Cerner acquired its first Irish customer – St James’s Hospital, Dublin in 2005 – when it won a contract to provide their electronic patient records system. It initially serviced the contract from its UK operation before opening its Irish office in November 2007. General Manager Amanda Green joined in March 2008.
The IDA client started the Dublin office with 12 people predominantly working on the localisation of software. Cerner is present in 24 countries and every market needs localisation in terms of language and customisation of the software to match the local healthcare system. The Dublin office initially provided support for customers in France, Spain and Germany.
In 2010, Cerner located its European support desk operations in the Dublin office and now 40 ‘associates’ undertake support desk and query handling tasks with each speaking two or three languages. In addition to supporting European customers the team provides out-of-hours support for customers in Latin America and the Far East. Cerner has expanded rapidly in Latin America and the Spanish and Portuguese language skills in the Dublin office have been in great demand.
Since delivering the St James’s project, new IT investment within Ireland has been limited with the exception of the National Integrated Medical Imaging System (NIMIS) project. Green says that the success of this project has “helped reduce the fear of IT programmes in Ireland and to help expel the memory of projects such as PPARS.”
The NIMIS project was overseen by Professor Neil O’Hare who is Director of Health Informatics at St James’s and has worked with Cerner on the patient records project. Green acknowledges that although there has been a lack of investment she sees a desire within Irish hospitals and our clinicians to better utilise IT in their work.
With the Irish market quiet, Green has led Cerner’s business development activities for the Nordic region out of the Dublin office. The healthcare technology company has been shortlisted in the final two suppliers on a large programme for health and social care transformation for Helsinki and its surrounding areas.
The programme will deliver a health and social care IT system for 30 hospitals and 50 health stations (primary care centres) for a population of 1.5 million.
“In Ireland, our fears are unfounded,” Green comments. “The use of IT in health and social care is fundamental elsewhere in the developed world. This fear, together with the lack of investment, has meant that IT here has very limited use in patient administration and some departmental systems like laboratory and radiology systems. We have very limited use of electronic clinical information. We need to get to a situation where we build an IT infrastructure so that information is shared when it is needed, with whoever needs it.”
Although Ireland has been “well behind the curve,” Green says that things are beginning to change. Cerner has been successful in recent projects including an EPR system for the HIV and sexual health clinic at St James’s which is the largest outpatient clinic in Ireland and is now entirely paperless.
Appointments are scheduled electronically. Previously, there were 80 different pieces of paper filled out including assessments, observations, follow-up notes, contact notes and referrals. Cerner worked with the clinic to produce electronic records, pathways and electronic prescribing and dispensing of medication.
“Although this is only a small pocket of digital technology, we were keen to show the potential.” The system has now been extended to use voice recognition. One doctor, Dr Gráinne Courtney, is dictating into the medical records directly, using handheld and mobile technology. The project has transformed the clinic’s workflow. Looking at the wider picture, Green believes that the HSE now has an opportunity to transform healthcare through the use of information technology and this has been reflected in the HSE’s recent Prior Information Notice.
“There is a realisation that we cannot keep throwing money at health and expect change, we have to do things differently. One of the areas is obviously IT. That in itself is not a panacea but with appropriate tools, developed with the involvement of all the stakeholders – doctors, nurses, hospital managers, administrators – we can make their work more efficient and improve outcomes. This is a huge opportunity to make a step change in healthcare in Ireland.”
It is not just about sick people either, but about managing the health of populations. Through wellness and public health initiatives such as managing people’s BMIs.
It is also critical to managing long-term conditions such as diabetes. Going forward, the free flow of information will be central to the transformation of health and Cerner look to work with the healthcare sector in delivering that step change.
Cerner has recently been appointed to deliver a national clinical system programme for the HSE and is expanding its business and hiring locally.
Green believes that the programme will make a significant impact “and quickly”. She remarks: “There are many case studies worldwide where benefits, ROI and improved patient outcomes are well known and information follows the patient wherever they may be – primary care, community care, in and out of hospital. Everyone has access to the current and most up-to-date information available.
“The ehealth Ireland strategy and some of the recent policy initiatives have to be underpinned – and cannot be implemented without information flowing, and information doesn’t flow freely on paper. It is about data liquidity. Wherever data is needed it should follow the patient.”
Profile: Amanda Green
Amanda Green has been General Manager, Cerner Ireland, for the past six years. Amanda previously headed up Cerner’s UK Business Development and Sales. North London-born with a master’s degree in Computer Science, Amanda worked for 15 years for Xerox and in IT consultancy across several sectors before making a conscious switch to healthcare IT in 2000: “Healthcare is very personal, it is something that impacts on family and friends.”