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Building a sustainable health
information infrastructure
Jane Grimson
Director of Health Information and
Deputy Chief Executive
Health Information and Quality Authority
The perfect storm

G
a
p
Good quality information is critical
Role of the Health Information and
Quality Authority:
To drive continuous improvements in the
quality and safety of health and social
care in Ireland.
Health information function
Develop standards and guidance
for health information
Identify gaps in health information
Publish accurate information
about the performance of the
health and social care system
Work completed to date
Develop standards and guidance for health information
Guidance on Information governance for health and social care services
Guidance on Privacy Impact Assessment
What you should know about information governance
What you should know about data quality
Catalogue of national health information sources
Guiding principles for health and social care data collections
GP messaging standard (v2)
Referral data set, discharge data set, demographic data set
Guidance on messaging standards for Ireland
Guidance on classification and terminology standards for Ireland
Overview of healthcare interoperability standards

Identify gaps in health information
Provide advice in relation to identifiers for individuals, professionals and organisations

Publish accurate information about the performance of the health and social care
system
All inspection and investigation reports published
Key principles for a sustainable health
information infrastructure

1. Patient-centred
2. Integrated
3. Standards-based
Key principle 1:
Patient centered
Informed, knowledgeable
and empowered patient
E
N
C
O
U
R
A
G
E
D

D
I
S
C
O
U
R
A
G
E
D

$
Tertiary
Secondary

Professional
Care

Primary

Self-Care
(off the Map)
¢

INDUSTRIAL AGE MEDICINE
Source: Tom Ferguson, “Consumer Health Informatics,” Healthcare Forum Journal, Jan/Feb 1995, pp 28-33.
(doctom@doctom.com, wwwfergusonreport.com
E
N
C
O
U
R
A
G
E
D

¢

Individual self-care

Friends and family

Self-help networks
Professionals as
facilitators

D
I
S
C
O
U
R
A
G
E
D

Professionals
as partners
Professionals
as authorities

$

INFORMATION AGE HEALTHCARE
Source: Tom Ferguson, “Consumer Health Informatics,” Healthcare Forum Journal, Jan/Feb 1995, pp 28-33.
(doctom@doctom.com, wwwfergusonreport.com
Patient Pathway
Day Care Facilities

Local
Authority

Age Action

Social Services

Primary/
Community

Housing Services

Community Nursing

Secondary / Acute Care

General Practice

Physiotherapy

Ward Care

Operating Theatre

Diagnostics

Ambulance
Service

Emergency Dept.

Ambulance Journey

Information flows the wrong
way
Local Health System

Voluntary
Sector
Ambulance Journey

Ambulance
Service

Threatens patient safety
and
increases costs
Patient Pathway
Day Care Facilities

Local
Authority

Age Action

Social Services

Primary/
Community

Housing Services

Community Nursing

Secondary / Acute Care

General Practice

Physiotherapy

Ward Care

Operating Theatre

Diagnostics

Emergency Dept.

Local Health System

Voluntary
Sector
Source: eHealth Strategy for Ireland, Department of Health, 2013.
The ability of share information is at the heart of
patient-centred eHealth
Key principle: 2
Integrated
Eliminate duplication
and fragmentation
Current information
infrastructure in Ireland
very fragmented
Drivers for integrating health information
•
•
•
•

Connect multiple locations of care delivery
Support team-based care
Deliver evidence-based healthcare
Improve safety
– Reduce errors and inequalities
– Reduce duplication and delay

•
•
•
•

Improve cost-effectiveness of health services
Empower and involve citizens
Underpin population health and research
Protect patient privacy
Key principle: 3
Standards-based
Support efficient
information sharing
Benefits of standards
• Major role in ensuring safety e.g. Safe Surgery Saves Lives
(WHO)
• Support health service improvements

• Deliver economic benefits
• Benefits stakeholders including patients
“the lack of ICT systems interoperability and of widely accepted

standards directly implies compromised quality of healthcare
and unnecessarily high costs”
[Empirica 2008]
Standards in healthcare
Conclusions
Why has progress been so slow?
• What’s the best approach?
• How much will it cost?
• Will it deliver the benefits?
• How do we get there?
• What standards should we
use?
• ……
What can we learn?
• Don’t assume that solution which works well in one context will work
well in another
• Identify and implement the key building blocks for eHealth
• Build on local solutions based on standards to ensure that everything
fits together
• Benefits claimed should be evidence-based
• Strategic goal should be better healthcare, not cash
• Engage pro-actively with all stakeholders including patients
• Make sure all information flows are identified from direct patient care,
to clinical audit, quality improvement, reimbursement, population
health, service planning, and research
• Put in place robust governance to ensure privacy and confidentiality
• Leadership for the long term is critical
• Ensure that eHealth strategy enables and supports all policy objectives
Can we leapfrog?
• Go directly to Personal
Health Records at national
level?
• Adopt an integrated
approach to primary and
secondary information
Thank you

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Jane grimson

  • 1. Building a sustainable health information infrastructure Jane Grimson Director of Health Information and Deputy Chief Executive Health Information and Quality Authority
  • 4. Role of the Health Information and Quality Authority: To drive continuous improvements in the quality and safety of health and social care in Ireland.
  • 5. Health information function Develop standards and guidance for health information Identify gaps in health information Publish accurate information about the performance of the health and social care system
  • 6. Work completed to date Develop standards and guidance for health information Guidance on Information governance for health and social care services Guidance on Privacy Impact Assessment What you should know about information governance What you should know about data quality Catalogue of national health information sources Guiding principles for health and social care data collections GP messaging standard (v2) Referral data set, discharge data set, demographic data set Guidance on messaging standards for Ireland Guidance on classification and terminology standards for Ireland Overview of healthcare interoperability standards Identify gaps in health information Provide advice in relation to identifiers for individuals, professionals and organisations Publish accurate information about the performance of the health and social care system All inspection and investigation reports published
  • 7. Key principles for a sustainable health information infrastructure 1. Patient-centred 2. Integrated 3. Standards-based
  • 8. Key principle 1: Patient centered Informed, knowledgeable and empowered patient
  • 9. E N C O U R A G E D D I S C O U R A G E D $ Tertiary Secondary Professional Care Primary Self-Care (off the Map) ¢ INDUSTRIAL AGE MEDICINE Source: Tom Ferguson, “Consumer Health Informatics,” Healthcare Forum Journal, Jan/Feb 1995, pp 28-33. (doctom@doctom.com, wwwfergusonreport.com
  • 10. E N C O U R A G E D ¢ Individual self-care Friends and family Self-help networks Professionals as facilitators D I S C O U R A G E D Professionals as partners Professionals as authorities $ INFORMATION AGE HEALTHCARE Source: Tom Ferguson, “Consumer Health Informatics,” Healthcare Forum Journal, Jan/Feb 1995, pp 28-33. (doctom@doctom.com, wwwfergusonreport.com
  • 11. Patient Pathway Day Care Facilities Local Authority Age Action Social Services Primary/ Community Housing Services Community Nursing Secondary / Acute Care General Practice Physiotherapy Ward Care Operating Theatre Diagnostics Ambulance Service Emergency Dept. Ambulance Journey Information flows the wrong way Local Health System Voluntary Sector
  • 12. Ambulance Journey Ambulance Service Threatens patient safety and increases costs Patient Pathway Day Care Facilities Local Authority Age Action Social Services Primary/ Community Housing Services Community Nursing Secondary / Acute Care General Practice Physiotherapy Ward Care Operating Theatre Diagnostics Emergency Dept. Local Health System Voluntary Sector
  • 13. Source: eHealth Strategy for Ireland, Department of Health, 2013.
  • 14. The ability of share information is at the heart of patient-centred eHealth
  • 15. Key principle: 2 Integrated Eliminate duplication and fragmentation
  • 16. Current information infrastructure in Ireland very fragmented
  • 17. Drivers for integrating health information • • • • Connect multiple locations of care delivery Support team-based care Deliver evidence-based healthcare Improve safety – Reduce errors and inequalities – Reduce duplication and delay • • • • Improve cost-effectiveness of health services Empower and involve citizens Underpin population health and research Protect patient privacy
  • 18. Key principle: 3 Standards-based Support efficient information sharing
  • 19. Benefits of standards • Major role in ensuring safety e.g. Safe Surgery Saves Lives (WHO) • Support health service improvements • Deliver economic benefits • Benefits stakeholders including patients
  • 20. “the lack of ICT systems interoperability and of widely accepted standards directly implies compromised quality of healthcare and unnecessarily high costs” [Empirica 2008]
  • 23. Why has progress been so slow? • What’s the best approach? • How much will it cost? • Will it deliver the benefits? • How do we get there? • What standards should we use? • ……
  • 24. What can we learn? • Don’t assume that solution which works well in one context will work well in another • Identify and implement the key building blocks for eHealth • Build on local solutions based on standards to ensure that everything fits together • Benefits claimed should be evidence-based • Strategic goal should be better healthcare, not cash • Engage pro-actively with all stakeholders including patients • Make sure all information flows are identified from direct patient care, to clinical audit, quality improvement, reimbursement, population health, service planning, and research • Put in place robust governance to ensure privacy and confidentiality • Leadership for the long term is critical • Ensure that eHealth strategy enables and supports all policy objectives
  • 25. Can we leapfrog? • Go directly to Personal Health Records at national level? • Adopt an integrated approach to primary and secondary information