Person-centered eHealth reform in Ireland 

Many of the challenges in Ireland’s health system such as insufficient investment in infrastructure, long wait times, and the rising burden of chronic disease resemble those that other health systems are facing worldwide.1  In 2013, Ireland launched its national eHealth strategy, the goal of which was to transform its health information system and keep pace with the rapid global proliferation of technology using patient-centered, information-based eHealth solutions.12 Electronic health, or eHealth, is defined as information and communication technology activities that use electronic means to deliver information, resources, and services for health.3 eHealth can facilitate improved service delivery and better allocation of resources, making it a cost-effective strategy for improving health system performance across many contexts.145 Key eHealth initiatives at the core of Ireland’s reform - described below -  seek to leverage the potential of innovative digital technologies to empower patients and healthcare workers by way of greater transparency, access to services, and information. 25

What is person-centered care?

Person-centeredness is an important function for improving system performance from the perspective of the user. Person-centered care involves engaging with people as equal partners in promoting and maintaining their health and assessing their experiences throughout the health system, including communication, trust, respect, and preferences.

Achieving more coordinated person-centered care through interoperable and personalized information infrastructure

In 2014, Health Service Executive (HSE), the provider of all of Ireland’s public health and hospital-based services, started the “Knowledge Information Plan” to create a unified vision and plan for a health system supported by a digital infrastructure.6 The National Electronic Health Record and National Individual Health Identifier are two innovative projects at the core of the eHealth Strategy.1 The Individual Health Identifier (IHI) bill (approved in 2013) establishes a unique health identifier for health service users and providers that is designed to be interoperable across the public and private health and social service sectors. The IHI establishes a system for clearly identifying the person and organization involved at each stage of care to ensure that providers have access to reliable, timely, and effective information needed to provide high-quality care.278 Ireland’s National Electronic Health Record system, which centrally stores patient medical data is aligned with the IHI national register to ensure the unique and safe identification of patients. Operationally, the IHI and National Electronic Health Record together serve to:7

  • Allow a Health Service Provider to search for an IHI number for an individual
  • Store the IHI number on the Health Service Provider system 
  • Notify the IHI National Register of any updates to the individual IHI record that may have been notified to the Health Service Provider by the individual

Together, these two projects link the specification of patient data across the continuum of care through the use of modern information systems and technologies. This coordinated transfer of critical patient information helps to ensure the delivery of appropriate and comprehensive care at the right place at the right time.2 Successfully scaling this identification system across all sectors and levels of care will rely on structures that underpin effective information systems, including improved and targeted investments, multisectoral stakeholder engagement and coordination, and well-established governance and delivery structure.12

Ways forward: sustaining eHealth reforms through targeted investment and support infrastructure

Ireland has already taken steps to support the longevity and modernization of the National IHI and EHR systems alongside other initiatives in its eHealth Strategy, including the development of the Health Information Bill, a policy intended to “facilitate enhanced information management processes relevant to a modern health system” through provisions such as a data matching programs and health information resources. Additionally, Ireland has launched an innovative “Cloud First Digital Strategy” with the aim of deploying a robust cloud infrastructure for all Irish Healthcare Solutions. Maintaining momentum for these ambitious reforms will depend on increased investment in eHealth systems and implementation support infrastructures, such as supportive policies, legal and regulatory frameworks, and a skilled workforce.12 Users can read more about Ireland’s eHealth Strategy and other country’s experiences with eHealth here.

References:

  1. Kent K, Furness O, Spelman R. Ireland’s eHealth Transformation: Prescriptions for Success. Deloitte; 2016. Available from: https://www2.deloitte.com/content/dam/Deloitte/ie/Documents/PublicSector/IE_Ireland_eHeath_report.pdf
  2. An Roinn Slainte Department of Health. eHealth Strategy for Ireland. An Roinn Slainte Department of Health; 2016. Available from: https://health.gov.ie/blog/publications/ehealth-strategy-for-ireland/
  3. WHO Europe. E-health [Internet]. World Health Organization Regional Office for Europe. [cited 2019 Jul 12]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/e-health
  4. Lewis T, Synowiec C, Lagomarsino G, Schweitzer J. E-health in low- and middle-income countries: findings from the Center for Health Market Innovations. Bull World Health Organ. 2012 May 1;90(5):332–40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341696/
  5. European Commission. eHealth Action Plan 2012-2020: Innovative healthcare for the 21st century | Digital Single Market [Internet]. 2012 [cited 2019 Jul 12]. Available from: https://ec.europa.eu/digital-single-market/en/news/ehealth-action-plan-2012-2020-innovative-healthcare-21st-century
  6. eHealth Ireland. Knowledge and Information Plan - eHealth Ireland [Internet]. [cited 2019 Jul 12]. Available from: https://www.ehealthireland.ie/Knowledge-Information-Plan/
  7. eHealth Ireland. Individual Health Identifier (IHI) - eHealth Ireland [Internet]. [cited 2019 Jul 11]. Available from: https://www.ehealthireland.ie/A2I-HIDs-Programme/Individual-Health-Identifier-IHI-/
  8. The Health Service Executive Ireland. A Patient Safety Initiative: Introducing the Individual Health Identifier - Your Own Digital Key. HSE; 2016. Available from: https://www.hse.ie/eng/services/publications/healthmatters/health-identifier.pdf