The last developed country to get a digital health record

Richard Corbridge is on a mission to engage thousands of clinicians to use technology for better patient care. Ireland’s CIO at the Health Service Executive tells Highland Marketing that whilst genomics and robotics are moving ahead with excitement, the country is also working hard to get the basics done.

Type ‘Richard Corbridge’ into Google and you can see evidence of his profile as an IT leader for Ireland. It has been some 18 months since he took the helm as chief information officer (CIO) for the Health Service Executive (HSE). And he is certainly making an impact.

Tasked with turning the eHealth Ireland Strategy into a reality, Corbridge is ensuring that technology supports healthcare efficiency and more importantly that it is improving the wellbeing of Ireland’s population, whilst also creating economic opportunities.

Owner of a popular blog, coverage in many informatics publications, and a Twitter feed followed by thousands, these efforts have not gone unnoticed. Since starting his role, he has already been recognised as the one of the most transformative and disruptive CIOs and won person of the year at the recent Tech Excellence Awards.

Revamping Ireland’s eHealth capabilities

Core strategies in Ireland have consistently pointed to one thing – a vision to encourage greater clinical engagement in IT projects. Corbridge has been helping to make this vision a reality.

“The role of a technology leader is not limited to IT,” he says, it is about communication, creating buy-in and using that to deliver real change. The creation of the Council of Clinical Information Officers (CCIO) is an example of this. Founded with a remit of educating clinicians on the benefits of digital solutions, the council now has more than 170 members, and is empowering clinicians to provide leadership themselves in the country’s key eHealth programmes. The leader of the CCIO group, Yvonne Goff, is now also the technology person of the year in Ireland, a huge achievement for an enthused group of clinicians.

“We’ve said quite openly on several occasions how we would like to see the role of a chief clinical information officer as the person in charge of eHealth by 2020,” says Corbridge. “We need to make sure we drive forward the business change from a clinical perspective and not from an IT perspective to try and build people’s views of how that can work and help deliver integrated care for the population.”

To its detriment, technology is seen as a high cost item (a national electronic health record is costing 0.7% of the entire health budget), which has held back digital adoption in times past. But is this still the case?

“People are starting to understand that an investment in digital is an investment in the future in healthcare” says Corbridge, who adds that the image of IT as a ‘nice to have’ is changing rapidly, a signal of change to come.

“We have whole processes and whole systems in Ireland that are still using pen and paper. 109,000 people work in healthcare in Ireland and 45,000 of those do not have any digital identity. In primary care there are 10,000 people delivering care without any technology; we need to get people confident in what it can do.”

Openness and transparency

Corbridge has a sharp focus on engaging with stakeholders to discuss and implement ideas. The #eHealthMoments initiative – an internal communication tool whereby staff upload short videos of themselves and what they do – is a good example of creative thinking that helps staff based around the country to identify with each other and bring teams closer together.

There is no such thing as typical day for Corbridge, but stakeholder engagement is a consistent theme across his work: “I am out and about a lot presenting to different clinical groups whether it’s a group of GPs that meet in an evening to talk through problems in their communities, through to the AGM of the Irish Association of Directors of Nursing and Midwifery, so there are a lot of engagements to spread the word about what technology could do and building peoples’ confidence”.

Corbridge is on a mission to change people’s opinions of the HSE, and sees social media as a key tool to help achieve this. He was recently named in the top 25 must-follow IT leaders on Twitter. His theory is that transparency and openness equals more positive relationships in the public domain: “It is not a secret government thing that’s happening, it needs to be a journey that people are on with us.”

Getting technical

What does Corbridge consider as the biggest success since his tenure so far? GP e-Referrals was live in 45 hospitals as of May 2016, and by the end of June was in place across every hospital in Ireland. This is cited as the project that has had the most impact for patients and clinicians: “Before this, patients could be given a referral letter and asked to post it themselves as they left the surgery. Now a patient sees the referral get to the hospital before they leave. To have done this so quickly into so many hospitals and practices has been really very, very good for patients and for the system. And importantly it builds confidence and trust in what we are here to do!”

Corbridge recently told the Future Health Summit that Ireland is the last developed country to get a national electronic health record. He insists it’s important to learn lessons from different health systems but emphasises the importance in applying technologies such as electronic health records (EHRs) to Ireland’s landscape: “It’s important that people register there is a difference in Ireland and don’t just bring in other successes deployed in other health systems. Ireland requires a different type of investment and a different type of route to delivery. This has been quite exciting as it’s a new system to learn and a new way of doing things, for a unique way healthcare is delivered.”

The worst in Europe – solving challenges in emergency care

Like many healthcare systems, Ireland struggles to cope with the influx of patient admissions leading to poor performance for waiting times – in fact the country is the worst in Europe. Corbridge cites greater access to data, and the analysis of information, as a must-have step to making service improvements in emergency departments.

The next stage of the e-Referrals project will see masses of referrals data from primary care to acute services analysed, to examine referral patterns and inform decisions on patient safety, service efficiency and business change.

“We collect a lot of data in the HSE but currently do not have much information we can analyse,” says Corbridge. “We are good at having large spreadsheets but we are not pulling it together and putting it into places where it can be used quickly and for the good of patient care.”

On a local level, St Vincent’s University Hospital has transformed the way it manages patient pathways by real-time tracking of patients, and using status reports, and analytical tools to inform changes in service delivery.

Corbridge visited the hospital in February to see the new emergency department system. “It’s quite phenomenal to see how enthused a group on clinicians under significant pressure can be about a key system. They say themselves that this changes the way they deliver care. Clinicians are in busy jobs with busy working hours, and so to actually make sure it brings about huge amounts of benefits and to do it so quickly is a massive credit to the IT team there”.

The art of supplier relations, but not as we know it

There is no doubt that software suppliers will play an integral part of Ireland’s digital health journey. Corbridge is keen to build partnerships rather than supplier relations, to focus on the needs of both parties, for the best possible result: “We need to accept that there has to be money that is made from any supplier whether that’s a consultancy firm helping us or an EHR supplier. But what’s our joint goal? Where do we need to get to?”

Transparent relationships with a variety of suppliers, will help foster innovation and reduce the reliance on a single partner, he adds: “We are trying to foster a wider eco-system and relationships.”

There is no one-size-fits-all for technology, but Corbridge insists it must meet clinical needs. Open source is an interesting prospect that Corbridge says will play a part in all of our futures, with less supplier lock-in and greater interoperability among the benefits. “We need to consider how we adopt it, I think it’s as much to do with the attitude that comes with open source, as it is to do with the actual technology.

“Actually enabling the clinician to be part of the journey and part of the process and being able to put their hands on a system and decide how the system works is a big part of it, it doesn’t necessarily need to be open source but it does need to be clinically configurable.”

Genomics, robotics, and ink pens – moving beyond the basics

Corbridge insists it’s not the type of technology that should take the limelight, it’s the impact it can have on how we manage our care. “We have this concept of how do we contextualise IT for each person, their medicine and the care they receive.”

A lot of exciting things are happening, which Ireland must continue to embrace. “We have a genomics programme starting off around epilepsy,” says Corbridge. “People get really excited about robots that can go around the ward and talk to patients, which is literally one thing that happened in one of our hospitals.”

“But we have to be mindful that there is still a long way to go,” he adds. “At the same time as genomics and robotics taking off, we have got 10,000 people delivering primary care, still writing with pens and hospitals without WiFi to support the automated systems being deployed.

“So there is a lot of work to be done to get the basics done before we leap forward into the new stuff which will bring huge benefits.”