Significant rollout of Individual Health Identifier

Maria McCann is an organisational psychologist and Director of Health Identity Management Services in Health Service Executive (HSE). With responsibility for the identity management services of the HSE – particularly the delivery of the Individual Health Identifier (IHI) – she sits down with Ciarán Galway to discuss its rollout and the wider Health Identifier Service programme.

Ciarán Galway (CG):
What are your strategic priorities in relation to the Health Identifier Service programme?

Maria McCann (MMC):
Our strategic priority for the Health Identifier Service is to continue the deployment of identity management services within key areas in 2024 including patient administration systems in hospitals, the Primary Care Reimbursement Service (PCRS), the GP practice software management systems, the National Immunisation Office, and many more.

If we can work with the high-level strategic systems, we can then work for the multiple systems feeding of the patient administration systems can receive the Individual Health Identifier and other associated health identifiers to support enhancement of the data quality for identity within the systems. Ultimately, for patients this will mean more a more efficient system and it will help us to find your records quickly.

It will also deliver:

• improved patient safety: Reducing the risk of medical errors associated with incorrect patient records or treatments;

• continuity of care: In time, the IHI will enable health records to be seamlessly accessible across care continuum; and

• efficient healthcare operations: IHIs on patient records reduces administrative burdens, minimises duplication of efforts, and optimises resources.

Furthermore, it will enable eHealth applications and allow us to link patient records together from different systems.

CG: To what extent is the Health Identifier Service a business change or governance programme rather than a technical implementation?

MMC: The programme, like all digital health programmes, is very much based on organisational change and people driving digital transformations. When the Health Identifier Service started in the beginning of 2020, the focus was on clear governance and understanding of who could utilise the IHI as an authorised body with a relevant purpose.

Clear governance helps in avoiding fragmentation, ensuring accountability, and maintaining a strategic focus on the desired outcomes of the transformation program. We worked with the Department of Health and the HSE Data Protection Office to revisit at the Health Identifiers Act 2014 and make additions to the data sets named in the Act to futureproof the policy for positive patient impact.

We created clear framework for decision-making and consumer engagement. Change management and communication is crucial, and organisations need to ensure that employees are informed about the changes, understand the benefits, and are motivated to contribute to the transformation journey.

To this end we had strong engagements with the consumers and partnered with them on this journey of learning together. Digital transformation involves a cultural shift within an organisation. It is not just about implementing new technologies; it is about changing the way people work and think. Employees need to adapt to new processes, tools, and ways of collaboration. The success of a digital transformation programme depends heavily on an organisation’s ability to foster a culture of innovation, adaptability, and continuous learning. It depends on the people driving the change.

“To date, the integration of the IHI into iPMS has been completed across almost all shared and single iPMS instances, representing 43 acute hospital settings nationally.”
Maria McCann, Director of Health Identity Management Services, Health Service Executive

CG: To what extent has the Individual Health Identifier been rolled out?

MMC: The IHI is currently being rolled out to all acute hospitals which use the iPMS as their patient administration system in a phased approach. This phased approach is initially focused on technically enabling services to store the IHI in their systems. The phased technical implementation of the IHI into all instances of iPMS began in late 2022, with significant progress being made since then.

To date, the integration of the IHI into iPMS has been completed across almost all shared and single iPMS instances, representing 43 acute hospital settings nationally. Future phases of the IHI rollout project will focus on supporting services to increase their IHI match rate, display the IHI in their patient systems, on patient healthcare records and patient related correspondence with other healthcare services. Engagement with acute hospitals, who use patient administration systems other than iPMS, regarding the implementation of the IHI is planned for the near future.

This project is running in parallel to the implementation of the IHI into all GP practice systems nationally. IHI is now live in over 95 per cent of all GP systems nationally and other national systems, such as the PCRS, the National Screening Service, the National Immunisation Office, and all Covid related services.

There have been 66 million direct interface IHI requests – with 43 million IHIs shared and 27.5 million IHIs seeded onto patient systems, as well as supporting the cyberattack response programme to contact affected persons, and research studies such as the HSE Fada Survey.

CG: How has the health landscape changed following the Covid pandemic and the May 2021 ransomware attack on the HSE?

MMC: I think there have been huge changes in the health landscape from a technology, innovation and most importantly culture perspective. There was an acceleration of implementation and adoption of many health technologies, including our own with the roll out of Health Identity Management Services into many systems. There was an increased focus on supporting staff technically and from an educational perspective to manage teams and work in a hybrid environment.

Personally, I feel from a cultural perspective, staff were more open to change as there was increased urgency to try new processes and technologies to support patients’ journeys, with less focus on fear of failure and more on making a difference efficiently and effectively. There has been a renewed focus on resilience both from a health system perspective and preparation for unforeseen challenges, as well as personal and staff resilience to balance unending demands.

I feel the personal and staff resilience is an area that needs increased support and should receive an unwavering and constant focus as our staff are the people behind all HSE transformation and innovation.

Also, collaboration and knowledge sharing across the health system in Ireland and globally, really accelerated as we all recognised the importance of supporting and sharing to increase innovation and transformation in healthcare as a global challenge faced by all.