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Building a sustainable health information infrastructure
Jane Grimson Director of Health Information and
Deputy Chief Executive
Health Information and Quality Authority
The perfect storm
Gap
Good quality information is critical
Role of the Health Information and
Quality Authority:
To drive continuous improvements in the quality and safety of health and social
care in Ireland.
Develop standards and guidance for health information
Identify gaps in health information Publish accurate information about the performance of the health and social care system
Health information function
Develop standards and guidance for health information Guidance on Information governance for health and social care services Guidance on Privacy Impact Assessment What you should know about information governance What you should know about data quality Catalogue of national health information sources Guiding principles for health and social care data collections GP messaging standard (v2) Referral data set, discharge data set, demographic data set Guidance on messaging standards for Ireland Guidance on classification and terminology standards for Ireland Overview of healthcare interoperability standards
Identify gaps in health information Provide advice in relation to identifiers for individuals, professionals and organisations
Publish accurate information about the performance of the health and social care system
All inspection and investigation reports published
Work completed to date
Key principles for a sustainable health information infrastructure
1. Patient-centred
2. Integrated
3. Standards-based
Key principle 1:
Patient centered
Informed, knowledgeable and empowered patient
Tertiary
Secondary
Primary
Self-Care
(off the Map)
INDUSTRIAL AGE MEDICINE
E
N
C
O
U
R
A
G
E
D
D
I
S
C
O
U
R
A
G
E
D
$
¢
Professional
Care
Source: Tom Ferguson, “Consumer Health Informatics,” Healthcare Forum Journal, Jan/Feb 1995, pp 28-33.
(doctom@doctom.com, wwwfergusonreport.com
INFORMATION AGE HEALTHCARE
E
N
C
O
U
R
A
G
E
D
D
I
S
C
O
U
R
A
G
E
D
$
¢
Source: Tom Ferguson, “Consumer Health Informatics,” Healthcare Forum Journal, Jan/Feb 1995, pp 28-33.
(doctom@doctom.com, wwwfergusonreport.com
Individual self-care
Friends and family
Self-help networks
Professionals as facilitators
Professionals as partners
Professionals as authorities
Local Health System
Ambulance Service
Am
bu
lan
ce J
ou
rney
Local Authority
Soci
al S
erv
ice
s
Ho
usi
ng
Serv
ice
s
Primary/ Community
Ge
ne
ral P
ract
ice
Co
mm
un
ity
Nu
rsin
g
Secondary / Acute Care
Eme
rge
ncy
De
pt.
War
d C
are
Op
era
tin
g Th
eat
re
Ph
ysio
the
rap
y
Dia
gno
stic
s
Voluntary Sector
Day
Car
e F
acili
tie
s
Age
Act
ion
Information flows the wrong way
Patient Pathway
Local Health System
Ambulance Service
Am
bu
lan
ce J
ou
rney
Local Authority
Soci
al S
erv
ice
s
Ho
usi
ng
Serv
ice
s
Primary/ Community
Ge
ne
ral P
ract
ice
Co
mm
un
ity
Nu
rsin
g
Secondary / Acute Care
Eme
rge
ncy
De
pt.
War
d C
are
Op
era
tin
g Th
eat
re
Ph
ysio
the
rap
y
Dia
gno
stic
s
Voluntary Sector
Day
Car
e F
acili
tie
s
Age
Act
ion
Patient Pathway
Threatens patient safety and
increases costs
Source: eHealth Strategy for Ireland, Department of Health, 2013.
The ability of share information is at the heart of patient-centred eHealth
Key principle: 2
Integrated
Eliminate duplication and fragmentation
Current information infrastructure in Ireland
very fragmented
Drivers for integrating health information
• Connect multiple locations of care delivery
• Support team-based care
• Deliver evidence-based healthcare
• Improve safety – Reduce errors and inequalities
– Reduce duplication and delay
• Improve cost-effectiveness of health services
• Empower and involve citizens
• Underpin population health and research
• Protect patient privacy
Key principle: 3
Standards-based
Support efficient information sharing
Benefits of standards
• Major role in ensuring safety e.g. Safe Surgery Saves Lives (WHO)
• Support health service improvements
• Deliver economic benefits
• Benefits stakeholders including patients
“the lack of ICT systems interoperability and of widely accepted
standards directly implies compromised quality of healthcare
and unnecessarily high costs”
[Empirica 2008]
Standards in healthcare
Conclusions
• What’s the best approach?
• How much will it cost?
• Will it deliver the benefits?
• How do we get there?
• What standards should we use?
• ……
Why has progress been so slow?
What can we learn?
• Don’t assume that solution which works well in one context will work well in another
• Identify and implement the key building blocks for eHealth • Build on local solutions based on standards to ensure that everything
fits together • Benefits claimed should be evidence-based • Strategic goal should be better healthcare, not cash • Engage pro-actively with all stakeholders including patients • Make sure all information flows are identified from direct patient care,
to clinical audit, quality improvement, reimbursement, population health, service planning, and research
• Put in place robust governance to ensure privacy and confidentiality • Leadership for the long term is critical • Ensure that eHealth strategy enables and supports all policy objectives
Can we leapfrog?
• Go directly to Personal Health Records at national level?
• Adopt an integrated approach to primary and secondary information
Thank you
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