Elaine Loughlin: Five years on, e-health plan not even at the starting line

Health Minister Stephen Donnelly was able to deliver some good news to his Cabinet colleagues last week, telling them that trolley figures are now “stable”.

The number of patients on trolleys was down by 5.2% compared to the previous week, which was the third consecutive week to show a decrease in weekly figures.

But as ministers sat around the Cabinet table listening to the update, 449 patients were lying on trolleys. Of these, 359 patients were waiting in emergency departments, while 90 were dotted elsewhere across hospitals.

How have we reached the stage where having more than 400 people, who are sick enough to need hospital admission, waiting on trolleys is categorised as “stable”?

Of course, emergency departments are just the outer more visible edge of a complex maze that makes up our creaking health system.

To function properly, systems need a user-friendly integrated structure that allows those operating in it to easily access information in real time.

It’s this type of system that doesn’t exist in the HSE.

Instead, nurses, doctors and consultants continue to rely on tracking down bits of paper, writing notes at the end of beds and hoping that patients might have a full recollection of any medication they have previously been prescribed by their GP.

Health Minister Stephen Donnelly is no closer to signing off on the vital e-health strategy first announced in 2018.

In October 2018, then health minister Simon Harris visited St James’s Hospital in Dublin and took the media with him for a very positive announcement.

The hospital had just rolled out a digital upgrade. It was to be the first of our healthcare facilities that would implement an e-health programme and in doing so would ease the workload of staff, streamline the system for patients, and ultimately improve health outcomes in hospitals across the country.

“We need to move beyond the days of lots and lots of patient files being passed from doctor to nurse back and forth all over our health service to having one place where all of our patient information is,” Mr Harris told reporters back in 2018, adding that the roll-out of an e-health programme was a key recommendation of Sláintecare.

The minister went on to say that the move to digital records was “long overdue” and would enable the reconfiguration of services across acute, community, and primary care sectors.

“On a very practical level, if you are not dependent on individual people writing notes and putting them in different places and different files and different pieces of paper and you have one central port that has all of that information about someone’s medication, about who has last seen the patient, about what observations or tests the patient has had or is going to undergo, it co-ordinates that information and therefore improves patient safety and improves outcomes,” said Mr Harris.

This transformation was to be part-funded with the help of a €225m loan from the European Investment Bank (EIB).

It all seemed like the commonsense approach that was long overdue.

But behind the scenes, the move from pen and paper to an integrated digital system was being blocked.

In fact, a government decision was made in 2018 — the same year as St James’s went digital — to refuse funding for the rollout of electronic health records until after the new children’s hospital is complete.

Five years later, this facility has yet to open its doors let alone test out its digital patient system.

Meanwhile, the Government has decided to ignore all the international evidence that strongly points to the benefits of introducing a comprehensive digital view of patient records that enables clinicians to track patients over the continuum of care.

It has also decided to ignore St James’s Hospital and the small number of maternity hospitals in this country that have moved to digital patient files.

Instead, a hospital which has run significantly over its estimated construction date and which is massively over budget will be the example to
follow.

This revelation only came to light in recent weeks during an Oireachtas health committee meeting and left members visibly surprised.

Social Democrats TD Róisín Shortall couldn’t quite believe what she had heard. She wanted to know how far along the e-health programme, developed in 2013 and announced in 2015, has progressed.

After funding was stopped in 2018, the HSE had to deploy what chief information officer Fran Thompson described as “tactical solutions” to get around this.

These tactical solutions have in reality amounted to a piecemeal approach where some services, such as radiology, have transferred to online systems but many others have not.

Clinicians still have to look up multiple systems that don’t speak to each other, chase down numerous files, and rely on written notes to get a comprehensive view of the patient in front of them.

Mr Thompson let slip that while the e-health strategy will be delivered by a combination of units in the HSE, they have yet to even get to the starting line.

“We have to go through the approvals and procurement process to get to that starting line.”

Social Democrats TD Róisín Shortall couldn’t believe her ears when she learned the much vaunted e-health digital health system, launched five years ago, hadn’t even got to the ‘starting line’.

It was a statement that almost sent Ms Shortall off her seat.

“I am sorry. Please, is he saying we have to get to the starting line?” she asked in the hope that she had misheard.

“The witness has said in order to get through a programme and get to the starting line. How is that after eight years we are talking about needing to get to the starting line?”

But Mr Thompson confirmed that this was indeed true.

There is no start date because the National Children’s Hospital, which will act as an e-health guinea pig, has yet to admit a single patient.

Even after sign-off is granted to introduce a proper digital system, it will take between five and seven years to deploy electronic healthcare records nationally.

In the meantime, our health service will continue to be held back by inefficient paper-based patient interactions.

As Fianna Fáil’s Cathal Crowe put it: “There is more known about each one of our cars through the national NCT database than there is about our public health.”

Did you know?

The word democracy comes from two Greek words: ‘demos’, which translates as ‘people’, and ‘kratia’, which means ‘to rule’. US president Abraham Lincoln described democracy as “government of the people, by the people for the people”.

Article 5 of our Constitution states: “Ireland is a sovereign, independent, democratic state.”

Article 6 then continues by stating: “All powers of government, legislative, executive and judicial, derive, under God, from the people, whose right it is to designate the rulers of the state and, in final appeal, to decide all questions of national policy, according to the requirements of the common good.”

This week in years gone by

1929

Feb 8: Éamon de Valera was sentenced to one month in jail for illegally entering Co Armagh. He had been arrested when he crossed the border on his way to Belfast. The arrest and sentence were later subject to a lengthy debate in the Dáil.

1968

Feb 8: Calls were made on Fine Gael TD OJ Flanagan to resign after he went on television to say he was in favour of the system of jobbery. Mr Flanagan said he saw nothing wrong in using influence to help friends to get jobs, but, he added the proviso, “all other things being equal, and provided they are suitably qualified”. In a sign of the times, it was reported that Mr Flanagan “was not available for comment last night. He had not arrived home from Dublin when the Examiner reporter telephoned his home.”

1991

Feb 7: A massive police hunt was underway after the IRA attacked Downing Street with a mortar bomb. While the bombers failed in what was described as a “badly executed bid to kill British prime minister John Major and his war cabinet”, the group succeeded in breaching the security cordon around the heart of the capital.

2015

Feb 9: TD Paul Murphy was released without charge after then tánaiste Joan Burton and her adviser were falsely imprisoned at a water charges protest the previous November. Speaking to reporters outside Terenure Garda Station, Mr Murphy said he was “not some sort of master criminal that deserves to have six gardaí at my door”. He claimed the arrests of him and three others were “trumped up”, with the investigation attempting to conclude he was personally in charge of the protest. Mr Murphy and five others were later found not guilty of false imprisonment.

Hot topicals

A very long weekend: After the St Brigid’s Day bank holiday, TDs are extending the weekend just a little bit more. The Dáil will resume on Wednesday this week instead of the usual Tuesday start.

EU summit: Taoiseach Leo Varadkar will be in Brussels on Thursday and Friday for an EU Council meeting with fellow European heads of state. It is expected that immigration and the ongoing war in Ukraine will feature largely on the agenda.

Taoiseach Leo Varadkar will be in Brussels on Thursday and Friday for an EU Council meeting. Picture: Brian Lawless/PA

PAC: Officials from the Department of Health are due before the Public Accounts Committee (PAC) on Thursday. It is expected that the recent controversy over nursing home charges as well as spending on emergency departments will all be up for discussion.