Finnegan's Take

Irish health services have been slow to embrace technology and need to mobilise its staff to catch up

Electronic patient records, access to specialist services from home, and more efficient use of scarce resources are just some of the much-vaunted benefits touted by advocates of e-health. But while technology has transformed most industries and public services, healthcare has been notoriously slow to embrace the high-tech revolution.

And, for its part, Ireland is behind the pack in terms of healthcare IT. The HSE spends just 0.75% of its budget on IT; our frontline staff are not as tech-savvy as some European neighbours; and just 0.4% of the health workforce are IT specialists – a few hundred computer wizards kept busy with mundane maintenance tasks.

Any hope of playing catch-up will depend on the willingness of the health workforce to buy into the promise of e-health at a time when budget cuts and staff ceilings are sapping goodwill from the system.

Cross-border challenges

Europe as a whole has hurdles to clear before it can make the most of e-health. Over the past decade or so, hospital departments have worked with niche IT companies to develop customised computer systems. This tailor-made software might be ideal for the radiology unit or emergency department, but might not be able to “speak to” the system used in, for example, the operating theatre.

If hospitals are running incompatible software, it’s going to take quite a leap to develop interoperable IT systems that would allow cross-border sharing of electronic patient records.

But for the most part, the technology isn’t the problem. It already exists. The stumbling blocks are linguistic and cultural, political and philosophical. They are about security, trust and data protection – and about addressing the disparity between the trend-setting Scandinavians and their less-developed cousins in Bulgaria. It’s a classic EU problem.

Now though, political momentum is gathering behind e-health as new technologies offer the prospect of shifting patient care away from spending expensive days being treated in city-centre hospitals.

EU health ministers have committed to putting e-health at the core of governments’ efforts to improve quality and safety, and the European Commission has just completed a consultation process which will feed into a revamped ehealth policy paper later this year.

Power to change

Brussels is limited in what it can do in the area of healthcare. The Lisbon Treaty is clear: how health systems are funded and organised is a matter for national governments. But standard-setting and cross-border cooperation fall neatly within Europe’s remit and the Commission is gearing up for a major push to break down barriers to the free movement of patients.

The future, we’re told, will see more patients with chronic conditions (like diabetes or heart disease) managed and monitored remotely in their homes – whether they live in the suburbs or on the edge of a rural village.

The impetus for change is the need to reform health systems to deal with Europe’s ageing population, along with the fashion for finding more cost-effective ways to run public services.

On paper, e-health is a no-brainer – hospitals and clinics should simply change their ways in the morning. Alas, we know well how challenging health reform can be given the numbers employed in the service and the strength of professional groups. And, even if efficiencies are promised in the long-term, finding cash to meet the upfront costs of shifting to e-health technologies is a hard sell in times of austerity.

Is it worth it?

The ACCA – the charted accountants’ professional body – hosted a conference in the European Parliament recently at which speakers wheeled out examples and pilot studies where e-health had saved time and money.

Whether it was by early diagnosis and intervention, or simply by saving the time of specialists who currently have to drive between hospitals to review files, the accountants seem to think it will work.

EU Health Commissioner John Dalli, himself a fellow of the ACCA and a former Maltese finance minister, also sees IT as the kind of game-changer that could put Europe’s health services back on a sustainable path.

Along with MEPs, he helped to ensure that the new EU cross-border healthcare directive includes a specific section designed to accelerate cooperation between national health authorities on e-health.

His colleague Máire Geoghean-Quinn, the Commissioner for Research, Innovation and Science, has made healthy ageing the subject of the EU’s first ‘Innovation Partnership’. This, in short, means money will start to flow to projects that develop telemedicine and ‘ambient assisted living’.

Skills deficit

So the moneymen and the politicians are on board. The big problem remains frontline staff. There is talk of developing a new grade of allied health professional – the ehealth technician. But in a world of staff ceilings and falling budgets, what will this mean for doctors and nurses?

At the HSE, the man in charge of steering the ship towards a high-tech future is Gerard Hurl, National Director of Information and Communications Technology. He says the evidence supporting the benefits of ICT in healthcare is “becoming mature” now and the returns on investment and patient care are clear, if it is done right.

However, big-ticket ICT projects have something of a chequered past in Ireland – think ‘PPARS’ – so winning over the public and staff is key to successfully deploying new technology.

“To get where we want to be is an issue given economic climate,” Hurl tells me. “We need buy-in from politicians and the public. But we also need commitment from the healthcare workforce.”

That means all staff. The HSE will need to train doctors, nurses and administrators in how to get the most out of IT. Of the 110,000 employed in the public health service, ICT directly accounts for 310 within the HSE, with a further 200 or so in voluntary hospitals.

A good chunk of these are the people you call when your email server crashes. They are not programmers, data encryption experts or IT architects. Those guys work in multinationals, financial services and management consultancies.

Silver lining

Healthcare has been slow to adopt IT, especially when compared with other sectors like banking where customer information is also sacrosanct. And Ireland is playing catch-up compared to the investments made in France, Denmark and some of the Spanish regions.

But the good news is that late developers get to learn from the mistakes of others. This helps us spend our scarce resources in a less speculative and wasteful way. We can look smarter, even if we’re not.

Whether doctors and others are in the mood to embrace high-tech reforms will decide the fate of ehealth in Ireland.

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