In the past two years Richard Corbridge has pulled the Irish health service up by its digital bootstraps, turning an organisation that had been calculated as some 16 years behind the digital curve into one that is catching up hand over fist and scoring world-firsts in the field of digital health. Just some of his successes are the creation of a digital hospital as well as an infrastructure to enable the genomic sequencing of patients with suspected epilepsy that is expected to cut over €5m from the drugs bill in 2017 and save the lives of 90 children under the age of five in the same year. He has also brought about cultural change in how digital is viewed by the organisation – no longer is IT the team that likes to say no, but a respected business partner that is listened to for its ability to transform healthcare in Ireland for the better.
Chief Information Officer and CEO of eHealth Ireland
How are you influencing the products, customer experience and services your organisation offers to its customers?
The role of the CIO in digital health has changed drastically. As CIO I have responsibility for influencing how digital impacts on the products offered as well as our customers’ experience and the services the health organisation has to offer. Over 2016 I have ensured that the benefits of digital health solutions in the whole of Ireland are clear to patients, clinicians, public and indeed politicians alike. Building a sense of understanding of the ‘art of the possible’ is key to driving the influence that I have over customer experience and the breadth of services we can offer.
I believe the health arena has the widest customer base and therefore the widest disruptive possibilities of any organisation that can be impacted upon by digital. I also believe that digital can make a bigger difference to healthcare than it can to any other business vertical, and that this can only be achieved through a CIO that influences change happening at a business level. In 2016 I have applied a focus to achieving this at all levels of my organisation.
One of the best examples of this process in action in 2016 is the ability to digitally refer a patient from GP practice to acute hospital. This was a new service in January 2016, and in one year the team has implemented this ability for every hospital in Ireland. The delivery of e-referral to every acute hospital in Ireland is a good case study to demonstrate how I, as a CIO, have influenced the delivery of a new product that changes customer experience and allows my organisation to offer a new service.
The achievement of this has been completed in a number of ways. There was clarity about the benefits to the patient through a communications and engagement programme with the patient being first and foremost. This drove ‘customer’ need for the solution. My team described the benefits clearly to the patient through a variety of channels; they would see their referral had arrived at the hospital before they left the GP surgery and would feel reassured that it was being considered by the hospital; they would also know where to go to follow up on information about the referral.
The referral process, though, has multiple customers. The team then ensured that the benefits to the GP would be clear, which involved describing the efficiencies and patient safety elements that the implementation of e-referrals would bring. In 2016 over 110,000 referrals moved from envelope and stamp to digital; this alone is an attractive price proposition for a GP surgery. The acute hospital is the other customer who benefits: they have access to immediate digital information, they can move the referral triage process to a more business intelligence-based central point, and can now access information on the referral live anywhere in the hospital.
Prior to e-referral a referral in Ireland would take over 10 days from GP practice to a decision-making clinician in a hospital. The referral would touch around 16 pairs of hands on this journey with many possibilities for the process to go awry. The e-referral capability now in 100% of hospitals removes these possibilities and instils confidence in digital and the benefits it can deliver.
The technology deployed to achieve it was simple: open standards-based at the core, and supported and maintained by our own integration team. Building on commercially available foundational elements, it also enabled us to flex the capacity of the system as it ramped up and provided a personalised support capability as each site came online.
The model used for e-referral has been repeated across all new digital lines of implementation and is best described below.
First discover the technology need through business engagement and ensure that the full width of the business is engaged. Then evaluate technology in conjunction with the business, implement quickly into the first sites, and evaluate the technology and business change requirements. Then make changes to make sure the solution is appropriate for the width of the business need. Each new digital implementation considers its early elements as foundations to be built upon, and the concept of chief clinical information officer (of which we now have over 200 across Ireland) provides expertise in ensuring the solutions then can be implemented from a clinical point of view.
This approach has been re-used across a number of projects including: individual health identifier for the population of Ireland, e-pharmacy in community, an electronic health record (EHR) for the maternity services of Ireland, and a digital identity for every member of staff working in health in Ireland.
Define the key business outcomes that you have delivered over the last 12 months and their impact on your organisation’s performance
In December 2014 the Irish healthcare system was said to be 16 years behind the digital curve for health in Europe. In two years Ireland has been able to catch up six of those years, and in 2016 four of those years were closed.
There are a number of key projects that have become the foundations of all business change and reform to the Irish healthcare system. They include an individual health identifier, e-referral, e-pharmacy and Ireland’s first digital hospital.
The Irish healthcare system can now uniquely and digitally identify every patient and member of staff, improving the ability to deliver enhanced patient safety significantly and the ability to manage performance based on information 10-fold. The system has broken down physical boundaries relating to the referral process by implementing fully an e-referral process completely in less than 12 months. The ability to prescribe in the community using a process that maintains patient choice of pharmacy has been piloted successfully and is now being implemented nationally. The first fully digital hospital has been delivered in one of the busiest maternity hospitals in the EU and will now be implemented in every maternity system in Ireland. This solution sees IoT solutions brought into the most complex of care delivery systems effectively, saving lives through real-time information analysis and the implementation of digital workflows across a whole care pathway, which is a first in the world.
As well as these foundational elements, the Irish healthcare organisation is now implementing several key innovative solutions that are bringing patient benefit and system-wide efficiencies. In 2016 the infrastructure to enable the genomic sequencing of consenting patients with suspected epilepsy and long-term epilepsy sufferers who also have learning difficulties was implemented. Globally unique to Ireland is the ability to view this information within the disease-specific EHR at meetings of the full multidisciplinary team. Being able to view this information means that the whole care pathway can be tailored using the geneticists’ view of the sequenced genome. It is independently predicted that this programme of work will cut over €5m from the drugs bill in 2017 and save the lives of 90 children under the age of five in the same year.
Other areas include the implementation of a fully digital supply chain model for haemophiliacs in Ireland that sees treatment tracked to the fridge of the patient and replenished with just in time methodologies, saving a predicted €20m in five years and allowing full traceability and recall of all treatments delivered. Additionally, the first national digital solution for the support of people with bipolar disorder has been developed and deployed utilising the outcomes of a hackathon. A chatbot-based digital assistant is now available to a number of bipolar patients in Ireland, providing an easy to use interface that acts as an early warning system to the patient and with consent can inform the person delivering care to the patient of an impending episode.
As well as the technology implementations and business changes that the team has been responsible for, it has succeeded in bringing about a cultural change in how digital is viewed by the organisation, which also brings about a change in expected outcomes for the organisation. Cloud first and digital first are new concepts to health. Indeed, Ireland’s cloud-first policy is the first in health in the EU and came as a concept from my office. These changes reflect on the business outcomes as the health system in Ireland is now more digitally agile through its adoption of technologically forward-thinking capabilities. The ability to move the cystic fibrosis patient register from paper to digital was achieved in days through the use of these two policies; being able to provide information governance and cybersecurity assurances beyond those associated with the paper record and the sharing protocols linked to this mean that Ireland now has an opt-out patient registry for cystic fibrosis that aids not just the delivery of care but the study of the disease.
All of this has been achieved without any significant increase in budget or head count for the digital team. It has been made possible through commitment and clarity of the benefits being sought and is merely a snapshot of the new digital fabric brought to the Irish healthcare system over the last 12 months.
What has been your involvement with innovation at your organisation – in particular, with products, business model and technology – over the last 12 months?
The ‘ownership’ of the innovation agenda falls to the CIO office in the healthcare system in Ireland. Significant effort has been applied to ‘exciting’ the system, using innovation as the lead concept.
Ireland, according to the World Health Organisation and HIMSS (Healthcare Information and Management Systems Society) is the first country in the world to deliver a health innovation week for the public of the whole country to take part in. This event was led by me and my office, and it saw over 3,200 members of the public attend events over six days, over 40 lectures delivered from health and technology experts from across the world, and over 50 exhibitors and events for patients, clinicians, startups, and students (ranging from primary school to third level). The event demonstrated the way innovation can come to health and enabled the public to be part of the conversation and decision-making process around innovation in their healthcare system. It also enabled the public to influence politicians and the civil and public service in their expectations of what should be delivered in the digital healthcare space.
The ability to innovate with current product sets in health is intrinsic to the concept of, ‘do more with less’ – a concept every health system across the globe is facing today. Public healthcare systems across the globe are not able to invest in technology in the same way as other business areas. In 2016 we have made innovative use of solutions procured from large multinationals and in partnerships with new SMEs. This includes the ‘simple’ implementation of Office 365 to over 47,000 staff who previously had no ability to log onto corporate IT. A nurse in a primary care centre can now use the basic tools available to a school child to deliver the administrative task previously covered by a Bic pen and spiral-ring notepad.
The delivery of Oracle’s OHMPI suite of solutions for the management of patient identity and the integration of this to a Microsoft integration and messaging layer has been described as innovative. While not without its challenges it has enabled appropriate local ownership of integration and national ownership of standards to be achieved.
Innovative action with local product sets deployed in conjunction with startups and SMEs has been an important catalyst for the enthusiasm for technology that has been built up throughout the Irish healthcare system. Solutions such as Medxnote that enable bot solutions to link secure, clinical, digital communications to large corporate-style patient administration systems, systems like TickerFit that enables the prescribing and monitoring of fitness regimes for heart surgery patients, and innovations like Beats Medical, which enables a Parkinson’s sufferer to walk again through access to a metronome-type beat. All these innovative products are now supported within the Irish healthcare system.
Business model innovation
The ability to be digitally innovative in the Irish healthcare system and be supported by the public health system is something that has only really begun in 2016. Three programmes of work have been put in place by my office to support and indeed fund innovation where a link to the national strategic programmes can be made or where a new innovative use of technology can be seen.
The first of these programmes is the eHealth Connects programme; delivered via the Chief Clinical Information Officers group, which is part of the OoCIO. A workshop is held the first Tuesday of every month in a different county in Ireland; startups, SMEs and the technology business in general are encouraged to attend the workshop, to pitch their ideas to the team present and build support for the solution. If the solution can be seen to benefit patient care, then funding and resources are made available to get it to pilot so that it can be evaluated and if successful taken forward. This programme has seen a number of clear successes in 2016, including a solution for the monitoring of capacity in emergency departments being adopted and implemented.
The second of these programmes is the Quality Innovation Corridor (QIC). The QIC programme was launched in the autumn of 2016 and is a process that enables a clinician with a good digital idea to seek support and funding from the digital ecosystem of Ireland to build the solution and bring to a point of evaluation what the solution can do to improve the delivery of patient care. In its first month over 40 applications were received, and 10 of these were adopted as projects to be developed.
The final programme is an accelerator run in conjunction with several government departments and sponsored by Irish companies looking for the next big idea to invest in. #HealthTech enabled 11 idea owners to be supported by the digital health system over an eight-week period to take their innovation from the germ of an idea to a proposition that could be invested in by business or investment teams. The diversity of participants, perspectives and ideas illustrated the way in which digital solutions can be brought to health to deliver benefit.
These three programmes in conjunction with the support which has been given to all partners and colleagues of the healthcare system has empowered a growth in the eHealth Ireland ecosystem. These collegial relationships have been transformational in the evolution of the business model delivering digital health in 2016.
Facilitating the evolution of technology in healthcare has to be an arena of focus, but one that requires very careful investment decisions to be made. The ability to invest in robotics-based operating machinery or organisation-wide group information systems is a tricky one and is a real example from 2016 where investment decisions have had to be a significant part of the technology innovation consideration.
Innovation in technology need not always be the adoption of the latest and greatest new technology. Indeed the already mentioned e-referral solution deployed Ireland-wide in 2016 is relatively simple technology deployed in an innovative way.
The two most innovative technology adoptions in Ireland in 2016 are less traditional IT solutions and fall closer to engineering, although they are still implemented under the auspices of the Office of the CIO in health, again showing, I believe, why the health CIO is a digital leader of a different brand than traditional CIOs. The adoption of the da Vinci Xi surgical system allows pairs of surgeons to perform intricate surgery in colorectal, renal and adrenal areas with hugely improved patient recovery time, significant reduction in infection rates, and the ability to share the burden of complex and intricate surgery with colleagues or as safe learning opportunities. The adoption of this surgical robot, originally designed for implementation in battlefield scenarios, has shown how innovative experiences and ideas applied to modern technology can bring huge reward.
The second example has to be the aforementioned genomic sequencing programme. The rate of change in this area is huge and the impact on each disease area is still in discovery. Ireland has led the way globally sequencing the DNA of epilepsy patients through super-compute cloud-based capability. The most innovative element of this, though, has been the ability to then deliver the sequenced genome and geneticists’ opinion to the care team, enabling findings from this detailed analytical work to impact on the care of the patient. Something as simple as diet change related to a specific genetic mutation can have an instrumental impact on an epilepsy patient’s seizure patterns and therefore their quality of life – again a real example from Ireland in 2016.
How have you delivered cultural and behavioural change as a CIO within the IT department and/or more broadly across the organisation?
The cultural change of the Office of the CIO has been a necessity in 2016. We have moved from a series of local teams with minimal interaction to a single national team supporting key local experts, which is a huge change for each and every person. Communication and support mechanisms were identified as key ways to effect the necessary cultural change within the OoCIO. Several tools were used to achieve this:
- eHealth Moments: Simply an introduction video from every member of staff lodged on an internal social discourse platform, it enabled staff to ‘meet’ each other and get a 120-second view of the role of each member of staff. This has further developed to allow staff members to use this platform to share knowledge, support each other and start discussion groups around common interests.
- Randomised coffee trial: Two team members were introduced to each other at random, and asked either in person or virtually to share a coffee break – to have a simple conversation about anything, creating the ability to collaborate beyond peer relationships. This has been so successful that the next one is being organised.
- #ONEeHI: A social media movement has been created around the concept of a single eHealth Ireland team, facilitating an open and transparent conversation about the benefits and pitfalls of digital in health to take place.
- All-staff meetings: In March 2015 the first all-staff meeting in over 10 years was held. Since then two each year have been held. These meetups enable staff to create an informative agenda, invite partners to an expo, deliver joint communication activity and hear from the latest and greatest in how the organisation is changing. The importance of these meetings has taken on quite a significance with the minister for health, director general and secretary general all taking part in them.
- The senior management team now hold their monthly meetings in a different venue around the country to facilitate continually meeting the wider team and to enable local one-to-one meetings to take place. As CIO I have implemented a more open and transparent culture across the team. We use different communication methods to try to appeal to different styles, ranging from quite traditional staff letters to a three-minute video message each fortnight entitled, Can You Spare a Moment. Openness, transparency and the ability to connect to me as the CIO of our organisation have all been instrumental in building the team’s trust in the direction, and creating a process that allows the wider team to input into strategic and operational decisions more easily.
The digital organisation believes it has transitioned to the new culture and new ways of working. It has also agreed that there are key transformational activities and targets that need to be achieved in 2017.
The wider organisation itself has also been part of this cultural change. No longer are we IT, the team that likes to say no. The opinion of the organisation has been changed by a number of activities, though all relate back to two key areas: transparency and responsiveness. Simple things like putting in place a catalogue of smart devices that can be chosen from by the business rather than a mandated piece of kit chosen by IT. Putting in place delivery directors for each of the care divisions of the healthcare system has given technology a face in areas that are clearly more focused on their day job has meant that the digital agenda can now be more easily owned across the organisation.
The advent of the chief clinical information officer role and the facilitation of the growth of this by my office has brought clinical ownership to all that has been delivered by digital to health in Ireland, which no other jurisdiction has yet achieved.
Finally, the cultural change now embedded in the organisation of bringing the public and patient on the journey with us is a cornerstone of how we deliver health. We have been engaging with the public and patients on multiple projects in 2016, in particular the EHR. We are working with the public, patients and clinicians to develop personas that we will present to the potential suppliers of the EHR. We will ask the suppliers not what their technology can do but how their technology can help improve the health and lives of these different personas of Ireland.
How have you worked with your CEO and/or board to communicate whatever ‘digital’ and IT means to your organisation/sector and improve digital literacy at the highest levels of the organisation?
The key role of a CIO in health is to get closer to not having IT projects run in separation from the business. I have worked tirelessly over 2016 to attempt to remove the silo and separation between the business and the digital transformation agenda. The health system of Ireland has a director general (DG) rather than a CEO, I report directly to the DG and have a seat on the health systems board. Over 2016 the DG and indeed minister for health set the team a series of challenges. Rather than do these as internal targets they were done in the public domain. This allowed the team to build confidence in the deliverables and gain a respected position in the eyes of clinicians and patients across the whole of Ireland. The concept of delivering these as challenges was a strategy to ensure that at a senior level focus could be applied to the digital agenda and engagement built off the back of these. This worked very well in 2016 and ranged from complex projects like Ireland’s first digital hospital go-live to the removal of the need for dot-matrix printers in every GP surgery.
Building an understanding of digital has been done by using two key tactics. The first is building an enthusiasm for the art of the possible, and the second is by building an understanding of what digital solutions can deliver. Simple solutions can build enthusiasm. An open attitude to the technology available to staff has reinvigorated an enthusiasm for new technology and created a desire to try new ways of working that are empowered by digital solutions. Involving the board of the organisation in decisions about the type of local infrastructure available, working with the board to move towards a paper-light board meeting, and creating infrastructure and solutions for greater collaboration powered by digital have all increased the degree of technology literacy and perhaps more importantly the enthusiasm for digital.
Building an understanding of a concept like digital has been a complex task for me and the team. The definition of e-health or digital in Ireland can be somewhat fluid, ranging from the boardroom projector in the head office to a complex EHR procurement for the whole country. A great deal of effort has been spent in the engagement of all staff, clinicians and patients. As CIO I have presented on many stages to many groups, ensuring that the use of storytelling is front and centre for how we portray what digital can achieve. We have provided media content via our own eHealth Ireland website in the form of infographics, digital magazines, videos and animations that explain what concepts as diverse as the IHI, e-referral, EHR and business intelligence are, how they impact on the patient and what benefits they bring to the delivery of care. During the health innovation week we held used hackathons, exhibitions, presentations, think-tanks and Minecraft to get schoolchildren build a digital healthcare of the future. This kind of engagement has led to a good media reaction to the concepts of e-health in Ireland, and a move towards a positive view of what can be delivered through the use of digital.
Working with the eHealth Ireland committee is a group of individuals with very relevant competencies to support the CIO, ranging from the CEO of Science Foundation Ireland to the CEO of one of the Irish hospital groups. This group has been instrumental in advising and supporting the increase in digital literacy around e-health in Ireland. This year will see a patient/citizen being recruited onto this committee.
December 2016 seen us embark on a refresh of the eHealth Ireland website. The website will reflect a wider remit, to try to promote the use of digital in health regardless of where it originated. We have opened the website up to partners and colleagues to become a central point of reference for all things digital health in Ireland. We also are encouraging guest writers from within the organisation and outside to submit blogs to richardcorbridge.com to facilitate different perspectives on digital health, and we will produce a short monthly digital magazine which will collect all that month’s news and be circulated to all interested parties.
The face of digital health has been something that I have fostered across the team, trying hard to give the team a public face. The chief clinical information officers fulfil this role with clinical staff; as CIO I fulfil it for the wider organisation; and the national directors with responsibility for digital in primary care, acute care, community care and corporate IT fulfil it at a local and clinical specialty level. Each of these ‘faces’ of IT has a responsibility to represent what can be achieved with digital via as many mediums as possible, including social media, blogging, guest writing for media and a significant number of presentations.
How have you worked with the technology and IT vendor market to achieve your business goals? How have you been able to influence IT suppliers and successfully manage your partnerships/relationships with large IT companies, SMEs and startups?
I believe in the concept of partnership with all vendors. The management of each relationship needs to be handled individually and with an outcome of creating a partnership in mind. The typical adage of win-win situations can be used well in Ireland in health as it is a country that is becoming a place where first of type solutions can be deployed and therefore can quickly become a place for both the ability to test new solutions and the place where case studies can be developed that can be reused worldwide.
Perhaps the two examples to illustrate the links to large IT companies would be those in place with both Microsoft and Oracle. In 2016 the partnership in place with Oracle enabled Ireland to use existing infrastructure to create a single health identifier for the population of Ireland. Through partnership working rather than vendor management, the solution was created and configured to be unique to Ireland. A similar relationship has been created with Microsoft, culminating in the implementation of Office 365 for over 47,000 health workers, and the implementation of Microsoft hardware as a standard offering to clinicians in an acute setting.
The partnerships created in Ireland are not done to simply deploy the standard offering. The decision to deploy solutions in Ireland requires the systems to be right for the Irish healthcare system or to be configured so it becomes so. This has been done with Microsoft and with Oracle. Perhaps the validation of the success of these two areas in particular comes from the interest globally in what has been achieved. The CEO of Microsoft visited in the summer of 2016 and I was invited to present on the solutions being deployed by eHealth Ireland, and also to present with Oracle at a number of global events through the year. I believe this is the balance that we offer, helping form and grow the relationship. We are happy to be part of the promotion of solutions deployed where they have brought significant success to our goals and challenges. This helps these goals and successes become shared between me and the partners we create.
A further example of the success that we have had with partnership working is with the development of Ireland’s first digital hospital. The partnership created with Cerner, the global electronic health record supplier, has been described as exemplary by a number of independent commentators. The partnership has endured a long period of development; in the last two years this has matured into a partnership that reconfigured the entire standard hospital system and its implementation process to be successful in an Irish maternity setting.
The focus, though, has not only been on the large multinational organisations. We have created several programmes to enable us to engage with startups and SMEs directly, all of which have the goal of creating mutually beneficial partnerships. Through seed funding, programme support and clinical leadership we have been able to assist a number of organisations to move from great idea to clinically beneficial pilots in 2016. We also strongly support collaboration between multinationals and SMEs, and facilitated events and introductions throughout 2016. These programmes of work will continue into 2017, with my office putting clinical leadership in place for every programme and ensuring that these partnerships are business-led and delivery-focused.
How have you tried to develop the diversity of your team?
The changes in the team make-up have been hugely impactful on the success that we have been able to achieve in 2016.
The mix of the team has come about through a significant reorganisation, with a concentration on a wide range of skills within the senior management team. Two members of the senior management team were shortlisted for Technology Professional of the Year in Ireland in 2016; both were new members of the team. The winner of the award in 2016 was, for the first time, a woman, a person without an academic technology background and someone from the public sector; for me that shows the success that the diverse range of professionals now in the team can bring to all that we do, and has been instrumental in inspiring others to take up the challenges of digital health.
The development of the wider team has led to a diversity of background and indeed skills within the leadership team. The creation of both a leadership development programme and a support network for future leaders has been beneficial in encouraging people from diverse backgrounds and in particular in Ireland from dispersed geographies to become part of the driving force of the team.
The randomised coffee trial initiative whereby two people chosen at random take a coffee break together to get to know each other, even if done virtually, has increased a wider understanding of the team members by the team members. Being able to create a relationship beyond that of simply colleagues has been a goal of the team. Allowing the team to get to know each other, and understand the motivations and the direction each member is taking, has been beneficial in getting the team to accept and become part of the wider strategic direction.
The later part of 2016 saw the team begin to prepare for a significant recruitment programme; 50 new resources will come to the team in 2017. The organisation would have previously advertised for new roles only on public sector-focused sites other than for the most senior roles. The decision to open this up more widely will also bring a diversity of new skills and outlooks to the team. To ensure the team are first internally supported in considering these new roles, a programme of training and development was also launched. The team has worked together in 2016 to prepare for an influx of new resources, ensuring that induction and on boarding programmes are as agile as possible, and that the culture of the team can be clearly articulated, thus enabling new ideas to be heard and applied to the way the team evolves. A talent management programme has been developed for the entire OoCIO in 2016 and will be implemented in 2017 to ensure that the digital skills that we have grown can continue to evolve, thus enabling us to flex our delivery capability internally.
Describe how you organise and operate IT and how this aligns effectively with business strategy and operations
2016 saw the completion of a programme of work to transform the Irish healthcare digital system from a locally based and focused one that duplicated effort throughout the country to one that enables a national approach and facilitates local ingenuity and innovation.
The ultimate strategy over the next five years is for the ‘centre’ to simply provide governance, procurement support and overall, high-level direction for digital. The delivery of healthcare is moving to a status of ‘earned autonomy’ and the delivery of digital needs to match this. However, this is an end goal of a journey and not where the delivery structure has got to in 2016.
The first steps taken to get to this new structure have been a major focus of the cultural change in 2016. The newly appointed role of delivery director has given digital a face in each care division, primary care, community care, acute services and the corporate side of the organisation. This role has been accepted into the management team of each of the areas, and now is seen as part of the care delivery function rather than a separate technology function.
This new role ensures that now we have an ear in the business, the adage of listening more than speaking is possible, and the team can have an informed, clinically based, digital strategy for each of the clinical areas across the whole of Ireland. This is a great outcome. However, perhaps more importantly and somewhat unexpected is the fact that the entire healthcare system now feels it has an accountable technology-based person for their needs.
Now that an owner of the relationship has been created, the ability to have a single support function was also identified. In 2016 the national health digital helpdesk was able to go live. In its first year the helpdesk function on this desk took over 177,785 support calls. All calls were answered in 15 seconds or less, with only 11.8% of calls breaching the service level agreement in place for a fix to be implemented. We committed to the implementation of new kit in the health system in 2016: we wanted to remove the reliance on the spiral notepad and Bic pen wherever possible. Over 15,000 new devices were deployed over the year and a plan is in place to add a further 10,000 devices to this estate in the first quarter of next year. A new process and procurement framework means that the devices deployed are new technology, smart devices – all devices have cloud capability and enable safe, secure and timely access to information.
National approaches have been created for information services, the technology office and a central portfolio and change management office. All of these areas are now setting national standards and process to be reused by local technology teams as a service for them to deliver benefit in the local health arena.
The CCIO role is an intrinsic part of the senior management team and has brought significant value to the business focus of everything that is done in health. The CCIO group itself is now at over 200 clinicians who give up their clinical time to offer business leadership to digital programmes.
The evolution from 2014 of the organisational structure from a responsive culture to a more reactive one is key for 2017 in enabling the team to utilise the resources available not only to support the health system but to drive changes that will be instrumental in changing the way the public and clinicians interact with the health system.
What strategic technology deals have you made in the last year and who are your main suppliers and IT partners?
The volume of contracts put in place is vast for a year where we are building the foundations of a digital fabric across a whole country. Large deals with Microsoft, Oracle, Vodafone and an Irish infrastructure company called PFH has seen the fundamental elements of the Irish digital fabric put in place. Health-specific deals with Cerner, McKesson, CSC, IMS Maxims, Clanwilliam Group, Deloitte and KPMG put in place many solutions that have delivered projects that are patient-focused and in several cases are world-first solutions in health.
The ability to mobilise the startup and SME environment in Ireland has also brought about many rewards to healthcare. Sonos, Investnet, TickerFit, SpireWorks, Think Visual, Leading Social and many more have been fundamental to the business change that has been achieved in Ireland. All are also partnerships that have been created rather than traditional contracts. Several of these relatively new organisations are now best considered as fundamental to the delivery of healthcare in Ireland.
The ability to contract and partner with other public sector initiatives like the National Digital Research Centre for support in the delivery of the startup accelerator, with University College Dublin’s Applied Research Centre for independent evaluation of key delivery programmes, and most impactful of all a research grant awarded to the Royal College of Surgeons in Ireland, who were able to deliver the genomic sequencing programme mentioned earlier have driven a diversity of relationships that has ensured the marketplace has remained agile and ready for new business. And also the relationships being created from the awareness of the progress in eHealth Ireland with organisations that are contacting us, such as the Interactive Design Authority of Ireland, MindRising, HIMSS and Spunout, are all influential in building a better health service in Ireland.
What are your key strategic aims for next year?
The delivery and approval of a business case for a nationwide HER is a key aim for the next 12 months. There are many steps on this journey, however, and with this in mind the delivery scheduled for 2017 has been kept busy to ensure that the health system does not feel that digital is waiting for process and governance to happen.
It’s important that this journey has the patient and clinicians involved as much as possible. Therefore workshops with patients and clinicians to help develop digital personas to present to the EHR suppliers are imperative.
Ireland will be the first country in the world to have a single digital solution across all maternity services that enables integrated care in a paperless manner to be delivered. A single lab system for the whole of the country will reduce repeat testing and speed up the process of delivering results to patients and clinicians. The implementation of an Ireland-wide cancer care information system will move the prescribing of key cancer care drugs from paper to digital. The first iterations of a patient portal will go live, enabling the public of Ireland to see which clinicians have been looking at their digital clinical records. Patient portals will also be deployed into maternity services, and for the first time globally a portal will be available for patients to view the geneticist’s opinion of a sequenced genome.
In 2017 Ireland will move from a 10-year digital gap in how it delivers healthcare to a five-year gap, Ireland has the ambition by 2018 to be one of the most digital advanced and supported healthcare systems in the world and be ready for a full country-wide electronic health record.
How are you preparing for any impacts Brexit might have on your organisation?
Ireland is the only country with a land border that needs to be considered as part of Brexit. Patients close to the border today receive care either side of the border, and once Brexit is implemented will need to continue to do so. Additionally, agreement with the North of Ireland sees Dublin hospitals cover acute care in the paediatric heart field and several other specialist areas.
Sharing of information securely, safely and legally is a key concern for health in Ireland in a post-Brexit era, and a great deal of effort is being put into place to ensure this is possible. The implementation of the health identifier in Ireland has been done with Brexit in mind, ensuring that the number is unique across the island of Ireland and that the number is of a similar system-based format to enable it to be reused in systems either side of the border.
The first Island of Ireland digital health ecosystem was held in 2016 and this ecosystem will continue to grow in 2017 and beyond, ensuring that the relationships being developed, and cross-border support for startups and SMEs are not impacted by Brexit.
Ireland and my office in particular has led the way in creating relationships with all of the devolved UK nations at a most senior level in digital health. The CIO of Scotland and Wales now sit on the non-executive board of eHealth Ireland as a way to ensure that links at a digital health and health information level are secure and that regardless of Brexit the sharing of best practice and experiences can continue to benefit the patients of these jurisdictions.
Academic links have been created around the e-health arena across the EU, and my office has been instrumental in bolstering these with key initiatives around the cross-border transition of information, particularly around prescribing, being put in place.
EU agreement on a health cloud-first policy has also been done with an eye to Brexit, ensuring that information in a cloud environment will remain in an EU environment in a post-Brexit world.
When did you start your current role?
What is your reporting line?
Direct to the director general (CEO)
Are you a member of the executive leadership?
Are you a member of the board of directors?
How often do you meet with your organisation’s CEO or equivalent?
How many people at your organisation does your function supply services to?
HSE Ireland IT budget
What is your annual IT budget, or your spend as a proportion of the organisation’s revenue?
What percentage of your budget is operational spend (ie keeping the lights on) and how much new development (ie innovation, R&D, exploratory IT)?
Two-thirds on operational; one-third on new programmes and innovation.
Rank the following sources of advice/information in order of importance:
- CIO peers
- Analyst houses
- Industry bodies
Has your organisation detected a cyber intrusion in the last 12 months?
Are you expecting an increase in budget specific to security in order to tackle the cyber threat?
Does your organisation have a designated security professional – CISO or otherwise – and what is their relationship to you?
Yes, and reports to me.
Are you finding it difficult to recruit the talent you need to drive transformation?
Has recruitment and retention risen up your agenda as a CIO?
Does your IT organisation operate an apprenticeship scheme?
How many employees are there in your IT team?
Are you increasing your headcount or planning to bring skills and the ability to react to needs in-house?
Which technologies or areas are you expecting to be investing in over the next year?
- data analytics/Business intelligence
- enterprise applications
- super compute
Which technologies or areas are you expecting to be investing in over the next one to three years?
- data analytics/business intelligence
- enterprise applications
- devices (mobile)
What emerging technologies are you investigating or expect to have a big impact on your sector or organisation?
IoT in health brings a whole new dimension to the delivery of care in a hospital. Dynamically collecting data on vital signs and applying to an EHR, while simple in other industries, is complex in health, and we have been able to achieve this in the new-born and maternity arena.
VR/AR technology is a leap forward for the training of new clinicians and is something we have now been able to consider.
Does your organisation do a significant amount of trade with the EU?
Does your department include technology staff from the EU?
Are you or have you been looking to the EU to recruit key skills?