Key Capability Areas

The capability requirements to deliver this experience were identified through engagement with the HSE National Directors, and distilled into five focus areas, which support the delivery of the overall reform agenda. The five focus areas are highlighted in Figure 2 below, supported by the critical enablers for a successful delivery – effective clinical and information governance, and the transformation of the Knowledge & Information function itself.

While other valuable initiatives will be identified, assessed and delivered over time in parallel to the implementation of this strategy, we are setting our focus now on capabilities which are expected to have the greatest impact across the service.

The focus areas identified in Figure 2 are described in more detail below.This distilled view is underpinned by a more detailed map of capability requirements, shown on the next page in Figure 3. The detailed capability requirements captured from each National Director are included in the appendix to this document. The five focus areas outlined here will also be referenced throughout this strategy, creating an explicit lineage between the capability requirements, their expected outcomes and benefits, and the delivery approach to realise these. The overlaps and mutual dependencies between these capabilities and their impacts are also recognised – international experience shows that a holistic, connected approach is at the heart of successful eHealth transformations.

Patient centric seamless care delivered across all integrated care pathways and all stages of delivery care

Figure A

5 focus areas summarising the capability requirements identified in engagement with HSE Leadership and Clinicians

Enabling the delivery of the capability requirements through the transformation of the K&I function

Cross Setting Information Integration

This capability delivers the required integration, information flows and process standardisation across care settings that reflect the patient care pathway, enabling the summary care record at a patient level, seamless transition between settings supported by secure handovers of patient information.

Patients will have an Individual Health Identifier (IHI), unique to them throughout their lifetime and across all healthcare settings
Care providers and care facilities will also have a similar unique identifier, enabling their mapping back to the patient throughout integrated care pathways
Standardised business processes and rules for data integration so that interoperability and data sharing are enabled across all care settings
Security & access processes and controls to support this increased level of data access and sharing

Electronic Health Records

This capability creates and enriches the patients’ electronic health records at each setting, stores the detailed care information at activity level, and feeds the summary care record to enable cross setting integration.

Electronic record of all patient interactions with care services – capability covering hospitals, community care, social care, health & wellbeing and mental health
Specific activities captured include ePrescribing, test ordering, care plans and transition management
Reduced dependence on paper records on forms through introduction of clinical documentation and workflow functionality
Decision support capabilities to provide contextual information to assist clinicians to make decisions
Patient facing capabilities (e.g. a patient portal) to enable health information exchange, helping patients to manage their care supported by clinicians sharing knowledge and information.

Care Delivery Enablement

This capability delivers a series of clinical and care delivery capabilities which digitise areas/processes thereby allowing electronic data capture, better quality of care, more clinician time spent with patients and greater ability for patients to participate in their own care.

Technology enabled function specific capabilities that support care delivery – a series of national programmes across the health service
Examples include Lab Systems, Radiology tooling, ePrescribing for primary care, Appointment management and eReferral systems (all of which have care and efficiency benefits)
Information and functionality can also be made available directly to patients through a patient portal to allow the patient to manage their own care and interact with clinicians
Can be implemented in parallel to and later integrated with EHR

National Support Systems

This capability provides the national backbone for the core support service – finance, procurement, and HR – it is crucial for integrated, efficient management of the health system as a whole.

Consolidated national finance solution including accounting, reporting, budgeting and forecasting, billing, and procurement
Enablement for activity based funding (patient level costing of healthcare delivery)
Human resource management, payroll & pensions, and learning management

Health Service Insight

This capability delivers the information management, reporting and analysis solutions and processes which provide timely, reliable information and decision support for patients, clinicians, and management from the micro level (e.g. individual patients or treatments) up to the macro view (e.g. system wide performance, population health trends).

A comprehensive data repository allowing consolidation and flexible manipulation of data from disparate data sources – a ’single source of truth’
Business intelligence tooling allowing rapid and flexible production of backward and forward looking management information and analytics
Tactical BI enhancements to provide short to medium term management information to support operational management.

Capability Contribution towards Integrated Care

Delivery of each of the core capabilities outlined above makes a significant contribution towards realising the eHealth vision. Figure 4 below illustrates the relative magnitude of impact of each capability on the different stages of integrated care delivery.

Figure 4: Impact of Priority Capabilities

fig4top

	Prevent	Access	Entry	Diagnose	Treat	Evaluate	Transfer	Maintain
Care Delivery Enablement
Electronic Health Records
Cross Setting Information Integration
Health Service Insights
National Support Systems

table-vhigh table-high table-medium table-low

Very High Impact High Impact Medium Impact Low Impact

These capabilities will unlock wide-ranging benefits across all stakeholders of the healthcare system. A non-exhaustive selection of the outcomes is highlighted below, from key stakeholder perspective where the term patient encompasses any person who uses any healthcare service, care providers covers the delivery of healthcare across all care settings and the health system entails the overall national structures and management of healthcare in Ireland.

Capability	Patient	Care Providers	Health System
Care Delivery Enablement	Better quality of care and a seamless patient experience Greater coverage of electronically supported care delivery (instead of paper based) – allowing the information generated in specific care delivery situations to be used in the future (underpins the electronic health record and patient-centric view of care history) Better diagnosis capability with decision support Improved specific care outcomes through use of enhanced capabilities Less risk of errors More flexible care experience and ability to self service Ability to schedule appointments based on patient choice over provider services More transparency over own care	Greater clinical efficiency and quality Increased use of information, decision support & automation (e.g. radiology and laboratory alerts based on abnormal results) Improved consistency of care within the hospital as systems are integrated More efficient management of clinical and other resources Facilitates an automated flow from appointment booking through to rostering across the entire patient journey Helps balancing patient demand with capacity across facilities (e.g. across a hospital group) More flexible and timely integrated care delivery Electronic referrals can shorten waiting lists by giving the referring clinician visibility of waiting times Allows mobile staff to more effectively schedule and manage home/community appointments Reduced risk Prescription errors are significantly reduced through ePrescribing Electronic ordering of blood tests improving reliability	More clinical and administrational data, to allow better planning and management Improves quality and quantity of data captured electronically Patient safety and outcomes improved through stronger clinical capabilities Enabling system-level efficiencies Efficiency gains through automation at all stages of care delivery and greater levels of patient self service

Capability

Patient

Care Providers

Health System

Care Delivery Enablement

Better quality of care and a seamless patient experience

Greater coverage of electronically supported care delivery (instead of paper based) – allowing the information generated in specific care delivery situations to be used in the future (underpins the electronic health record and patient-centric view of care history)
Better diagnosis capability with decision support
Improved specific care outcomes through use of enhanced capabilities
Less risk of errors

More flexible care experience and ability to self service

Ability to schedule appointments based on patient choice over provider services
More transparency over own care

Greater clinical efficiency and quality

Increased use of information, decision support & automation (e.g. radiology and laboratory alerts based on abnormal results)
Improved consistency of care within the hospital as systems are integrated

More efficient management of clinical and other resources

Facilitates an automated flow from appointment booking through to rostering across the entire patient journey
Helps balancing patient demand with capacity across facilities (e.g. across a hospital group)

More flexible and timely integrated care delivery

Electronic referrals can shorten waiting lists by giving the referring clinician visibility of waiting times
Allows mobile staff to more effectively schedule and manage home/community appointments

Reduced risk

Prescription errors are significantly reduced through ePrescribing
Electronic ordering of blood tests improving reliability

More clinical and administrational data, to allow better planning and management

Improves quality and quantity of data captured electronically
Patient safety and outcomes improved through stronger clinical capabilities

Enabling system-level efficiencies

Efficiency gains through automation at all stages of care delivery and greater levels of patient self service

Capability

Patient

Care Providers

Health System

Electronic Health Record

Better quality patient care and patient experience across all stages of care

Patients provide information once that is reused across departments, tests and procedures – the health record is the prime source of information instead of the patient
More rapid diagnosis through electronic ordering and provision of tests and results
Better quality diagnosis through decision support systems that provide contextual information and advice to the clinician – such as decision trees
More effective, joined-up care plans across settings

Increased ability for self-care

Reduced unnecessary visits to healthcare facilities as patients can self-serve for basic requests (e.g. medication repeat prescriptions)
Patients can help maintain their own data and contribute to care plans to demonstrate adherence to post discharge plans

Better clinical outcomes

Supports care providers delivering better care outcomes through richer information including longitudinal data, decision support, and reduction in errors

More efficient care delivery

Implementation of standard clinical pathways will support clinical best practice to reduce average length of stay for patients
Full electronic capture of clinical events - clinicians can send and receive appropriate order requests & prescriptions electronically
Electronic ordering and result provision of tests to hospitals, reducing administrational time and paper based processes

More effective risk management

Clinical decisions are supported by information and rules based warnings (e.g. drug interactions)
Electronically captured (as opposed to paper based) information of prescriptions mitigates risk of error

Greater degree of care delivered in the community

Sharing of care plans and notes between hospitals and other settings, enables as much of the patients care as possible to take place outside of the acute hospital setting and improving the quality and consistency of care

Better quality of care

Rich data can be analysed to identify areas for review of clinical care protocols or outcomes
Improved data quality as patients act as the guardians of their own records
Health system develops best practice over time due to access to date especially in cases of rare/specialist illnesses/cases

Better management of healthcare resources:

Underpins activity based costing and funding
Greater efficiency through reduced paperwork, use of workflow etc.

Capability

Patient

Care Providers

Health System

Cross Setting Information Integration

More patient involvement in own care planning and delivery

Access and ability contribute to own health care information and history

Easier access to care

Self service capabilities (e.g. scheduling most suitable appointments)
More transparent availability of services across providers

Better patient care experience

Seamless transition between care providers supported by the integrated patient health information – e.g.: between GPs and hospitals; or between different specialists within a hospital
Reduced repeat procedures and information requests

Improved patient safety & security

Ensuring all information can be linked to an individual e.g. allergy information being available to new care givers
Clear rules and protection over who can access personal data

More timely transition to convenient & appropriate care setting

Enabling more community care and telehealth

Improved patient safety and quality of care

Sharing of critical information in a timely manner (e.g. sharing of previous historical information like x-rays or lab tests to quickly understand a patient’s history when these events may have taken place in different hospitals)
Reduced errors due to more accurate patient identification and access to records

More efficient management of scarce resources

Reduced delayed discharges, enabled by faster patient flow
Reduction in repeat tests, procedures and administrational time through more complete information
Overall reduced demand for acute hospital care

Enabling and transferring care from acute hospitals to community care settings

Better collaboration and information sharing by GPs, clinicians and other allied health professionals to deliver health in a community setting
Enabling more effective patient pathway management including appropriate intervention prior to acute re-admission based on access to latest medical information and cross setting care planning

Improved population health

Better patient outcomes overall
Ability more rapidly and effectively identify and address macro level trends in population health

Greater focus on prevention

Foundation to carry out detailed cross health setting clinical research and identify preventable trends
Reduced cost of healthcare

More effective and efficient overall care delivery and planning

Enable end to end evaluation of care delivery effectiveness
Faster flow of patients between settings
Combining data sets across care settings allows for a more holistic view of the usage profile of patients
Enabling health economics of Ireland to be linked to the patient rather than the process

Capability

Patient

Care Providers

Health System

Health Service Insights

Better quality of care

Better management information to drive continuous improvement in care quality
More rigorous performance management across healthcare delivery to improve patient outcomes
Richer data to support more accurate diagnosis and treatments, and evaluation of care effectiveness

Greater access to care

More proactive, forward looking intelligence about care delivery needs to allow timely adjustments in capacity, speciality skills etc. – improving the level of patient access to care and waiting times

More holistic view of care delivery and impacts, driving better patient care

Timely and accurate care delivery performance reporting within hospitals, Hospital Groups and Community Health Organisations and analysis of, and reaction to, variances
Operational reporting of care metrics (e.g. incident reporting, attendance rates etc.) that may trigger specific care interventions such as understanding patient’s use of multiple services (e.g. instances of mental health patients attending at Emergency Department)

More effective and predictive resource management, leading to greater access to care

For example, bed management, allocation of staff, medical device utilisation etc.

More advanced clinical research and analysis

BI capabilities be used to support medical research activities

More comprehensive and accurate planning of national trends and service requirements

Supports health care planning for all time horizons
Enables population health and disease surveillance and control, and initiation of interventions (e.g. national programmes) to address undesirable trends and effects

More effective care delivery

Comparative reporting across providers allows for effective provider management, continuous improvement and allocation of financial resources
Stronger operational management across the entire healthcare system through the efficient collation of local service data into macro level balanced scorecards outlined in the HSE Accountability Framework.

Capability

Patient

Care Providers

Health System

National Support Systems

Greater access to care

Enhanced resource planning enables greater access to care
More granular management and planning of scarce resource will help address care delivery bottlenecks and support reduction in waiting times
More care provided closer to the patient in the community settings

More proactive and effective resource planning and allocation, leading to greater access to care

Ability to project resourcing needs and more effectively allocate resources across temporary peaks and troughs (e.g. within a Hospital Group or Community Health Organisation)

More care delivered through the community

Provides the basis for funding mechanisms to allow more care to be delivered within the community setting (instead of acute hospitals)

More accurate, granular financial management and planning

Underpins transition to activity based funding that will align funding with the care provided
More effective billing of private medical insurers
Supports financial management of hospital groups

More efficient short and long term resource planning & management

Ensuring that capacity gaps are identified early and structural programmes are put in place to address these
Providing data to underpin the balanced scorecard approach outlined in the HSE Accountability Framework

Healthcare funding model aligned to strategy

Activity based funding to align funding with care delivery

More proactive financial management of the health system

More rapid and efficient reporting to allow timely corrective action if required, and more granular information allowing detailed analysis and focus on variances
More proactive forecasting capabilities

The capabilities described above will result in a fundamentally more ‘user friendly’ experience for all stakeholders of the health service. A selection of future experiences are highlighted below in Figure 5, to illustrate the ‘look and feel’ of the eHealth enabled care delivery system.

Key eHealth User Experiences
Patient	*“I don’t have to provide all of my information again and again” -* Electronic Health Records	*“I don’t have to go to the doctor as much as I used to. Now I just do the tests at home” -* Care Delivery Enablement	*“I can check my medical records online to check how something was treated before”* - Cross Setting Information Integration	*“I can request prescription, appointments and check results from home”* - Cross Setting Information Integration
Hospital Doctor	*“I can see my patients medical history, regardless of where treatment took place” -* Electronic Health Records	*“I can consult support tools to help me make a decision” -* Electronic Health Records	*“I can request tests and issue prescriptions electronically, saving critical time” -* Electronic Health Records	*“Funding for my service is responsive to the number of patients needing my help” -* National Support Systems
Community Nurse	*“I can see my patients medical history, regardless of where treatment took place” -* Electronic Health Records	*“Collaborating with my colleagues is now easier as we can share and update care plans” -* Electronic Health Records	*“I have my tools available on my mobile when out visiting patients” -* Care Delivery Enablement	*“I can submit test requests and referrals to others electronically” -* Electronic Health Records
Physiotherapist	*“My time is well utilised as referrals and bookings happen electronically” -* Care Delivery Enablement	“*I can capture my patient notes as I go on my tablet in the treatment room*” - Care Delivery Enablement	*“I can check how my patients are doing as they log their progress on the portal”* - Cross Setting Information Integration	*“I can update my colleagues who are also treating my patients” -* Electronic Health Records
Hospital Group Manager	*“I can manage my beds more effectively as I can predict how many will be free”* -Health Service Insights	*“I can see resource availability across my hospital group and reallocate resources or patients as required” -* National Support Systems	*“I can manage patient safety closely with detailed reports on clinical trends”* -Health Service Insights	*“I can review performance across all of my hospitals to see where needs improvement”* -Health Service Insights
GP	*“I can electronically refer my patients to specialists” -* Electronic Health Records	*“I can securely communicate with my patients and other health professionals”* - Cross Setting Information Integration	*“I can see my patient medical history including hospital prescriptions, discharge summaries and lab reports”* - Electronic Health Records	*“I can help my patients manage their chronic illnesses through telehealth devices” -* Care Delivery Enablement

Knowledge & Information Plan