The first quarterly Digital Academy Forum was held in the boardroom in Dr Steeven’s Hospital on September 4th. The event heard from a range of speakers representing the four aspects of the quadruple helix of HSE, Industry, Academia and Patient Groups. The highlight of the day was the launch of the new Masters in Digital Health Transformation (DHT).
The proceedings were opened by Dr Martin Curley, Director of the Digital Academy and Open Innovation. Martin began by welcoming everyone to the Inaugural Digital Academy forum and gave us an overview of the speakers and themes we would be hearing. These included the Masters program, Open innovation, the new Slaintecare Shared Record and some innovations in digital healthcare.
Paul Reid - Welcome
Our first speaker was Paul Reid, CEO of the HSE. Paul began by telling us that one of the major priorities of the HSE Board is to build trust and confidence in the organization and the health delivery system. He then told us how happy he was to be at the Digital Academy Forum as the initiatives which were being showcased provided a great platform to work towards this confidence-building objective.
We were then given an insight into how Paul views successful innovation within technology. He advised that when facing up to the inevitable challenges, we would do well to keep three primary messages in mind. The first is to start by looking at the work itself, how people engage with us, how we get the thing done and not to be daunted by the enabling technology challenge. Essentially he said to focus on the process. The second message is to try and look from the outside in. If we are to meet the expectations of the people who engage with us, we need to understand what success looks like to them and not just to us. We also have to be mindful of the challenges our stakeholders face. The final message Paul asked us to remember is the importance of staff retention and motivation. He believes that the capacity to attract and retain people for the future will be determined by the extent to which we make the world of work different and motivating for the next generation of workers.
Paul concluded by congratulating Martin Curley on the success of the Digital Academy and asking us to keep his messages in mind when innovating into the future.
Martin Curley - Introduction
Martin Curley took to the podium next. He outlined some of the aims of the Digital Academy. These are celebrating the adoption of digital technology and solutions across the broader organization including Sláintecare, supporting the building of digital capacity and capability within healthcare and ensuring this is matched with a high level of digital competence.
He told us that we are living in an era of unprecedented disruptive technology such as social media, cloud-based systems, internet of things, Genomics and Digital Health, and told us how All of these are creating the perfect disruptive storm. This does, however, give us a unique opportunity to harness these technologies to improve Healthcare.
The healthcare system is moving from analogue to digital and from reactive to proactive and digital innovation is to the fore in enabling this. We aspire to have a real-time health system which is citizen-centred and one where we can take advantage of data. There are vast amounts of data in the system but not enough examples where this data is used to close the loop and drive both system-wide improvement and patient improvement. Martin spoke of the “Stay left Shift left strategy” which is how he describes Sláintecare in four words. Stay Left is about using technologies to keep people well while shift left is about using technology to move people from an acute setting to a community setting and finally a home setting, A good example of this is the DaVinci robot in UHL which can transform eight-day procedures to one and half days with less blood loss and consequent faster recovery times for patients. These innovations are son beneficial they lead to reduced cost of care, improved quality of life, improved quality of care and improved experience for the clinician.
Returning to the new Masters program he explained that it is focused on building the digital leaders of the HSE who will help change to culture to ensure the HSE is receptive to the advent of digital technologies. This will support the objective we have of moving from a laggard to a digital leader in eHealth worldwide. While doing this in five years might be ambitious, it should be attainable in ten .
Martin concluded by inviting Dr Colm Henry to officially launch the Masters Program.
Dr Colm Henry – Developing Digital Leaders
Dr Henry began his talk by discussing how hard it is to explain to young graduates today about the world pre-mobile phones and digital technology. The past was a time of greater uncertainty and things as simple as meeting up with people was often left to chance. In Healthcare however, we don't have the luxury of leaving things to chance. Digital Technology helps with this by improving the safety and quality of healthcare we deliver. One example he used was digital imaging. In the past images were film-based and could be lost or duplicated. It was very difficult to audit access to images and to see how they were followed through. The next example he discussed was the electronic health record system at Cork University Maternity Hospital. He contrasted the efficiency and speed of this system with the world of paper healthcare records and to highlight this difference, he spoke of his hometown in Cork where individuals could have up to five different paper based healthcare records depending on what services they used, a system which is not safe and inefficient. The final example he gave was in drug reconciliation where digital technology has led to huge reductions in errors caused by simple human mistakes.
He framed Digital Transformation as a critical component of integrated care which is itself a vehicle of Slaintecare. He warned that we will not derive the benefits of Slaintecare unless we have an Individual Healthcare record in place and he spoke of how this record has been identified by Executive Director of Sláintecare, Laura Magahy as a critical enabler of Slaintecare.
Returning to the digital academy, Dr Henry forecast that the academy will improve the workforce, enhance their capability, knowledge and their engagement with digital healthcare. One unique concept within the Masters program which particularly impressed Dr Henry is that the program will not have a 30,000-word thesis at the end but instead will have a real-life project which must be proven to facilitate digital health transformation. He concluded by saying how proud he was to launch the Masters program and wishing Martin and the Digital Academy the best of luck and good fortune into the future.
Professor Anne Ledwith – The Academic Perspective
Professor Anne Ledwith took us through the academic perspective of the Masters program. She acknowledged the huge difficulties in change in an organization as large complex and diverse as the HSE and characterized the efforts to put education at the centre of driving these changes as both innovative and inspiring.
She contrasted change management which refers to basic tools and structures designed to keep change under control with change leadership which is more to do with the driving force and vision which fuels large scale change in organizations.
She believes using the Masters program to create this leadership is an excellent idea. Also she looked forward to the synergies of having an experienced and mature cohort on the and predicted that the competitive and collaborative approach the mature students would take would result in a cohort of motivated and engaged leaders.
The unique project at the centre of the program is designed to facilitate action and to ensure groups learn to work together using disruptive technologies.
She then detailed a summary of the main points of the course which were
- It will open in January to over 30 students.
- It will run over eighteen months
- There will be two semesters
- The fees are 12,000 Euro’s
- There will be a limited amount of Scholarships for HSE staff
- Residential blocks to be held in the University of Limerick and other Institutions
- It is now open for applicants
- Details available on www.digitalhealthtransformation.ie
Ann then closed by saying how she was looking forward to seeing the program commenced in January and seeing the impact it would have going forward.
Kieran Daly – The Industry Perspective
We were given a business perspective next from Kieran Daly. He is the CTO of HealthBeacon, a medication adherence company that develops smart tools for managing medication. They have deployed connected sharps bins to homes for people who are taking injectable medication and these devices are proven to improve adherence in taking medication by extending the continuum of care into homes through the smart devices.
Kieran outlined the reason he believed from an industry perspective why the Masters was important. Digital transformation will never succeed if it merely consists of throwing shiny new technology into an organization. It requires changes in the processes and the way of thinking within an organization. Managing that complex change requires vision and skills and these are competencies Kieran believes the Masters Program will bring out in people. Kieran praised the project dimension to the Masters course and the fact it would be more than just theoretical but would look at innovations that could be brought to fruition and developed. The other element he told us he found to be eye-catching in the course is the focus on making innovation scalable and making it stick, thinking about the longer term and designing the criteria for scalability at a pilot stage.
Anne Marie Hoey – HSE People Strategy and Digital Academy
Anne Marie Hoey stepped up the podium and presented the perspective of Human Resources within the HSE. She referenced the importance of the People Strategy 2091-2024 to the HSE and in particular, the critical element which relates to the training of our current staff and the staff of the future.
She reiterated that digital transformation is not just about the technology but about the people and the culture of the HSE. The digital academy and the Masters program will help in the development of our leadership to support the staff now and into the future. AnneMarie spoke about the digital factory which has been created in parallel to the academy. This manages a portfolio of digital solutions. She then revealed that two of the companies working in conjunction with the factory would speak to us later in the day. She closed off her presentation by describing the digital academy as being somewhat in its infancy but having huge potential. She encouraged us all to be part of the academy as it develops and grows in the future.
Derek Mitchell - The Patient Perspective
Derek is the chief executive officer with the Irish Platform for Patient Organizations, Science and Industry (IPPOSI). He began by explaining how IPPOSI is a patient-led organisation that works with patients, government, industry, science and academia to put patients at the heart of health innovation. He then spoke about the power of education in terms of the transformative nature of it on patients and healthcare providers. He considers digital to be a space which is ripe for patients to participate with at national level for design and redesign of digital health solutions, and he sees a great opportunity within the Masters program to get involved. IPPOSI has been training and educating patients on aspects of health innovation for several years through the European Patients Academy program and they have a blended learning approach on topics such as clinical trials, regulatory affairs and health technology assessment. Digital Health is the next obvious stage for this learning and IPPOSI are using their experience work with the HSE and Academic partners to help develop patient appropriate content for the Masters program.
Derek invited people to their upcoming conference on October 7th where they will have discussion and debate on the design and development of eHealth technologies in Ireland. He welcomed anyone to attend the upcoming conference which is open to the public. He ended his talk by saying that the confidence that comes from being involved in education is an intangible benefit which they have seen from their training program and is a benefit he believes we will see from the Masters program.
Loretto Grogan - The Practitioner Perspective
The national clinical information officer for Nursing and Midwifery, Loretto Grogan began by showing us how Nursing and Midwifery is key to delivering transformation change in the Health Service because their roles see them working right across the service in areas from corporate to the frontline in the Department of Health. They have a central role in care delivery care co-ordination and the promotion and use of self-management. Loretto informed us that she is in her role a year and in that time she has found that there is a large amount of untapped Nursing and Midwifery leadership potential in the Digital Space. She sees the Masters and the digital academy as offering a great opportunity to move into that space. With the help of the Academy she hopes to develop ready, informed educated and skilled staff to be able to be key leaders in driving the digital agenda forward. The areas they are looking at are Executive Nursing Informatics roles, information and system governance, nurses and midwifery being more involved in strategy development, standards of practice and a strong nursing presence in informatics teams. Nursing and Midwifery intend to be a key partner with the Digital Academy and they believe this partnership will help them make a difference for the people who come to the Health Service every day.
Dr Michael Harty - The 1% Proposition
Dr Harty was able to give us a unique perspective as he is both a GP with 40 years’ experience from Clare, in Independent TD and also the chair of the committee on Health in Dail Eireann.
He spoke with pride about the Slaintecare report and its objectives and while he accepted that implementation has been slow, he is encouraged that it is increasing its pace now. Other positive changes which are helping Slaintecare in Health are the establishment of regional structures where hospital groups and community care organizations are being aligned and this allows regional development of Health Services to the needs of that particular population. The needs of inner-city Dublin are quite different from the needs of a rural area in County Clare.
One of the critical enablers of Slaintecare identified by Dr Harty is a Digital Healthcare record coupled with an Individual Health Identifier. It drives efficiency and avoids duplication, provides real-time clinical and administrative provides information which leads to better patient care and outcomes and this is the core purpose of any Health System.
He spoke of his confidence that the Digital Academy Forum meeting this morning would be a catalyst which drives the development of a digital healthcare record.
The cost of eHealth development in healthcare is estimated to be 875 Million over 10 years but we were told this funding is unlikely to be available given the current economic environment and cost overruns in the Healthcare system. We are faced with different options. One is to purchase a large off the shelf product and adapt it to the Irish Healthcare system. This would, however, require a large investment upfront and no guarantee of success.
As an alternative to the big bang approach, Dr Harty proposed a system which is flexible, agile and capable of adaption to the complex healthcare system and he calls this the 1% proposition.
With this in mind, Dr Harty in conjunction with experts in the area will put forward proposals to develop a Sláintecare shared care digital record which can be initiated quickly, piloted to demonstrate its potential and scaled up. Dr Harty cautioned that for this technology to be viable, it needs to be based on open source technology which is affordable, it needs to be clinically led, patient-focused and above all safe for the patient.
It is envisaged this will be developed and controlled within Ireland. There are many silos of healthcare knowledge and these can be joined with the advent of Digital Healthcare records. This will deliver a huge gain to the patient and the health system. One of the big benefits Dr Harty sees from the digital healthcare record is that it will speed up the flow of patients through the health system.
Finally, Dr Harty spoke of his enthusiasm about the Digital Academy, the MSc and the proposals Martin Curley had brought forward to develop an open-source, open platform digital healthcare record. He concluded by saying he fully endorsed the driving principles behind this open model which will deliver one of the key reforms of Sláintecare.
Professor Anthony Staines - The Logic of Open
Professor Staines asked the assembled audience a simple question to start. Who owns our medical information? In the UK some court decisions indicate the secretary of Health owns that data and Professor Staines advised us that were we to transfer that reasoning to Ireland, the logical conclusion would be that Simon Harris owns our Data. This he suggested is not very satisfactory so his proposal called the Logic of Open is that the patient should own their data.
To do this we need to find a way to cede control to the data to the patients. The other group who would like our data is tech companies; the example given was where users of Fitbits cede control of all the data gathered by the Fitbit without any thought .
In Healthcare today in Ireland when we require patient data from the companies who provide us with digital solutions, we are paying sizeable amounts of money to them. The systems are not designed for clinicians or patients and this must change
Going forward we should build from the ground up to ensure we control the data, not like the present where the data is controlled by large corporations in America or Germany or anywhere else. It must be open as otherwise, patients will not be able to see their data. It also has to be open so we can add in new systems and functionality without paying extra fees to outside corporations. Failure to do this runs the risk of huge capital spend over time
We spend the same kind of money as the Germans and the Swedes yet they have better systems. If we continue at the current rate of the rollout, the Individual Health Identifier project will be not be delivered to the entire population until the year 3053. That is not acceptable, we do not even have a basic working data dictionary. We need a clear program to deliver Slaintecare in the short term. We are likely to spend 450 Million euro’s on the Healthcare supplementary budget this year and this should be invested in developing Slaintecare rather than plugging holes in the current system.
Professor Staines’ takeaway was we are at a crunch point in Healthcare Ireland and the current direction is unsustainable. The choice he sees is to go Open or to go Home. His preference and his advice to us all are to go Open.
Dr Tony Shannon / Ross Cullen – Open and Agile Slaintecare record demonstration
Ross Cullen from the Digital academy gave us the first live demonstration of a pilot Electronic Slaintecare Health Record system which they have built-in conjunction with the Ripple Foundation and Health Atlas.
The main dashboard had information on medication, allergies, vaccinations and other information a clinician would need to get an overall view of the health and history of a patient. Ross drilled down into each of the information categories and was able to draw up detailed time-stamped records. Through viewing the events section he was able to show a timeline of the patients’ journey through the Health system with times and dates of when the patient was admitted, transferred to various wards and discharged. It was impressive to see so much information available at the touch of a button and it demonstrated starkly the benefit from having an electronic healthcare record and IHI.
Dr Tony Shannon joined Ross on stage and told us how the Ripple Foundation is a clinically led team who support the concept of open source, open standards and open architecture.
Dr Shannon echoed what many of the previous speakers had said when he spoke of the need for a new approach to doing Health IT using an agile open scalable system. He revealed that Scotland and Finland use this approach as well as some of the larger medical groups in Germany. The challenges for Ireland are we require changes from the top down and bottom up but Dr Shannon has seen our potential and believes we can to take the future into our own hands and deliver the Slaintecare vision that has been set out.
David Toohey – Digitizing Vital Signs collection and Sepsis Clinical Protocols
David Toohey was the first of two speakers who showcased digital systems which are already in use.
David’s system is called KEWS300 and this is an eHealth system dedicated at a point of care in the ward. It is a workflow support system supporting digital observations and higher protocol adherence.
David showed the difference between complex paper-based systems and the ease of the KEWS300 in imputing data. He showed the typical medical scoring chart used in Hospitals and detailed the average error count on them. When the KEW300 system was introduced into St Luke’s Hospital Kilkenny, independent trials showed a reduction in error count from 49% to 0% . This has also been reflected in trials in the NHS UK and NHS Scotland. If we were to implement this system fully across the HSE it is estimated it would eliminate 5 million errors per year.
Where this system has been implemented it has been independently audited and shown to deliver staff productivity gains, dramatically reduced recording errors, earlier identification of deteriorating patients, fewer escalations to ICU and lower admin costs. There is also independent evidence which has shown that in wards where this system has been used, there is an average 13% reduction in the length of stay for patients.
In closing, David told us that there is the potential to increase capacity in the Health Service by simply reducing the average length of stay through the use of innovative technology systems like KEWS300.
Simon Keirsey - Digitizing Diabetic Foot Ulcer Detection
Simon Kiersey gave a frank and graphic presentation on diabetic foot ulcers and the cost to the Health Service and the patients in Ireland. He explained that there are 225,000 patients in Ireland with diabetes and 26,000 of these will develop a foot ulcer at some point in their life. Of the patients with ulcers, 8,000 will require amputation. These ulcers are the most common cause of hospitalisation amongst diabetics. For those unfortunate enough to develop theses ulcers the healing time can be anywhere from 2 weeks to over a year and the chance of developing subsequent ulcers is vastly increased. The cost to the HSE is estimated as more than 200 million euro's per year and 144 beds are taken up every night by people with diabetic ulcers.
Bluedrop Medical’s device is a bathroom scales which also scans the feet for temperature changes indicating inflammation and the beginnings of diabetic foot ulcers. This information is used to treat the patient at the earliest stage when treatment is easier and outcomes and costs are greatly improved.
The home-based system performs a daily scan of the patient's feet and sends the data to the cloud for analysis through advanced algorithms capable of detecting abnormalities. Patients are contacted by clinicians when anomalies are detected and treatment can begin before the problem develops.
Use of this monitoring system has shown to reduce ulcers by 70% and this is a great example of the shift-left stay left model of care as it moves patients away from acute settings to primary and home care. The system can save costs but more importantly, adoption of this will save many patients from amputations and the hardship that that entails.
Muiris O’Connor - Slaintecare and Digital
Muiris told us the Department of Health was hugely supportive of the Digital Academy and the Masters program and looked forward to the capacity building it would deliver. He then turned his focus to eHealth and Slaintecare and he recalled the huge boost that Slaintecare gave the department of Health when it was launched by the cross-party group. He described eHealth as essential to the implementation of Slaintecare and also as being about more just the technology but rather eHealth is about building capabilities and skills into the health and social care services. It is for that reason the department is so enthusiastic about the Masters program as it is focused very intentionally on the development of skills. The Department is always trying to encourage Health Service professionals championing digitisation in the Healthcare system.
Having read the literature for the Masters Program, Muiris said he was encouraged greatly to see the diversity in modules and the ambition to getting people with specialist clinical expertise up skilled with greater awareness of the digitization program.
He recognised the input from the quadruple helix and he said how great it was to see the helix applied so directly in how the course is framed and in the people that are associated in its development
On behalf of himself and the department, Muiris saluted Martin Curley for the foresight in developing the Masters program that would greatly assist digital transformation in the health service and that showed the appreciation we have for the staff that work in healthcare.
For More information on the MSc in Digital Health Transformation please go to