Delivering effective technology based solutions
Yvonne Goff, Chief Clinical Information Officer for the HSE talks to Adam Morton about the importance of clinical engagement in the development of an eHealth system.
Across the globe, there have been many attempts to integrate ICT and healthcare. While there have been some successes there have also been many failures. Most of the projects that have failed, have done so due to a lack of clinical engagement from concept through to implementation.
As eHealth Ireland looks towards the implementation of its electronic health record over the coming years the team, led by Richard Corbridge, is fully aware of the importance of clinical engagement. The role of the Chief Clinical Information Officer is the first of its type in Ireland and as the incumbent Yvonne Goff explains it is crucial for the future development of the health services digital revolution.
“It is a very new concept, having clinicians involved in the development of our IT systems,” says Goff. She is tasked with ensuring that all key stakeholders are consulted in the design, delivery and evaluation of clinical informatics systems, including service users, carers, clinicians, technical and programme teams and best practice groups. Goff is also working closely with Richard Corbridge to ensure that proposed service redesigns will be effective in improving clinical practice and patient care outcomes, whilst adhering to professional and informatics standards. She is also aware of the importance of delivering a complete system and knows that while much of the focus will be centred on large scale clinically led National projects it is crucial that the development of smaller specialist programmes is also supported.
Goff has 18 years’ experience as a radiographer and six years ago studied for an MSc in health informatics, which led to her becoming an ICT project manager. Goff explains that at a very high level her role is to be an interpreter. Having both clinical and IT experience allows her to understand the requirements of both clinicians and IT staff.
“The IT people know how to deliver a system but they don’t necessarily understand what the end result should be,” says Goff. “This communication will allow them to see that goal and ensure that our systems are designed to meet the needs of both the patients and the clinicians.”
As part of her role, Goff is also the head of the Council of Clinical Information Officers (CCIOs). The council has 130 clinicians that provide advice in the delivery of electronic health systems. It is made up of clinicians and Information Leaders who promote and deliver eHealth solutions. The CCIOs meets four times a year to discuss the relevant issues for clinicians in the implementation of technology across the health service. It looks at the progress made and how it can be furthered while keeping the patient at the centre of every development.
Clinicians and technology
Reflecting on the importance of clinical involvement in the delivery of IT systems Goff states that it is the obvious solution. “The users of the system are the clinicians,” she says. “We need to engage them to ensure success. They are the only ones who can say this is what we need and this is how it will work for us so both the clinician and the patient have to be involved in some form.”
One of the HSE’s major targets is the delivery of an Electronic Health Record (EHR). An EHR is an electronic version of a patient’s medical history that is maintained by the provider and includes all key clinical data relevant to the patient. Focusing on the development of this system, Goff notes that both clinicians and patients have their own ideas as to what they need the EHR to do. The solutions being worked on by eHealth Ireland are all about improving services for patients and clinicians. As healthcare professionals interact with patients, they are best placed to explain what is needed in future developments and their suggestions can help ensure what is delivered will work effectively for all end users.
Technology is a tool that will, if designed and implemented accordingly, enable the improvement of health outcomes, the quality of care and the healthcare experience for patients. eHealth solutions encompass a wide range of electronic tools that can help the experience. Just over 12 months ago eHealth Ireland was created and its knowledge and information plan sets out its desired strategy and intended collaboration across the health care system.
Goff highlights the success of the knowledge and information plan to date as significant. The transparency and openness that it has brought the deliverance of IT systems has been beneficial for both the patient and practitioners.
The main elements of the HSE’s eHealth programmes includes the EHR, individual health identifier (IHI), eReferrals, ePrescribing, a Maternal and Newborn Clinical Management System (MN-CMS) and a National Medical Laboratory Information System (MedLIS).
While the ultimate goal of eHealth Ireland is to enable the national roll-out of elements like the Electronic Health Record and the Individual Health Identifier, there are also smaller projects like the Lighthouse projects that will help lay the foundation for the delivery of these bigger targets. “You might say we are late to the digital age in Ireland,” says Goff. “But that isn’t a bad thing because you can learn a lot from others’ mistakes and our desire to have clinical involvement in all we do is a great example of that.”
Further developments
The Lighthouse projects are small targeted schemes that will allow eHealth Ireland to build an understanding of the requirements of an EHR and a further understanding of how they can assist patients in managing their care. At present there are three Lighthouse projects in the clinical disciplines of Epilepsy, Haemophilia and Bipolar Disorder. These projects will be carried out over a 12 month period with specific deliverables.
The Epilepsy Lighthouse Project will move away from the one size fits all treatment of care for people with particular conditions. The study will look at 50 adults and 50 children as no two patients are the same and many can respond differently to specific treatments. With genomic sequencing, individualised treatment and targeted care, it will be one of the first projects to use the individual health identifier in Ireland. The feedback will provide vital information as the HSE plans ahead for the national roll-out of the project.
Similarly, the Haemophilia and Bipolar Disorder Lighthouse projects will look at elements empowering the patient to manage their care through patient apps and patient portals. For Goff, the key is to take it slow with these small sample sizes fixing problems as they arise on a small scale. “We want to take our time and get it right rather than pushing it out in bulk and finding flaws in the system that way,” she says.
“It is all about delivering projects within set time frames with rigorous consultation and a phased roll-out. Providing the public with regular updates will also be crucial. This concept as opposed to the large, simultaneous roll-outs of the past has been a strong and effective feature of the HSE’s more recent approaches to clinical driven technology.”
“In my position it is important to ensure that all health projects are clinically led and that it not just a token gesture. A clinical presence will be required from procurement through to support.”
Looking ahead, Goff notes that large systems like the e-Referral system will be starting its second phase of development shortly and this will bring e-Referrals and orders into systems such as the National Patient Administration System and the National Integrated Medical Imaging System. Also in the pipeline is the development of the business case to propose the early adoption of an EHR in the National Rehabilitation Hospital, this will help prove and provide learning about the impacts of an EHR in a medium-sized hospital which will feed in to the strategy for the national EHR programme.
It is an exciting time for the development of technology in the health sector and it is clear that eHealth Ireland are determined to get it right. For more information on any of eHealth Ireland’s projects please contact yvonne.goff@hse.ie or visit www.ehealthireland.ie.
Yvonne Goff is the Chief Clinical Information Officer of the Health Service Executive. A radiographer by background, she has over 18 years of experience in the Health Sector with five of these directly involved in Informatics. Having completed an MSc in Health Informatics (TCD) in 2010 she joined the national implementation team of the NIMIS project as both a project manager and subject matter expert.
Yvonne was appointed to her current role in 2015. She has supported and driven the need for progression of eHealth solutions across Ireland. Yvonne has an inherent knowledge of the needs of the clinician and the patient, but sees the benefits in progressing aspects such as standardisation, quality and safety, and effective and efficient system implementation.
Work aside, Yvonne comes from a farming background, and with a young family, she knows all about hard work and the irrelevance of a clock when work needs to be done. She welcomes a challenge but, as a former rugby player is no push-over.
