Digital Health Strategic Roadmap – Ireland – 48 projects to win

Digital Health Strategic Roadmap – Ireland – 48 projects to win

by | Aug 27, 2024 | Business, Digital, Healthcare, Strategy

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Digital Health Strategic Implementation Roadmap

This Digital Health Strategic Roadmap was published in July this year.  I took a few hours over the weekend to review it.  While I might like to see a little more emphasis on use of AI to drive more innovation it is fair to say the document does not lack for lots of ambition.  The document also is clear on the resources and challenges associated with this proposed 7 year implementation effort.  Having worked in the sector over the last 15 years (in private healthcare) I have had first hand experience of the challenges associated with the required levels of change. 

Interestingly the outline budget requires IT spend to go from 2.2% of total healthcare spend to 4-6%. Given current pressures on healthcare spend this would most likely require additional funding – at east until we begin to see payback in terms of efficiency post implementation.

The Summary – Digital Health Strategic Roadmap

At summary level the Roadmap aims to integrate digital technologies into Ireland’s healthcare system, promoting a patient-centered, digitally enabled environment. This roadmap aligns with key frameworks, including the Department of Health’s “Digital for Care” framework, the Sláintecare Action Plan, and the Digital Ireland Framework. It emphasises six core principles:

  • patient empowerment,
  • enhancing workforce and workplace,
  • enabling digitally connected care,
  • using data-driven services,
  • fostering a digital health ecosystem and innovation, and
  • establishing secure digital foundations.

The roadmap outlines 48 strategic initiatives over seven years, focusing on improving access, efficiency, and quality of care. It seeks to empower patients by giving them greater access to information and enhancing the healthcare workforce’s digital capabilities. Key outcomes include seamless data sharing, better patient involvement in care, and enhanced decision-making through data and analytics.

The roadmap stresses significant investment in digital infrastructure and skills, collaboration across healthcare systems, and robust governance to support this transformation. The goal is to create a more resilient, efficient, and high-quality healthcare system, benefiting patients and healthcare professionals alike

My ‘top 5’ projects

The following five projects – of 48 in total, caught my immediate attention:

  1. Electronic Health Records (EHR) Deployment: This project focuses on developing a national EHR system that provides seamless integration of patient data across various healthcare settings. This includes creating business cases, establishing standards, and setting up a procurement framework to ensure the EHR system is interoperable and secure
  2. National Shared Care Record (NCSR): Aimed at integrating health information to provide a holistic view of patient care, this initiative seeks to establish a unified care record accessible to healthcare providers across the country. This will enhance care coordination and improve patient outcomes by ensuring all relevant health data is available to caregivers
  3. Integrated Community Case Management System (ICCMS): This project aims to implement a system that supports the management of complex care cases within the community setting. By enabling better data sharing and coordination among community healthcare providers, this system will improve patient care and reduce the need for hospital admissions
  4. Digital Front Door and Managed Health Content: This initiative involves creating a central digital platform to provide health information, access to services, and digital tools for self-management. It will act as the primary entry point for patients to engage with the health system, facilitating easier access to care and information
  5. Cybersecurity Enhancement Program: Following the cyberattack on the HSE, this project is designed to bolster the digital health system’s cybersecurity infrastructure. It aims to protect patient data and healthcare systems from future cyber threats by implementing robust security measures and continuous monitoring​

Risks to the Implementation Roadmap

  • Cybersecurity Threats: There is a significant risk of cyber attacks, as demonstrated by the 2021 ransomware attack on the HSE, which disrupted patient care and access to health records. To mitigate this, a dedicated cybersecurity program is proposed to enhance the cyber resilience of the health system​
  • Funding and Resource Allocation: The roadmap requires substantial and sustained investment, estimated to be between 4% and 6% of the overall healthcare expenditure annually. Securing this funding is critical for the development of infrastructure, digital tools, and workforce skills
  • Change Management and Adoption: Successfully transitioning to a digital health system involves overcoming resistance to change within the workforce and ensuring that patients and healthcare professionals are adequately trained and supported. Effective change management and leadership are essential to facilitate this transformation
  • Data Quality and Integration: Ensuring high-quality data and seamless interoperability across various healthcare systems is crucial. Poor data quality and fragmented data sources could hinder effective care delivery and decision-making​

Other points of interest in the Digital Health Strategic Roadmap

EHR implementation

There are a range of ERP products already in place. Cerner (now Oracle Healthcare) is in the Maternity Hospitals, the National Labs and James’.  The Children’s Hospital recently selected and is implemting Epic.  Many of the other hospitals have developed and implemented other solutions over the years. On the private side MEDITECH seems to have the bulk of the market (Beacon, Mater Private, Bons and Blackrock Health).

Given the objective appears to be to have one patient recrod – sourcing data from both public and private – will be interesting to see how this unfolds in the next 2 years. With this in mind also to be noted that the private sector in general is not coding diagnosis and treatment (will this be a requirement in order to develop an effective patient record?)  Who will provide the budget for this, if required?

Digital Maturity

Strategy includes an outline digital maturity assessment – this assessment is directy relevant to the abiility of the healthcare system to take on board the level of change associated with the listed 48 projects. If the objective, as it should be, is to improve digital maturity there may be a significant requirement for development/ training/ building of sustainable teams.

Artificial Intelligence

This is addressed in a number of places in the roadmap.  In fairness digitalisation (and availability of digital data) is a prerequiste for deployment of AI.  However I suspect there are lots of opportunities to front load some of the AI delivery – even leveraging what’s available digitally now.

Shift Left, Stay Left

Great to see this called out in the roadmap – essential to move as much as possible out of acute care and back to community and/or home.  Digital plays a key role in making this happen.

What are the next steps?

A roadmap without resources (cash, people, partners) is only a roadmap.  Presumably now critical to approve funding to enable the healthcare digital transformation accelerate (and finalise the deliverables and timelines). Given pressures on staffing and resources critical to drive forward with this scope of work.

 

Love 12 hospital digital transformation spends

Love 12 hospital digital transformation spends

by | Jun 12, 2024 | Business, Healthcare, Strategy

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12 places hospitals are spending their hospital digital transformation budgets

Interesting research just released by McKinsey about hospital digital transformation spend. And it’s not all about EHR – but I think that’s probably because most have already done this.

The Summary findings:

  • The survey indicates a significant interest in digital transformation
  • Despite recognising AI’s potential, there is a gap in investment
  • A shift towards more patient-centric and decentralised care approaches

Think through why?

Key Insights:

High Priority on Hospital Digital Transformation: 75% of health system executives recognise digital transformation as a priority but face resource constraints.

Not that surprising: limited budgets, insufficient skilled personnel and competing priorities within healthcare organisations, making it challenging to allocate adequate resources for comprehensive digital initiatives. May also struggle to attract and retain top digital resources around Data and AI, given competition for these people.

Potential of Artificial Intelligence: 88% of healthcare leaders see AI as the technology with the most potential, yet less than half have made investments in it.

The slow adoption of AI may be due to high upfront costs, lack of expertise (clinically, administratively and IT wise), concerns about data privacy and uncertainty about the return on investment. There are lots of papers out there researching impact of use of AI in healthcare. But perhaps not enough published examples of how AI has actually improved patient safety and driven cost savings in the business.

Investment Areas in Hospital Digital Transformation:

  1. Virtual Health to Enhance Patient Experience and Access: 76%
    • Investments in telemedicine and virtual care aim to improve patient interactions with healthcare providers, increasing accessibility and convenience for patients, especially in remote areas. This is generally in line with general ‘Stay Left Shift Left’ philosophy.  Virtual care also has potential to free up much needed capacity for more complex procedures/ care.
    • Technologies such as video consultations, mobile health apps, and online patient portals are central to these improvements.
  2. Revenue Cycle Management and Back-Office Automation: 70%
    • Focusing on automating administrative tasks to improve efficiency, reduce errors, and lower operational costs, thereby streamlining financial and administrative processes in healthcare organisations.
    • This includes improved integration and adoption of standards, the use of robotic process automation (RPA) and machine learning algorithms to handle billing and claims processing.
  3. Digital Front Door: 62%
    • This is a basic recognition of the patient as a digital consumer – who is expecting a very different experience to the traditional ‘at the beck and call of the hospital/ consultant’ approach. Enhancements in digital access points for patients, such as online appointment scheduling and patient portals, aim to simplify and improve the patient experience from the first point of contact.
    • Patient engagement platforms including CRM and chatbots are key technologies driving these enhancements.
  4. Acute Care Workflow and Throughput: 58%
    • Investing in technologies to optimise patient flow and care delivery in acute settings, reducing delays and improving overall hospital efficiency and patient outcomes.
    • Real-time location systems (RTLS) and electronic health records (EHR) systems are pivotal in these initiatives.
  5. Ambulatory Care Management: 55%
    • Hospital Digital Transformation solutions for managing outpatient care enhance coordination, monitoring, and follow-up, leading to better patient outcomes and more efficient care delivery.
    • Technologies such as electronic medical records (EMR) and care management software play a crucial role.
  6. Remote Patient Monitoring: 54%
    • Technologies that allow continuous health monitoring outside traditional healthcare settings enable proactive management of chronic conditions and early intervention.
    • Wearable devices, IoT sensors, and remote monitoring platforms are integral to these efforts.
  7. Contracting or Value-Based Care: 51%
    • Implementing digital tools to support value-based care models focuses on improving patient outcomes and cost efficiency, aligning provider incentives with patient health.
    • Analytics platforms and population health management tools are essential for these models.
  8. Virtual Health to Address Labor Shortages: 48%
    • Utilising virtual health solutions helps mitigate the impact of healthcare labour shortages by extending the reach of existing healthcare professionals and services.
    • Telehealth platforms and virtual care coordination systems are key technologies in this area.
  9. Advanced Analytics, AI, Machine Learning, Generative AI: 45%
    • Leveraging advanced data analysis technologies aids in clinical decision-making, operational efficiencies, and personalised patient care, despite current investment gaps.
    • These technologies include predictive analytics, natural language processing (NLP), and AI-driven diagnostic tools.
  10. Cross-Site Capacity Management: 45%
    • Managing resources and patient flow across multiple sites improves capacity utilization and ensures that patients receive timely care in the most appropriate setting.
    • Cloud-based capacity management systems, control rooms and inter-facility coordination platforms are vital technologies.
  11. Robotics or Physical Automation: 40%
    • Investing in robotics and physical automation enhances surgical precision, logistics efficiency, and overall operational effectiveness within healthcare facilities.
    • This includes surgical robots, automated guided vehicles (AGVs), and pharmacy automation systems.
  12. “Hospital at Home”: 36%
    • Providing hospital-level care at home reduces the need for hospital stays, increases patient comfort, and can lead to better health outcomes through personalized, convenient care.
    • Remote monitoring devices, telehealth platforms, and home health software are critical components.

Conclusion re Hospital Digital Transformation

There is no doubt that healthcare providers are switched on to requirement for digital transformation (and the associated investment).  For now, while AI may be seen as representing the biggest potential impact, investment in AI would appear to rank behind a number of other initiatives: in particular: virtual care, revenue management and digital front door. However it should also be noted that all of the vendors being used across any of these initiatives are looking to embed AI in their own applications and tools.

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IT Strategy – 5 elements

IT Strategy – 5 elements

by | May 13, 2024 | Business, Strategy

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IT Strategy – designed to generate Business Advantage through Technology

Over the last several years we have worked with a number of businesses to develop it strategy and business strategy. Sometimes this has resulted in one inclusive document, on other occasions standalone, but cross referenced, Business and IT Strategy documents.

In any strategy work over the last several years I have tended to assess our approach against Richard Rumelt’s framework (outlined in ‘Good Strategy, Bad Strategy’).

Have always liked his approach to business strategy and it also lends itself well to IT Strategy work.

There are five elements:

  • Diagnosis
  • Policy
  • Coherent actions
  • Execution
  • Continuous improvement and learning

 

DIAGNOSIS

You are not going to develop worthwhile thinking and planning re IT without understanding the business and its challenges and opportunities.  In completing a diagnosis would look to address the following:

  • Understand the business: business environment, market trends, customer requirements, competitors. Readiness/ willingness to change.
  • Stakeholders – identify (shareholders, management, employees, customers, regulators, etc) and understand expectations, attitude to change, competition, adapting.
  • Assess current IT – including infrastructure, processes, data management and support for informed decision making
  • Research industry trends as may impact company competitiveness – data analytics, artificial intelligence, robotics, etc
  • Identify opportunities/ challenges for the business which can be addressed through IT enhancement/ innovation

GUIDING POLICY

  • Align to business priorities – including innovation, agility, customer centricity – recognising importance of data
  • Define core principles and values that guide IT decision-making, while ensuring alignment with stakeholder expectations and company values. Consider cybersecurity, Mobile, Data, Artificial Intelligence, Build v. Buy, Platform centric, Interoperatibility, Cloud/ On Prem/ Hybrid – emphasise flexibility, adaptability and responsiveness to the market and competition.
  • Prioritise initiatives that supporting strategic objectives, drive operational efficiency, and enable the company to exploit opportunities.

 

COHERENT ACTIONS

  • Develop required actions/ projects to address the key business challenges and opportunities
  • Prioritise these actions in context of impact for the business, while understanding any interdependencies across the actions/ projects
  • Align resources in line with prioritisation – designed to deliver innovation, growth, competitiveness with a focus on data and analytics to identify/ uncover additional actions of value to the business.

EXECUTION

  • Deliver business advantage. Execute the identified projects in line with the agreed prioritisation. Demonstrate tangibl benefits to the relevant stakeholders..
  • Communicate with all relevant stakeholders while executing each project. Ensure timely feedback and understanding of changes/ impact across the business.
  • Capture and use data to demonstrate project progress and to measure actual Business Advantage delivered.

CONTINUOUS IMPROVEMENT AND LEARNING

  • Feedback – gather feedback from users and stakeholders – to identify further opportunities for improvements and /or innovation – potentially at policy level, with respect to completed or ongoing projects or identification of potential new projects.
  • Promote culture of continuous improvement and innovation – ensuring understanding of the business in IT and across the business the capability of emerging technologies. Encourage experimentation and data driven research.
  • Monitor emerging business and technology trends – to identify further opportunities to drive efficiency, grow the business and improve customer experience.

FITTING WITH OUR APPROACH

While strategy may be determined over a fixed period of time the dynamics of the current business environment very much drive the requirement that the strategy is a living strategy – and Rumelt’s inclusion and emphasis on Continuous Improvement and Learning speaks well to this.  Typically we see the Section Guiding Policy as being critical to providing the framework for ongoing IT decision making.  It too may be subject to change – given the velocity of new developments e.g. Generative AI. We typically look to capture the ‘Coherent Actions’ in a Tech Roadmap – agreed jointly between all relevant stakeholders.  Typically we are looking at 18 to 24 months for such a roadmap – and within this time it may itself be subject to review and/or overhaul.  For us critical that the Execution of the prioritised projects delivers the targeted Business Advantage. Communication, Data and Feedback are all key to this.

What are the 4 main points of IT strategic planning?

In developing an IT Strategy we are looking to use IT in a business to achieve business objectives.  So the main points are:

  1. Understand the business objectives and the business itself (how it operates)
  2. Prioritise/ focus efforts on IT according to its potential to drive achievement of those objectives
  3. Manage/ develop IT in such a way as to provide the required flexibility to support the business as it reacts to the marketplace, new trends, competitors
  4. Manage data as a stratgic asset of the business

CONCLUSION

We have found Rumelt very useful in it strategy development – driving the focus toward Coherent Actions, aligned with Business Priorities and which will drive realisation of Business Advantage through Technology.

 

 

 

EHR now paying multiple dividends

EHR now paying multiple dividends

by | May 7, 2024 | Business, Healthcare

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 Have EHRs been good for patients?

Good piece by Giles Bruce in Becker’s Health IT last week: ‘Have EHRs been good for healthcare?’ And interesting commentary by Kelan Daly of KPMG on Linkedin same week referencing KPMG partner Alberto di Negri in Italy, rolling out ‘Regional Electronic Health Records in Italy’.

Having spent 15 years or so working with Electronic Health Record deployment in Ireland found all of this interesting and encouraging. And AI is now offering the opportunity to leverage the data in EHR solutions and driving the demand for EHR where hospitals continue to operate in paper based or hybrid mode.

Sample EHR Benefits quoted (US) by Becker’s Health

Clearly the ‘meaningful’ use initiative and associated major government funding program of 15 years ago in US gave EHR deployment and adoption a real focus.  Interesting to hear the views expressed by representatives of a number of the major providers in the US.  In Ireland we trail the US in EHR deployment but are now seeing significant projects underway.

Sandra Hales, associate vice president for IT clinical applications at Phoenix-based Banner Health. “Patients now have timely access to records and data that is simplified for understanding, and there’s a level of inclusivity and responsibility for patients to engage in their own care…Lives are saved from simple human error.”

Laura Wilt, chief digital officer of Sacramento, Calif.-based Sutter Health “While there is always room for improvement within our field, EHRs have helped propel medicine and patient care into the modern era.”

Kaiser Permanente Chief Medical Officer Andrew Bindman, MD: “Our EHR system enables our teams of experts to seamlessly collaborate and coordinate care across departments and specialties and has fueled transformational health research and clinical practices that continue to improve patient outcomes.”

Dan Roth, MD, chief clinical officer of Livonia, Mich.-based Trinity Health, said the industry is at an “inflection point” with AI, where the technology has the potential to reduce clinicians’ documentation workloads rather than add to them.  Still, he said, EHRs’ benefits have been indisputable with medication safety having improved dramatically via barcode medication administration and care gaps being narrowed by electronic data exchange.

EHR has not been without its challenges

On the flip side, she said EHRs made everything in healthcare seem like an “emergency,” since patients and colleagues can easily send messages at any time, regardless of the acuity of the issue. She said EHRs were also designed for documenting appointments and not the holistic, patient-centered experience that the industry hopes to move toward.

She doesn’t expect anything to replace EHRs anytime soon, as they do an adequate job of safeguarding data and boosting patient safety in a litigious healthcare industry. But she said the EHR experience could inform healthcare’s shift to the next big technology. “One of the things that we missed out on with EMR implementation was really getting the clinical voice in the design of it,” she said. “We should not make that mistake when it comes to AI.”

EHRs, meanwhile, have given way to the larger “digital transformation” in healthcare, which aims to address some of the issues where the technology fell short, including interoperability and connectivity, clinician burnout and patient “stickiness,” he said.

“On the input side, ambient listening is a total game changer,” he said. “I think the core record stays the same … but what we put around the record changes substantially in the next five to 10 years.”

Vinay Vaidya, MD, chief medical information officer of Phoenix Children’s, said early EHRs were “clunky,” comparing them to the first iPhone. But they became pretty consistent about eight years ago.

Progress since 2018

1n October 2018 I was blogging, while a CFO in private healthcare in Ireland, on the subject of generating an ROI on investment in EHR – although clearly noting that EHR had become a ‘given’, a basic requirement (6 years ago). ‘Looks like the industry, the regulators, the public, science – all demand the availability of an Electronic Health Record.  “We work in an industry which is highly dependent on technology  – be that radiology, robots, theatres, measuring and recording of vital indicators.  Patients are all using very powerful technology (on their mobile phones and/or laptops) all day, every day – leveraging the latest in cloud, artificial intelligence and mobility.” And I also referenced ownership of the data (since covered off very clearly by GDPR): “Traditional thinking means that providers sometimes struggle to recognise that the data is really the patient’s data – even if the provider needs to make major investments to receive basic patient data, generate and record lots of data with respect to the treatment of the patient and provide this back to the patient (and her doctor as may be required).  But I think we’re not far from the idea of patients choosing providers, making data available to providers on a temporary basis, updating the data with data from the provider and then taking the data with them (potentially not leaving a copy with the provider)”.

I returned to this subject in 2022: ‘Where is my electronic medical record’ – from the perspective of an individual (me!) not having a consolidated electronic medical record of their various treatments.

The paper by Alberto Di Negri (referenced by Kelan Daly) addresses my exact point (and frustration): ‘Historically, as patients have moved between these settings, the data collected and generated by clinicians in each care setting has not followed the patients’

Regional EHRs

In Italy they are looking to achieve regional EHRs: ‘Across the country, the Italian government is working to realize the vision of digital interoperability and single, lifelong patient digital identities through the expanded use of EHRs. The goal of this undertaking is to empower patients, support healthcare service planning and population health research and management’.

The key ‘takeaways’ from this project are:

  • Establishing regional or national EHRs are key to supporting service design, coordinating care between settings, and improving patient and healthcare professional experiences. However, lack of interoperability between digital systems is a barrier to transformation for many healthcare systems around the world.
  • Projects of such immense scale will likely need to be driven by governments, regulators or payers who demand interoperability, strict privacy compliance and cybersecurity capabilities.
  • EHRs need to be designed with the end users and their experiences in mind. These systems should be designed to help healthcare professionals do their jobs or lighten their workloads. Patients need systems that make accessing services and their health information easier.

Conclusion

In Ireland we have seen EHR initiatives in the HSE in respect of Maternity Hospitals, National Children’s Hospital and several at individual HSE hospitals.  In the private sector we have seen significant developments at Blackrock Health, Bons and Mater, amongst others.  Unfortunately as of yet I do not have any sight of my one electronic medical record, owned by me, shared with any provider I choose to use and updated by that provider.  What I see being reported in Italy – with EU funding – looks like the right direction.  And for society and provision of improved, affordable healthcare we need, inter alia, the ability to share medical records in a secure way to support research and development.

 

 

Cybersecurity 1 – Beware – the hackers don’t go home at 5…

Cybersecurity 1 – Beware – the hackers don’t go home at 5…

by | Mar 14, 2024 | Cybersecurity

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The hackers don’t go home at 5…

Businesses have gone digital – staying paper based is no longer an option. A business’s data is one of its most valued assets. We see large enterprises implementing comprehensive cybersecurity frameworks.

Small business and cybersecurity

How do these cybersecurity steps scale to a small business (say less than 25 employees, less than €1m turnover)? If you have digital assets you need to protect them.  But where to start?

You are another target on the web for any hacker out there.  The implications for you of any such attack may range from financial losses to reputational damage to closure of your business.  You may not have the resources available to you to recover from a significant cybersecurity attack. And insurance is not the answer (even if you can get it and can afford it).

Cybersecurity risks

What are the cybersecurity risks your business?

  • Ransomware Attacks: Malicious software that locks you out of your system and data until you pay a ransom.
  • Phishing Scams: Efforts to steal sensitive information via emails and messages.
  • Insider Threats: Risks from you employees or your contractors misusing their access on your systems to harm your business.
  • Supply Chain Vulnerabilities: Cyber risks in respect of third-parties on whom you depend e.g. service providers, software providers, etc

You need to:

  • understand the significance of cybersecurity and the emerging risks to your business, and
  • implement robust protective measures to safeguard your assets and the continuity of your business

There are a number of excellent frameworks to assist you in developing a comprehensive cybersecurity defence.  And there is an ever-increasing list of vendor products.  But what should you do first?

Top 7 Cybersecurity Recommendations

  1. Strong Password Policies and Multi-Factor Authentication (MFA) – Use complex passwords and MFA to secure user identities and enhance defense mechanisms.
  2. Regular Updates and Patches – Maintain up-to-date software and operating systems to protect against known vulnerabilities – apply patches on a timely basis
  3. Employee Cybersecurity Training – Raise awareness with all your employees and contractors on cybersecurity best practices, including recognising phishing attempts and the requirement to protect sensitive data.
  4. Regular Data Backups – Backup critical business data in a secure, off-site location to minimise the impact of data loss.
  5. Comprehensive Security Suite  – Deploy security software offering including: antivirus, anti-malware, firewall, and web filtering – to protect against various threats.
  6. Limit Access to Sensitive Information (‘need to know’) – Apply the principle of least privilege, ensuring that employees have access only to the data necessary for their jobs.
  7. Incident Response Plan – Develop a plan to address potential cyber incidents and regularly conduct drills to test scope and readiness.

Is this all?

No – and far from it.  But, in the first instance, make sure you have these seven steps covered off. 

Lots more to be considered – including the various frameworks (ISO 27001, CIS Controls, NIST Cybersecurity Framework), Zero Based Trust, End Point Security, Security Incident and Event Management (‘SIEM’), Security Operations Centres. 

You depend on your information systems.  Your employees, customers, partners, regulators, shareholders have expectations of you with respect to protecting these assets. When you go home the hackers don’t. Review the seven steps as an immediate initiative – then a broader risk assessment may inform/ direct further actions