The Irish Medical Times - Digital Healthcare from the Inside Out


Virtual wards are already ramping up in University Hospital Limerick and St Vincent's Hospital Dublin. 

I am an average person, I am a patient, I am a middle-aged mother (I prefer the term ‘gently used’). I am also one of the 91% of the global population that owns a smartphone. I am open to anything that can make my healthcare experience more seamless. I already use google maps, google calendar, phone reminders and pharmacy apps to try and keep on top of things. So it doesn't make sense to me that all the tech help stops as soon as I get to the door of the doctors. In fact, do I even need to go through the door?

In the same way we all got used to (dare I say, grew to prefer) booking our own flights online, we will get used to virtual wards, remote monitoring, online therapies, patient apps, patient portals and video/audio enabled care. There will be giving out, Joe Duffy will be very busy, but we’ll get there, because the alternative is bleak.  

There was a running theme throughout the conference speakers that we are approaching an inflection point of unsustainability, and we have to start leveraging digital technology. Patients and healthcare workers alike are tired of the legacy systems, the staff retention issue, the lack of connectivity and the poor access. It was refreshing to see that it's not just patients who are frustrated with the old way of doing things, the humans that make up the HSE want things to change.

As a patient with multiple problems, one of my bugbears is how siloed our healthcare system is. So I enjoyed hearing about a new approach where teams integrate together to manage the full cycle of care alongside the patient using a National Shared Care Record. It was interesting to learn that there may even be a future potential for patients to add the information from their wearables as a data source. Although, like anything that touches on first party data the shared care record will have to jump through some hoops before we see it in action. 

I’m actually even more excited about the planned HSE patient app that will let us cancel and rebook appointments, store prescriptions, etc. It was described as ‘Bringing all the information we have into our own data lake’. The next meeting invite I get I fully intend to reply with ‘My apologies, I have gone phishing in my own data lake. For any urgent queries - ask Alexa.’   

Speaking of data there was a call to standardize terminology in order to map internationally. This alignment could allow for further leveraging of tech such as using AI to search all the standardized data with medical queries. Loretto Grogan, National Clinical Information Officer for Nursing and Midwifery (and conference organizer), made the astute point that information is at the core of healthcare delivery, so let’s put the supports in place to get the data right at capture. With standardisation we can achieve improved interoperability.  

With a flare of cross border camaraderie, colleagues from north of the border spoke about the lesson they learned introducing a digital health operating system in Northern Ireland. They trained 7,500 staff in 3 months. The audience listened with rapt attention, it was like we were teenagers and they were our cool older cousin telling us what life in university is really like. I’m pretty sure I heard a few ‘No way’, ‘Wow’, ‘That’s crazy’, ‘A 24 hour bar?’ (maybe I misheard the last one). Some of their key takeaways included  - teamwork, communication, and remaining agile. 

As we approached lunch and feet began to shuffle and throats cleared, a slide popped up on the screen - ‘The Metaverse is Already Here!’. I think this is an important point to take in. These days most people are digitally empowered in their everyday lives, so, while there will still be very real and valid fears around telehealth from a patient perspective; there was an emphasis on getting there together. 

The good news is that through different HSE digital initiatives dotted around the country, the journey has already begun.

I flitted around the conference centre talking to people, reading posters and dropping into hear speakers give the low down on their digital enterprises. The tech and results were impressive but most impressive of all was the passion and drive from the people behind it. 

The new Children's Hospital in Dublin has adopted a ‘Digital First’ approach. Glancing at the presenters slide I counted at least 45 tasks that a staff member on a ward of the new hospital will be able to do digitally; from ordering tests and procedures, writing e-prescriptions, sending and receiving clinical comms, assigning patient information via a patient portal, through to requesting patient transport. 

I learned about a Health Performance Visualisation Platform (HPVP) providing key performance values across acute hospitals. Showing data from EDs and bed management, to help manage flow. The up to date big picture of data can also be used to manage waiting lists for outpatients, surgery, radiology, etc. It’s currently used in 28 hospitals and planned for more this year. I know this seems like an invaluable piece of tech that surely should have been already in use for the last 10 years. But platform tech is a relatively recent phenomenon, 10 years ago people were still using fax machines. I know there are many industries, including healthcare, that still use fax machines in 2024. Some old technologies will never die, like candles and pencils, but I am hoping the fax machine will slowly be pushed off a cliff. 

Another stroke of efficiency, that can be used by the patient this time, is a new dashboard for Emergency Departments. This would be a real-time dashboard that would live on the HSE website. It would refresh every 10 minutes and show waiting times for patients in EDs based on triage categories. This invention was a suggestion straight from the HSE CEO after he himself paid a visit to an ED in Cork. 

This suggestion from the CEO reminded me that we are all patients ultimately. To me that is the standout difference between this HSE digital revolution and other initiatives in the past. Every human in Ireland has the potential to become a digital patient. The crazy thing about life is that we’re all one misstep away from calling an ambulance. The people at that conference that day, both speakers, organizers and spectators were all acting like major stakeholders, because in the truest sense, we all are. 

If you were ever going to sit up and pay attention to what the HSE is undertaking, now is the time. Communication around these changes will be key to its uptake and success. 

When I floated the idea of virtual wards recently to some fellow patients, there was some misapprehension that severely ill patients would be taxied off home with a thermometer in their gob and heart surgery would be offered across zoom, etc. The comments were obviously meant to highlight the ridiculous heights this could reach. The important point that needs to be communicated clearly is that patients monitored virtually are not the critically ill cohort. Virtual wards will be for those who are stable but still need some daily monitoring (that could be done from home), freeing up their hospital bed for a patient in worse shape who is currently hanging off a trolley in A&E. It’s also optional, there is no compulsion to move to a virtual ward if you are not comfortable with that set up. 

The HSE Social Inclusion team gave a really thought provoking example of how video enabled care (VEC) came to the rescue. Following the outbreak of war in the Ukraine, 1,300 migrants were arriving here a week. EDs began to notice that a large number of migrants were visiting the hospitals with non-emergency conditions. The HSE contacted 72 GPs, provided them with equipment, trained them up, put procedures in place, supplied access to interpreters and went live. 500 migrant people received GP VEC from Jan-Oct 2023. They are now looking into potential use of this in the homeless service.  

I was the last speaker, with a lot to say. Like most Irish people I am most comfortable conversing in a story format sprinkled with references to disease/death/drama/eejits and so forth. I told the story of a fall I had during the year (drama) that resulted in a broken pelvis (eejit). I tried to get hold of a scan from hospital A to pass it to hospital B. When I rang I was passed from X-ray to Nuclear Medicine to the doctors secretary back to X-ray and so on. I was told “The computer is broken”, “The person in charge is having their breakfast”, “We don’t give information to patients, because patients wouldn’t understand it” and my favourite “What is a CD?”

The next day I got through to a lady called Michelle. Michelle told me that they had new technology in place called ‘Beam’ that could share scans between hospitals with the press of a button. While on the phone to me Michelle shared the scan with the hospital that needed it. Michelle made the point “As a patient you have enough on your plate, you don’t need to worry if the right person has the right information - that’s our job.” We need more Michelles.

Patients have understandable fears around telehealth;

- The patient will be the last consideration

- We won't be able to do it physically or psychologically

- We'll lose the in-person benefits 

Throughout the conference there was an emphasis on the patient, on digital education, and on getting there together. Everybody was very enthusiastic and I personally learned a lot. There is a digital choo-choo train coming around the corner and we need to find a way to address patients' concerns, and offer reassurance through awareness, education and participation. 

Afterall, digital healthcare is “our” future.

For the online article read here - Digital healthcare from the inside out