Report

eHealth Ireland Ecosystem considers Electronic Health Records

Introduction

The third official meeting of the eHealth Ireland Ecosystem was held on Wednesday 25th November 2015 at the Aviva Stadium Conference Centre, Dublin 4. The event was facilitated by the Health Informatics Society of Ireland (HISI) and the European Connected Health Alliance (ECHAlliance).

The main objectives of the meeting were:

  1. To build consensus around the term Electronic Health Record
  2. To compile expert opinions and experiences of EHR's, its benefits, challenges and lessons learned.
  3. To support and motivate the HSE to pursue their agenda around EHR's

Project Team

The project team consisted of representatives from the Health Informatics Society of Ireland (HISI), The Irish Computer Society (ICS), The European Connected Health Alliance (ECHAlliance), The Health Service Executive (HSE) and eHealth Ireland.

Promotion

Websites

The event was promoted on the eHealth Ireland website, and also on the HISI  and ICS websites. The event was also promoted on the ECHAlliance website.

All stakeholders were asked to promote the event on their websites also.

Each website included an introduction to the Ecosystem and a description of the theme of the event. Once the agenda was finalised, it was added to the websites.

Email campaigns

A newsletter announcing the event was sent out to the eHealth database including key hospital, industry, academic and executive personnel, HISI and ICS members, and previous Ecosystem attendees. All stakeholders were asked to inform members and contacts also. A meeting update email was circulated weekly to all attendees of previous Ecosystem events in the run-up to the meeting.

Social media

The event was promoted on Twitter by the project team. The hashtag #eHealth4All was used with a strong uptake prior to the meeting, and by attendees on the day of the event. The graphic design company Think Visual was contracted by the HSE to document the event graphically.

Speakers

A consultation process took place with Ecosystem stakeholders, clinicians, academics, patient organisation representatives, industry leads, government and HSE, for thoughts on approach and appropriate speakers to ensure that the maximum benefit was derived from the eHealth Ireland Ecosystem meeting and that a high quality set of recommendations could be produced for advancing the EHR national project. A range of appropriate speakers was chosen representing the HSE, academics, patient organisations, and industry.

Delegate profiles

The meeting was attended by at least 320 delegates, including dedicated registrants and attendees at the HISI Conference, at which the Ecosystem meeting was hosted. Delegates included health professionals, medical educators, research students, nurses, general practitioners, industry leads and policy makers. For a detailed breakdown of registered delegates, and their organisations, please see Appendix D.

Exhibitors

Typically, at an Ecosystem event, exhibitors are invited to display pop-ups. This opportunity was offered on this occasion also, but given that this particular Ecosystem event was held at the Annual HISI Conference, most industry attendees were already displaying their pop-ups upstairs in the exhibition area.


Theme

The Electronic Health Record (EHR) was selected as the theme for this Ecosystem meeting to elaborate its benefits, the expectations and desires of stakeholders, on both demand and supply sides, and to ensure a common understanding of the ambitions of the HSE, the constraints and challenges of the project, and the implementation plan.

The insight of Dr. Áine Carroll, National Director Clinical Strategy and Programmes for the HSE supports the rationale for the selection of the theme of EHR for this Ecosystem meeting.

In order to deliver truly patient centred, safe and excellent integrated care, we need integrated information management and technology. Technology allows better access to accurate information, quick and efficient sharing of patient information which releases more time to treat patients. It allows access to potentially life-saving patient information and faster access to relevant information. Perhaps more importantly, it allows individuals to better manage their own health and become active participants in planning for their own needs. In short, connected health is better health

It is hoped that the Ecosystem contribution to the EHR planning process will maintain the momentum to delivering this key strategy.

Challenges

In compiling the agenda for the meeting, there were some initial challenges around the term Electronic Health Record. The consensus, from the consultation process, was that this meeting needed to provide clarification around the term, from the various perspectives of all stakeholders within the sector. It was agreed that the programme would provide a general overview of EHR's, in both theory and in practice, and the challenges faced when implementing them.

The key challenges, identified by the HSE around the topic, were resources, privacy, integration, and legacy systems.

Format and rationale

Previous Ecosystem events have included roundtables and panel discussions. However, given the very large number of attendees at this particular event, the format was modified, and contributions from different perspectives were more formally presented. The Ecosystem also benefited from elaboration of its theme at several other sessions over the 2 day HISI conference, including the CCIO meeting.

The event was structured in three sessions each discussing aspects of EHR development and deployment and providing case studies to illustrate thinking to date, progress and forward planning.

  1. The Vision – clarifications, definitions, common language
  2. On the Job - perspectives from different workplace domains and roles
  3. Challenges, and how to meet them

Analysis of speaker input

A consolidation of the view of clinicians, researchers, industry representatives, government agencies, HSE and Dept. of Health was compiled to encourage the progression of the national Electronic Health Record project.

Key Messages

  • A clear recommendation from the meeting came in the form of a call for clarification around the term Electronic Health Record.
  • Patient safety and improved healthcare must be the goal of a national EHR, taking priority over budgetary matters.
  • The biggest obstacles to implementing a national EHR:
    • Time
      • Clinicians and other staff typically do not have protected time for user training
      • Lengthy implementation timeline can lead to built-in technical obsolescence
    • Resources
    • Communication
    • Costs
    • Low user adoption rates
    • Poor user interface. 's must be easy to use, with a simple interface, to ensure adoption.
  • It is imperative that the HSE engage with clinicians at every stage to ensure 100% adoption.
  • EHR’s can provide evidence-based, meaningful, feasible and actionable patient information which can translate into standardized data that can be benchmarked
  • Ownership of the EHR
    • Clinical ownership of the record is vital
    • EHRs should be the intellectual property of the hospital.
  • The national EHR should integrate with existing fragmented systems, tests and procedures
  • An EHR should eliminate redundant exams tests, and procedures.

What to Avoid

  • Stand-alone systems
  • Too many clicks and screens
  • Information that is not named, captured, or stored in a consistent way across EHRs - information should be consistent and standardised for both clinicians and patients as they use different parts of EHRs
  • EHRs structures that do not efficiently support team communication and / or decision making
  • EHRs that fail to provide an accurate up-to date ‘big picture” summary of care that represents the multidisciplinary team’s collective care and the contributions by each discipline/clinician involved in care

Conclusion

The meeting ended with HSE CIO Richard Corbridge launching the public consultation process on the new national Electronic Health Record.

Evaluation

Planning phase

A consultation process took place with various stakeholders to solicit their thoughts on how the topic would be best approached. This process ensured that the maximum benefit was derived from the eHealth Ireland Ecosystem meeting and that a high quality set of recommendations could be produced for advancing the EHR national project.

An initial meeting with the Aviva Stadium staff was held in order to determine most appropriate room layout settings and any other facilities required.

Contribution of project team

The event was professionally facilitated by HISI and the ECHAlliance, who planned, managed and delivered the meeting alongside the CCIO meeting and the Annual HISI Conference.

Speakers

The speakers were chosen after a consultation process with various stakeholders in the sector.

The first session of the afternoon, TheVision, heard from Richard Corbridge, Professor Jane Grimson, Dairin Hines, and Oscar Solans Fernandez. These speakers provided an insight in to how the HSE envision the EHR and how EHRs have successfully been implemented across Catalonia and within a Dublin Hospital.

During the second session, On the Job, we heard from Dr Gráinne Courtney, Louise Geraghty, Dr Conor O’Shea, and Simon Moores, all of whom work day to day in hospitals and in general practice, and they presented convincing arguments on how EHR’s could improve their work environment and patient care.

In the final session, Challenges, and how to meet them, Derick Mitchell, Declan Fitzgerald, Dr Daniel Stegmann, Andrew Murphy, and Dmitri Wall explored some of the key challenges we face when implementing EHRs such as resources, privacy, integration, and legacy systems.

Delegates

There was a strong uptake on social media from delegates in discussing the topics further.


Disclaimer

The views expressed by speakers and delegates are their own, and not those of the HSE.