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October 4, 2005 5:39 pm

Irish health services executive: End to Sinatra doctrine

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IT managers in large organisations often complain about the problem of getting dozens of disparate IT systems to talk to one another.

They should think themselves lucky. An IT audit of Ireland’s Southern Health Board, conducted in 2003, revealed more than 1,800 applications.

Even in the same hospital, there was often a hotch-potch of incompatible systems, the result of years of fragmented funding and a lack of decentralised decision-making.

As in the Frank Sinatra song, everyone had done it their way.

“It was chaos,” says Ursula O’Sullivan, regional IT manager for Ireland’s Health Service Executive. “Everything was done on a local basis and there were lots of bespoke systems written in the 1980s.”

Many of the applications were no longer supported, as the vendors had disappeared. The legacy systems struggled to cope with the increased workload caused by Ireland’s population boom.

What was worse, the systems had been developed in isolation with little thought to sharing data across departments in the same hospital, let alone across a region or, as is now required, an entire country.

On January 1 2005, Ireland’s health services underwent a radical change. The SHB and 10 other regional health boards were subsumed into a single nationwide organisation, the Health Services Executive.

With the organisational shake-up came a long-overdue overhaul of IT systems. “The advent of the HSE gave us a unique opportunity to replace all our legacy systems on a national basis,” says Ms O’Sullivan, who was previously IT director for the SHB.

Instead of having 11 regional health boards, each with its own IT policy, the HSE has adopted a national IT strategy and a limited number of strategic platforms and technologies.

“We moved from having systems that were appropriate and affordable, to ones that are effective and efficient,” says Ms O’Sullivan.

Central to Ireland’s healthcare reform is the idea of an integrated electronic health record. The aim is to eliminate paper records and provide a “single version of the truth”, so reducing potentially fatal errors due to missing or wrong patient data.

The SHB was the first region to adopt the new patient record system and it will be extended across the country by 2007.

According to Ms O’Sullivan, one of the biggest challenges thrown up by the project was “data cleansing”, meaning reconciling multiple records held in various computer systems that refer to the same patient.

For example, a man could be entered as Paddy Murphy in one hospital record, butbe known on his GP’s system as Patrick Murphy on his GP’s system. There were even problems with people being on the system under the wrong gender. in one extreme case, a female patient had 19 distinct records, in four of which she was described as being male.

For the new health record system, the HSE standardised on software from iSoft, a UK health technology specialist. But for other types of system, the HSE may have more than one recommended provider.

Tendering is now done on a framework basis with contracts lasting for five years.

Connections between the systems are handled by a virtual private network, which uses satellite links to allow ambulances and other mobile workers in remoter regions to stay connected.

Ask any IT director and they will tell you that one of the biggest problems with this type of radical overhaul is getting users to abandon familiar legacy systems and “buy in” to the new strategy.

To achieve this “buy-in”, the new IT systems were tested and refined over many years using local pilot programmes, starting with a “greenfield” site at a new general hospital in Tralee, Co Kerry.

“There, we could introduce new systems from the start and we did not have a legacy mindset,” says Ms O’Sullivan.

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