We're late, but we can still get patient care right.

Our centralised Patient Record System has been in planning since 2016, but the promise of better healthcare outcomes is still to be realised. There is a path forward though – if the HSE will take it.


Chris DonnellyPrincipal UX Designer

Healthcare is a complex domain. Aged health systems, a broad coalition of actors and stakeholders, misaligned incentives and thousands of moving parts make it one of the more complicated things we do as as society.

In the act of trying to just make the system work, we lose sight of the patients; the people who it is supposed to work for.

As technology transforms healthcare we have an opportunity to build patient centricity into the system. But only if that is a primary goal for the design of the system – a user first, not technology first approach.

Are we prepared to view the challenge in this way?

The foundational enabler for success, is a central view of a patients health, that both the healthcare system and the patient have access to. Benefits include:

  • Authorising the patients to review, confirm, and monitor their health data and providing them with scheduled preventive health reminders can facilitate their self-management.
  • More improved relationships between care providers and patients can also be achieved through patients' ability to exchange e-messages with doctors' offices to refill prescriptions or schedule appointments.
  • Increased patient safety can be obtained by a review of drug interactions, access to care plans, and early access to the results of important lab tests.
  • Higher care quality is possible through the provision of coordinated, comprehensive, and continuous care.
  • More effective care can be achieved through easier access to patients' health history and prevention of duplicate tests and unnecessary services.
1. The NCBI has a good paper that outlines the potential benefits.

Link here

UK, Austria, Australia, Canada, among others, have successfully implemented patient portals or apps, each with unique features tailored to their healthcare systems. Countries our size and smaller – such as Estonia, Denmark and Finland – have done it and done it well. Ireland, on the other hand, has yet to deploy its patient portal even though it has been promised since at least 2016.

2. Estonia: Pop 1.3m; 6.7% GDP on health. Finland: Pop 5.5m; 7.7% GDP on health. Ireland: Pop 5m; 6.1% of GDP on health.

Because we're late to market, we have an opportunity to avoid under-delivery and learn lessons from other jurisdictions.

However, the NCBI paper points out that “no [Patient Health Record] PHR supported all of the identified features and functions.”

We have examples from around the globe of expensive tools that didn't realise the full opportunities presented by technology.

Because we're late to market, we have an opportunity to avoid under-delivery and learn lessons from other jurisdictions.

So how do we actually get this right?

We have to do 4 things right:

  • Take a Service Design approach,
  • Define the Vision,
  • Be laser-focused on the outcomes,
  • And treat it like a product.

Let's outline these briefly…

1. Start with the Service Design

Service Design is a tool to coordinate and articulate the needs of multiple and varied stakeholders in a complex process and how they interact – taking a helicopter view of clinics, conditions, patient types and any other dimensions that matter we can capture:

  • What is appropriate to transact digitally, where does digital help?
  • What is better served in person?
  • What are the risks around acceptance and adoption with clinicians AND patients?
  • And can we achieve a genuine reduction in admin work and a refocus on the patient?

2. Defining the vision before procurement and spec

Before we start procurement, technical and operational planning we need to create a view of the reality we want to create for patients in this country. It should be ambitious and aspirational but achievable within a defined timescale.

3. Outcome metrics built into the design

Creating PHR system is expensive, anywhere in the range of 10s - 100s of millions of euros. To justify the investment we need to be clear with ourselves on the value we will be realising with that investment. Define these metrics up front and use them to guide the design and build.

At the very high level metrics need to include

  • Time saved at both patient and clinic
  • Cost reductions
  • Improved patient health outcomes (qualitative and quantitative measures)
  • Reduction in waiting lists

Adopt a culture of experimentation, testing and iteration.

An finally, it is just too complicated a process to expect to get a product 100% right and optimised right out of the box.

This means that the HSE will have to adopt a "product mindset" – that is to create a culture of iteration and testing in digital releases. Start small and release and test and iterate relentlessly.

There are two paths for the HSE to travel here.

The HSE can go down the road of a technology led, procurement heavy process, of creating a portal which will lead to something that works but that will be sub-standard by any measure.

Or, they can walk the path of patient centricity, embracing the values, strategies and tactics we've already discussed.

Even though our portal is several years behind our contemporaries in Europe, there is still time to do the right thing. If we approach the challenge in the right way, we can build something truly great that will improve the quality of care for patients and enhance the healthcare system in this country.

All we need to do is choose the right path.

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