Seven key enablers in transforming Ireland's digital health landscape

In addition, with five different generations now working across our health services, we also need to consider the heterogeneity of skillsets and knowledge requirements across the health workforce. Successful digital transformation in health will need to be led by the end users: those working with the technologies on the coalface of care provision.

However, the majority of our current workforce are self-taught in the use of digital technologies and there is a need to:

• Ensure that workforce planning takes account of the digitally enabled models of care which will define the health system of the future.
• Establish digital skills as a core component of education and professional training for our future health workforce.

5. Infostructure with interoperability by default

One of the major challenges faced at the outset of the pandemic was our inability at times to collate and fully understand what was happening in terms of the virus and its consequences because of the inefficient, disconnected use of data.

Ultimately, if we want to improve and strengthen our health system, including achieving the Sláintecare vision of ensuring that people can access the right care in the right place at the right time, then we will need to ensure that people, and the healthcare workforce serving them, also have access to the right information in the right place at the right time. Indeed, it will be virtually impossible to achieve patient-centred, integrated care for people in our communities without adequate health information systems, including Electronic Health Records (EHR) and individual health identifiers (IHI), to support the work of staff tasked with providing that care. 

Rather than the traditional model of having patients navigate a static and largely physically based system, our health system will have to change to revolve around the individual, with modern, robust, secure ‘infostructures’ which:

• Support data liquidity and interoperability, with seamless flow of data (with appropriate safeguards) within and between systems and organisations; this will be dependent upon the implementation of standards based (openEHR, FHIR) digital technologies.
• Enable the meaningful use of data for local needs facilitating ‘bottom-up’ innovation and data exchange while maintaining ‘top-down’ standardisation of approach.

At the heart of this must be a central tenet that individuals are entitled to access their own data and to have a say over how their data is being used, both for themselves and to improve population health, planning and research and innovation.

6. Spend, scale and sustain

Can digital health technologies deliver greater efficiency, make healthcare more affordable and improve the resiliency of the healthcare system? Yes. However, this won’t come cheap.

The reality is that spending in the short term is required if the health system is to save in the long term. In order to take full advantage of the opportunities that new digital technologies can bring, the health sector will have to first invest in the foundation stones of our basic digital architecture, including those technologies that the healthcare workforce requires at point of care. 

The experience of the pandemic has led to a greater understanding and appreciation of the potential for digital technologies to impact positively on service delivery and reform within the Irish health system. A variety of initiatives, including the introduction of ePrescribing, the expansion of eReferrals, the development of the COVID Care Tracker demonstrated a capacity to develop and implement innovative solutions at pace.

Likewise, there has been significant adoption of telemedicine by GPs and other healthcare professionals and by the general public. In addition, the cyber incident in May 2021 highlighted the need to continuously strengthen the health system’s ICT and cyber resilience.  However, the challenge now is to maintain that momentum, to continue to promote the need for digital investment in healthcare in the face of so many other government priorities. Key to this will be communication of the cost of not investing:

• Unsustainable increases in healthcare spending
• Inefficient delivery of siloed care and unwarranted variation in care
• Poorer healthcare outcomes
• Hampered ability to plan the development of health services
• Decreased patient, public and workforce satisfaction
• Vulnerability to future cyber events

Where we do invest, it will be vital that innovation is aligned with national strategic health priorities and that a long-term commitment is given to transformation.

It will be vital, too, that when investments in new technologies are being considered, their implementation, interoperability and potential value is assessed in the context of the real-world complexities of the Irish healthcare system and the future vision for that system and the citizens it serves. The clinical impact, cost effectiveness, user acceptance and safety of new technologies will need to be considered with reference to the maturity of our digital infrastructure.

And of course, the successful implementation of these technologies can only be achieved and sustained if they are accepted and indeed championed by those for whom they are intended, which brings me to the importance of trust.

7. Trust at the core

One of the key takeaways from the pandemic was the importance of public trust in mobilising change in healthcare. Health and healthcare is first and foremost about people. The opportunities provided through new health technologies will only be realised if the public and frontline professionals understand and trust this technology and have trust in what is being proposed.

In addition to data privacy and security, other key elements of building and maintaining this trust will include:

• Recognition that digital transformation will bring uncertainty and new ways of working, with adequate preparation of people for those changes.
• Honesty that there is no one perfect technological solution to all our ills and acknowledgment that some initiatives will fail.
• Reassurance that new technologies will be subject to ongoing review, that their value will be assessed; in terms of both improved outcomes and financial efficiency.
• Clarity that the core purpose of implementing change should be to augment rather than replace what is currently working well in healthcare.
• Recognition that digital health will not be suitable for everyone or for every situation and that there are both benefits and limitations.
• Understanding that not all innovation requires technology and that people across our health services are constantly innovating and coming up with novel solutions to the problems they face in the absence of digital technologies.

The reality is that a successful digital transformation will amount to a health-system-wide reorganisation, and it will require leadership, commitment to change and an overarching strategy that articulates how technology-driven innovation can be used to improve health outcomes.

Summary

While the explosion in data and technological innovation offers us a real opportunity to move away from the episodic, siloed care models of today and to instead reinvent care as a truly patient-centred, integrated, personalised health experience, this can only become a reality if we shift our mindsets, harness the extraordinary levels of interdisciplinary, inter-agency and inter-sectoral collaboration that we have seen over the past couple of years, and utilise all of the fantastic resources, people and technologies that are available to us in Ireland to improve health outcomes for all.