Way back, during the height of the pandemic, I presented at a conference, online of course, under the auspices of a group called ‘UNICOM’, funded by the European Commission (to the tune of €40 million). Most of you would have never heard of them, as I hadn’t until shortly before, but they had one primary objective: promoting standards in medicines information flow throughout the EU. A few months ago, I got another invite, this time they wanted me to attend in-person, to wrap-up the project. I respectfully declined. I live in the real world and much of this project was of little apparent relevance to the current Irish situation.
For historic perspective, UNICOM appears to be epSOS Mark 3; this, initially, was a mechanism for setting standards to enable sharing prescriptions between countries within the European Community. It would be fair to say that a lot of work took place, much of our Euro tax was spent, and there was very little to show at the end. No, I don’t want to sound too negative — there were several small successful projects that allowed cross-border prescription movement electronically. They were limited in scope, whatever about ambition, and fundamentally did not herald any sort of greater electronic prescription integration. Of course, in 2008 when this project started, electronic prescriptions were just around the corner for us. We even had a few pilot projects. We were going to have an amazing infrastructure, all we needed was a few pesky little items. These were, primarily, a unique identifier for every patient, a unique identifier for every drug, and a way of ensuring that the prescription was secure and not fraudulent. I hear you laughing. To be honest, I have moved into a post-humour world in relation to this issue. I lost my knowing smile when I realised how cheap talk is. How some people’s livelihoods depended on churning out massive quantities of verbosity, with little recognition that these words were supposed to be precursors to action.
For the last four decades there has been nobody willing to walk the walk but, lo and behold, we now have the launch of the Digital Health Framework 2024-2030. This initiative represents the latest effort to strategise our national eHealth infrastructure. No, I don’t want to be too negative. It is quite clear that the HSE and Department of Health have finally started to grasp the nettle. We have several projects on the go. Perhaps the main one will be a national patient electronic record which, hopefully, would be in a position to give point of care summary records for every patient. The other, from the pharmacy point of view, and even more important, is putting the building blocks in place for a proper electronic prescription system. We’re told that, because we’re late to the party, we have learned from everybody else’s mistakes. Our system will be the best of breed. I hope what I’m hearing is right. There are some very bright and talented people working in the space, but you have to be cognisant of a fairly simple principle — this system is being designed and delivered by the State. This obviously has the advantage of deep pockets. On the flip side, it has the risk of a poor record in both IT and major infrastructure projects. Throwing lots of money and resources at a project is no guarantee of success. Most of us look no further than our new National Children’s Hospital. This shining beacon of the State’s inability to successfully deliver a single major project on time, or anything resembling a budget. It is not clear that the State has learned many lessons from this rolling disaster. Bureaucratisation is a feature of all governments. What separates the mundane from the good is a clear vision, clear capability, and clear lines of responsibility at senior management and leadership level. As many of you will know there have been multiple reports, committees, standards, recommendations and IT czars, all aspiring to modernise our paper-based anachronistic healthcare records system.
To use that lovely phrase, the rubber is due to hit the road, sometime in the next five years according to the freshly published Digital Health Framework 2024-2030. The irony is that we have shown that we have both the people and the ability to successfully deliver targeted IT projects. The rollout of HSE PharmaVax is an example of an excellent project that does what it says on the tin. It arrived quickly, without a whole lot of fanfare, and with a solid infrastructure that served the national vaccine campaign well. Healthmail also arrived in record time, despite its obvious limitations, and it has served the State well for the last few years. We know that when the right people, with the right motivation, and relatively limited resources are presented with a targeted IT project, it can be delivered quickly and relatively inexpensively. You have to wonder if this simple lesson has been learned by anyone?
Jack Shanahan
MPSI
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