Reflecting on the 2013 eHealth Strategy

The eHealth Strategy for Ireland (2013) aimed to harness digital technologies to enhance healthcare delivery, with core components including the implementation of a nationwide Electronic Health Record (EHR) system and the introduction of electronic prescribing. It was envisioned that these initiatives would provide a comprehensive and unified view of patient health information and enhance the accuracy and efficiency of medication management from a community pharmacy perspective​​.

Despite its ambitious goals, the Strategy faced several obstacles, including underfunding and fragmented implementation. The annual ICT budget for healthcare at the time the Strategy was published, was approximately 0.85 per cent of total healthcare expenditure, significantly below the EU average of 2-3 per cent​​. This underinvestment led to missed opportunities in creating a cohesive and efficient digital health infrastructure.

Building blocks

Following the 2013 eHealth Strategy, the HSE introduced the Knowledge and Information Plan in 2015. This plan outlined the implementation of the eHealth Strategy through several critical building blocks, which are underway, but not all available to community pharmacies:

1. Individual Health Identifier (IHI): Introduced in August 2016, the IHI is a unique number used to safely identify individuals using health services in Ireland. While it integrates with various health systems, including HSE PharmaVax and GP systems, community pharmacy systems have yet to adopt the IHI, presenting a significant opportunity to enhance patient safety and operational efficiency​​;
2. National Medicinal Product Catalogue (NMPC): The NMPC Service aims to deliver a standardised national dictionary of descriptions and identifiers for medicinal products and medical devices. This standardisation is currently met by the IPU National Health Product Catalogue (IPU Product File), and the HSE NMPC project is currently active and progressing​;
3. ePrescribing: Part of the eHealth Strategy and the Sláintecare programme, the National ePrescribing Project aims to digitise prescribing and dispensing processes. Emergency legislative changes in March 2020 allowed secure email prescription transfers, but a long-term solution is needed. The ePrescribing project’s vision is to create a unified source of prescribing and dispensing data, enhancing medication safety and patient empowerment​​; and
4. National Shared Care Record (NSCR): The NSCR aims to facilitate seamless care transitions and improve clinical decision-making by integrating acute and community services. This initiative will empower patients to engage in their care decisions and provide clinicians with comprehensive, real-time data, supporting safe clinical decisions and continuity of care​​.

Upcoming legislation

The upcoming European Health Data Space (EHDS) regulation and the Health Information Bill are set to further transform the digital health landscape. The EHDS emphasises robust data standards and interoperability, ensuring seamless access to health records across the EU. The Health Information Bill will provide the legal framework necessary to support the secure sharing of health information across various healthcare providers, establishing a robust foundation for the Digital Health Framework’s goals.

Key deliverables of the Digital Health Framework

The Digital Health Framework for Ireland 2024-2030 outlines several key deliverables aimed at modernising the healthcare system:

1. Patient health app: The HSE will introduce a Patient App providing patients access to personal health data, including appointments and prescriptions, empowering patients with broader access to their own health information. This app will enable patients to access and contribute to their digital health records, share information with healthcare providers, and carry digital credentials such as the European health insurance card and vaccination certificates. Over time, the app will be enhanced to include reminders, self-care advice, and more personalised patient-led health services;
2. National Shared Care Record (NSCR): The NSCR aims to integrate acute and community services, facilitating seamless care transitions and improving clinical decision-making by providing clinicians with comprehensive, real-time data. This will support safe clinical decisions and continuity of care​​;
3. Hospital Medicines Management System (HMMS): Planned to enhance the efficiency, reliability, and visibility of drug usage and costs across hospital pharmacies from procurement to administration. The HMMS will support electronic prescribing, eDischarge functionalities, and interoperability with other systems, using standards like the NMPC and SNOMED CT. This system aims to enhance patient safety, streamline hospital pharmacy operations, and ensure compliance with national regulations​​;
4. ePrescribing: The Framework continues to push for the full implementation of ePrescribing, aiming to create a unified source of prescribing and dispensing data to enhance medication safety and patient empowerment​​; and
5. Integration of Individual Health Identifier (IHI): Expanding the adoption of IHI across all health systems, including community pharmacies, to enhance patient safety and operational efficiency​​.

“By integrating EHRs, pharmacists can access comprehensive patient health information, enabling better-informed decisions regarding medication management and reducing the risk of adverse drug interactions.”  

Opportunities for community pharmacists

The Digital Health Framework offers several opportunities for community pharmacists:

1. Enhanced patient care: By integrating EHRs, pharmacists can access comprehensive patient health information, enabling better-informed decisions regarding medication management and reducing the risk of adverse drug interactions​​;
2. Digital prescriptions: The introduction of electronic prescribing (ePrescribing) can streamline the prescription process, reducing errors and improving the efficiency of medication dispensing​​; and
3. Telepharmacy services: With the Framework’s focus on telehealth, community pharmacists can expand their services to include remote consultations, thereby increasing accessibility for patients, especially in rural areas​​.

Lessons learned

The implementation of digital health initiatives during the COVID-19 pandemic provided valuable lessons:

1. ETP via Healthmail: Healthmail, established in 2014 as a safe communication means between hospitals and GPs, was expanded during the COVID-19 pandemic to include the electronic transfer of prescriptions (ETP). This change allowed prescriptions to be sent electronically from prescribers to pharmacies, eliminating the need for paper copies; however, this did have a knock-on effect. The resulting surge in usage highlighted the success and necessity of a true ePrescribing solution;
2. COVAX: Launched in January 2021, the COVAX system managed the administration of COVID-19, influenza, and pneumococcal vaccinations. Recording over 14.5 million vaccine doses and maintaining approximately 4.2 million client records, COVAX supported over 8,000 daily users at its peak, showcasing the importance of robust digital platforms in managing public health​​; and
3. HSE PharmaVax: This system enables community pharmacies to centrally record vaccination events into a national vaccination information system. PharmaVax is part of the Health Provider Portal and has been instrumental in streamlining the recording and monitoring of vaccinations across Ireland​​.

These initiatives demonstrated the critical role of digital health solutions in enhancing healthcare delivery and highlighted the need for continuous investment in digital infrastructure and training.

Ensuring success

For the framework to succeed, it must address several critical factors:

• Sustained investment: Ensuring adequate and sustained funding for digital health initiatives is crucial. This includes capital investment for new systems and recurring funding for maintenance and support​​;
• Stakeholder engagement: Continuous engagement with all stakeholders, including community pharmacists, is essential to ensure the solutions developed meet their needs and those of their patients​​; and
• Governance and leadership: Establishing clear governance structures, such as the proposed Digital Health Advisory Board, will provide oversight and ensure accountability in the implementation of digital health initiatives​​.

Conclusion

Ireland’s Digital Health Framework for 2024-2030 represents a significant step forward in transforming healthcare delivery through technology. For community pharmacists, it offers the potential to enhance patient care, streamline operations, and expand services. By learning from past experiences and ensuring robust support and engagement, Ireland can realise the full potential of its digital health ambitions, benefiting both healthcare providers and patients alike.