enable the HSE to work with innovators and new start-up organisations. Michael’s is to ensure that we have good governance in place and that we’re delivering project plans. Darach’s priority is to ensure that our customer base is happy with what we’re delivering and Fran’s will be to drive forward those programmes to make sure that we have the bigger picture of the Electronic Health Record (EHR) moving in the right direction.”

Overall, the EHR is eHealth Ireland’s primary priority. “A plethora of projects and programmes are coming together and will ultimately deliver an EHR for Ireland. Whether that’s the integration capability to make sure that the systems can communicate with each other, or whether that’s the digital identifier for patients and clinicians, all of those things are now starting to move in that direction.”

Other priorities include rolling out the Individual Health Indicator (IHI) and pulling it into all the systems that exist. Increasingly, due to the existence of a large legacy estate, the Office of the CIO is looking at GDPR from a governance and cybersecurity perspective.

“While clinicians and the general public have been enthused by achievements so far and we have some wonderful ideas for what we should try to achieve going forward, budgets are limited and resources even more so. As such there is a need to focus on the actual capacity to deliver. When we look at patient benefit, that’s how I want to start prioritising. Where’s the most value that can be accrued?”

“What this new structure allows us to do is be clear on what eHealth Ireland actually is. It is a programme with many foundation elements and many footstones towards delivering the EHR.”

Tangible benefits

One of the most noticeable benefits acquired through restructuring is the ability to move forward as an organisation. “One of the things that we have struggled with over the last two and half years is an identity for the HSE’s Office of the CIO delivering eHealth Ireland. What this new structure allows us to do is be clear on what eHealth Ireland actually is. It is a programme with many foundation elements and many footstones towards delivering the EHR.”

Likewise, in December 2014, an independent review suggested that Ireland was 16 years behind the digital curve for health. The same organisation conducted a review in December last year and suggested that the State had caught up by eight years in just 24 months. Corbridge suggests: “We can patch it, but catching up costs money. The investment in digital needs to move away from something that would be aspirational for healthcare. If we truly believe that digital is how we transform our health service and is how we deliver integrated care then it does require money to be spent.”

Critical reflection

The CIO stresses the importance of critical reflection. “We know that the initial organisational structure that we put in place in March 2015 wasn’t fit for purpose. We didn’t get that right and it’s why we are making changes. We need to look at each of the projects and programmes monthly and understand the successes and the challenges that we face.

“Michael Redmond’s team in the PMO are in that space. Having a Chief Operating Officer for eHealth Ireland gives us a new ability to be quite independently critical of where we are. The eHealth Ireland Committee is the group that we go to get advice and guidance. They are our critical support structure,” he adds.

Focus

With so many strategic programmes underway, it is important for eHealth Ireland to always return to the concept of placing the patient at the centre and being clinically-led. Corbridge acknowledges: “IT people and technology professionals can be distracted by innovative new technologies, but by keeping Yvonne Goff in her capacity as CCIO on top of what we do, by making sure that everything we do is linked back to the patient, we remain aware of what we’re here to provide, which is patient focused care.”

EHR

The Electronic Health Record for Ireland, whilst the most expensive strategic programme and the most difficult to implement, is without doubt the most transformative. “If you consider that every piece of paper within the health system can be moved onto a digital platform and, with consent and appropriate controls, start to allow the sharing of clinical information then that becomes massively powerful. The use cases, the personas and the work that is being done to understand what the benefit can be to Ireland by having an EHR is huge,” Corbridge explains.

“The EHR business case is with Government now for consideration. Once we get the go ahead, the procurement, implementation and go-live period would take place over five years. At the same time, we see ourselves building more and more foundations of an EHR. For example, in both maternity and epilepsy we have an EHR.”

Patient perspective

Currently, the most noticeable difference in patient experience occurs in GP practices when they are referred. “A digital referral instead of a letter arrives in the hospital before the patient leaves the GP practice, so the patient knows it has arrived, it’s in the system quicker and has more clarity. Similarly, if you’re in the south, you’ll now receive a prescription with a barcode. You take that to the pharmacy where upon scanning the barcode, they get access to your name and the different elements of your prescription.”

Furthermore, if an individual gives birth in Cork or Kerry, they now know that they are entering a digital health system. The speed, the efficiency and the safety measures that are now in place because of the systems which are live in those two hospitals is massively significant.

Vision

Overall, Corbridge feels that his team is now in a very strong position in so far as where they can go and what they can achieve. “The team has come together in an amazing way over the last 12 months in particular to consider how digital delivers for healthcare. Our focus has to be on the pillars of the EHR business case and what can be done in that space, but if we don’t get the go ahead we can still start to deliver some of the fundamentals which are needed for healthcare. This focus also has to include our reaction to things like GDPR, our ability to deliver cybersecurity to digital solutions that are deployed.

“It’s been a phenomenal two and half year journey. The things that we are doing and plan to do are really exciting. The enthusiasm and engagement, not just in Ireland, but across the world as they look at Ireland, does make you realise that we’re breaking ground now and are starting to pick up the pace.”

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