The A2i-HIDs team supporting the HSE’s fight against Covid

The 2018 Autumn edition of Health Matters provided me with the opportunity to introduce the HSE OCIO Access to Information and Health Identifier Team (A2I-HIDs).  I had only been a few months in my new role, tasked with bringing together two existing teams HealthLink and the Health Identifiers teams. 

I referred to them in that article as my dream team and how right I was. Having previously worked with both teams, I was not in any way daunted, knowing the calibre, professionalism and indeed the personalities of the individuals involved.  Probably showing my vintage here but I refer to it as the Brady Bunch challenge, blending two families together.  This has been a great success, in no small part attributable to our ‘Alice’ Marie Lalor, a rock of sense and well able to knock our heads together and bring us back to practicality and sense when we ‘we technical types’ start dreaming of all the technical innovation we get so excited about.

In June 2019 some of the braver members of A2I-HIDs took on the aptly named ‘Hell&Back’ challenge in honour of two of our recently deceased colleagues.  Little did we know then of the challenge that we would face and conquer with Covid less than a year later.

It all seems a long time ago now, prior to what I now refer to as the ‘Covid Space Time Continuum’ in which units of time have changed with things that used to take months being achieved, by necessity in days.  Late on the evening of Friday March the 6th, I got the call to arms I had been expecting – Covid had arrived - what could A2I-HIDs do to help? 

The team gathered in Drogheda the following day to brain storm what we could do.  We looked at our arsenal of technical expertise and tools such as the IHI, Health Identifiers, HealthLink, eReferrals, Lab Results, Eircodes, the HealthDirectory and HealthMail,  what we had been quietly working on for Citizen and Health Provider Portals and came up with a blend of solutions that we could rapidly deploy to support real-time electronic referrals for Covid Tests, scheduling of Covid Test Appointments and the message brokering of test results from the laboratories back to clinicians and the Covid Case Tracking system for contact tracing. 

We did not realise then then that this would be the last time we would all sit in a room together but that hasn’t deterred us from delivering all that we set out to do and even more as I will now describe as the A2i-HIDs team have been working at pace, 12 hour days and frequently 7 days a week for the last year responding to the Covid-19 pandemic initially for Covid-19 Testing and Tracing and now for the roll-out of Covid-19 Vaccinations.

The A2I-HIDs HealthLink team rapidly deployed electronic Covid-19 Test Referrals within 2 weeks of the onset of the pandemic in response to the urgent requirement to provide a solution for Public Health, General Practitioners (GPs) and Occupational Health clinicians to refer their patients for Covid-19 tests.  This went live on March 15th and was quickly followed by Covid-19 Assessment referrals.

At the same time, the A2I-HIDs Health Identifiers Team (HIDs) rapidly deployed the IHI (Individual Health Identifier) for Covid along with Eircodes and Health Identifiers for Practitioners and Health Facilities such as Covid Test, Assessment and Vaccination Centres and working with the Swiftqueue team to deliver a Covid-19 Test Appointment Scheduling solution.

Meanwhile, the A2I-HIDs HealthLink team used the national messaging broker HealthLink to provide real-time Covid-19 Test results from the National Virus Reference Laboratory (NVRL) back to GPs and clinicians and directly into the Covid Case Tracker (CCT) system which supports testing, results and contact tracing for positive results.

Within only 8 weeks the A2I-HIDs team had provided the end-to-end electronic solution for taking a person from being referred for a Covid-19 test, scheduling their appointment and getting the correct test results from the labs back to their GP and the Covid Case Tracker within an average of 3 days from start to finish. 

The provision of the Health Identifiers, in conjunction with Eircodes enabled HSE Community Operations to plan for and identify the demand and support the roll out of Covid-testing for patients and long stay residential facilities such as Nursing Homes and for serial testing of congregated settings and outbreak sites using test centres in proximity to the patient’s home or location.  

There have been over 4.75 million Covid e-Referrals, appointments and results processed to date. 

Having barely had a chance to draw our breath supporting Covid-19 Referrals, Testing and Tracing, we found ourselves supporting the roll-out of Covid-19 vaccinations as the IHI and was now needed for the Covax Vaccination System (Covax) system along with Eircodes and Health Identifiers for facilities and vaccinators its Vaccine Registration Portals and integration via HealthLink for GPs to the Covax system itself.

Just a note regarding the IHI (Individual Health Identifier) and Covid.  The IHI is required for patient safety.  Using the IHI helps to ensure that the correct health records are linked to the correct person.  Where possible, the person’s PPSN is used to find their IHI. The lawful basis for this is contained in the Health Identifiers Act 2014. If a person does not have a PPSN they may provide other identifying particulars in order to help locate their IHI or if they are not entitled to a PPSN (for e.g. a non-resident) an IHI will be assigned to them.  In cases where the person does not have a PPSN, e.g. a foreign student or non-resident, they are asked for their passport to confirm their name, dob, gender, nationality and home address and subsequently an IHI is created on the IHI Register and recorded in the Vaccination System. This means that no individual presenting to receive a Covid vaccine will be denied the vaccine because they are unable to provide their PPSN.

The IHI was implemented for the COVID Case Tracker (CCT), The Covid-19 Test and Assessment Appointment Scheduler (Swiftqueue) and the IHI has been linked with all Covid e-referrals since March of last year. To date this is a total of 4,011,148 referrals.  We also implemented the IHI for the GP Out of Hours service (CareDOC) and the Flu Vaccination System flu vaccination system at the end of last year.

With the IHI having already been used for the schools immunisation programme it is anticipated that the IHI will be linked to vaccination records for any individual who receives a vaccine in Ireland. 

The A2IHIDs Health Identifiers Team (HIDs) recently completed a hugely successful IHI match rate improvement project and with the inclusion of the PPSN as provided for with Covid Vaccinations and the inclusion of data quality APIs to assist with finding Eircodes for addresses, have taken match rates of between 33% to 58% to returning match rates in the 90-93% range.  

The GP Covid-19 vaccination solution is designed to be used in real time, with data being entered as work is completed and patients are vaccinated. GP practice staff use their accredited practice systems to record the vaccinations and send the vaccination report via Healthlink to the Covid Immunisation System (COVAX).  The vaccination report contains patient demographics, eligibility and consent plus vaccine details and identity data for the vaccinator.  To date 450,571 vaccination reports have been processed by Healthlink. GPs are also notified via HealthLink if a patient of theirs has been vaccinated elsewhere.

For community Pharmacists coming on board administering vaccines, the A2I-HIDs team rapidly designed a facility using our Health Provider Portal (HPP) to provide the same functionality to Pharmacists (HSE-PharmaVax) and potentially others who may be administering the vaccine.

In addition, Healthmail (secure encrypted email) was rapidly stepped up to provide the facility for GPs to send ePrescriptions to Pharmacies and over 10 million scripts have been sent via Healthmail since April last year. The electronic transfer of prescriptions over Healthmail has realised real benefits for patients and health care professionals during the Covid crisis.  Prescribers can send prescriptions securely to the patient’s pharmacy, very often following a telephone consultation, eliminating the manual exchanges involved in processing a paper prescription and reducing the amount of movement of the population, making it safer and easier for everyone.

Lastly, as if we weren’t already busy enough, the A2I-HIDs team, in conjunction with colleagues from Tusla, developed a Healthcare Worker Accommodation system to allow health workers with the need to find alternative accommodation from their homes in order to protect their households.

So as I write this, just over 12 months from that Saturday in March 2020, I have to say that the A2IHIDs team really have been on a journey to ‘hell and back’. We are all exhausted and tired but have such a great sense of achievement and are justifiably proud of the contribution that we have made to help support the response to Covid.  For me personally, I can only say how proud I am of each and every one of my dream team, silent heroes and true professionals.  It has been an absolute privilege to work with you all.