ÚrCHIN (New Child Health Information Network)
Update December 2013
Dear ÚrCHIN member,
Since our February 2013 inaugural Workshop on integration of Child Health Information in Ireland, a number of developments have taken place which may be of interest to network members.
A) Workshop updates
(The updates for these have kindly been provided by the speakers in relation to the systems they described at the workshop)
1. Newborn Bloodspot Screening (Phase 1 ILSMS)
The first phase of integrated screening laboratory management system( Specimengate ) based in Childrens University Hospital Temple Street went live on 20 May 2013 - the electronic reports module(eReports) is now available to 4 maternity hospitals which provides confirmation of sample receipt and has reduced reporting time. This will be rolled out to other maternity units, PHN Child Health Departments and paediatric referral hospitals over the coming months. The Patient Care module of Specimengate which supports the referral process is expected to go live by early 2014.
2. Newborn Bloodspot Screening (Phase 2 ILSMS)
Enhancements to Careworks Schemes * approved by CMOD will include provision for data fields for Newborn Bloodspot Screening (NBS) outcomes
(* Applicable in former North East, North West, Mid West and East areas)
Further developments conditional upon outcome of N.I.C.I.S (see below)
3. National Immunisation and Child Health Information System (N.I.C.I.S)
The NICIS Steering Group undertook a market sounding exercise for the National Immunisation and Childhealth System and met potential suppliers in September with the purpose of assessing the availability of existing systems to meet Irish needs.
4. Universal Neonatal Hearing Screening (UNHS)
UNHS has now been rolled out nationally since early November 2013.
81,815 babies have had their screening to date and 115 babies with a permanent childhood hearing impairment have been identified.
5. National Child Care Information System
A contract to supply a National Child Care Information System was signed at the end of March 2013. The system selected (based on the Microsoft Dynamics CRM Platform) is currently at development stage i.e. being configured to align with Social Work business processes and other the requirements set out in the system specification. A number of initial releases have already been made available for preliminary testing.
The database servers have been built in the National Data Centre and a first (alpha) version of the software will be installed shortly.
The Midwest Area has been selected as the initial implementation (pilot) site. A local implementation team is in place and is actively preparing the area for deployment of NCCIS. New laptop and desktop computer equipment has been ordered and delivered and is currently being prepared for deployment.
System test and User Acceptance Testing of NCCIS will begin in January 2014. Local data migration will begin in February with a go-live date (first site) planned for the end of March 2014.
6. Maternal and Newborn Clinical Management System (MNCMS)
The aim of the project is to develop an electronic platform that can be used across all services and locations to support the necessary maternity and neonatal workflow and include clinical and management interfaces. A contract between the HSE and Cerner Corporation is due to be signed in the final quarter of 2013 for a new system. This will be installed in the 19 public hospitals maternity hospitals over an expected 2-3 year timeframe in four phases.
The new iPM Patient Management System went live in Waterford Regional Hospital on the 29th of November replacing their 30 year old PAS. The system provides functionality in the areas of In Patient and Out Patient waiting lists, OPD appointments and scheduling, Admissions and Discharges, Real-time bed management, ED and Document Tracking. Clinics are now being booked from one hospital for clinics that are provided in another hospital. In the coming months the hospital plan to implement theatre scheduling and discharge summaries. This system now shares a patient index with the 17 sites in Cork that are also users of what is now the largest multi-campus PAS in the country. Multiple patient identifiers are stored for each patient depending on what hospitals they have attended and these are linked via a regional number. Activity and management reports are being upgraded giving better information to meet local and national reporting needs. The next implementation sites in Q1 and Q2 2014 include Wexford General, St Luke and Kilcreene in Kilkenny and South Tipp General. Over Q3 and Q4 implementation will start across the 6 hospitals in the Mid West and at Mullingar and Portlaoise in the Midlands.
The National IPMS programme welcomes the announcement of the new IHI and looks forward to integrating and utilising this identifier at current iPM sites.
8. ISF (Integrated Service Framework)
A contract has recently been awarded for the development of a Standards Based Information Architecture Reference Model to optimise opportunities for integration of health information across relevant settings. A series of 4 initial workshops is planned for key stakeholders.
B) The HSE Systems Reform Programme has held workshops in recent weeks for the purpose of stakeholder consultation towards the development of a HSE ICT strategy. A number of ÚrCHIN members nominated from their HSE work settings have contributed to the workshops and a further meeting with the Project Group is planned to provide a briefing on Child Health Information issues.
C) A Bill which provides for the introduction of an Individual Health Identifier (I.H.I.) for patients and health care professionals was published on 13 December 2013 by the Department of Health and Children( DoHC) – see press release in Appendix 1
As you can see from the brief snapshot 2013 has been a very busy year for Child Health Information and there is every reason to hope that 2014 will be even more exciting if the I.H.I. Bill is enacted. The ÚrCHIN network will keep you updated of further developments as they emerge.
Kind regards and Happy Christmas
Dr. Kevin Kelleher
Assistant National Director (Public Health) HSE
Press Release, Friday, 13th December 2013
Minister Reilly publishes eHealth Strategy for Ireland
The Minister for Health, Dr James Reilly TD, today (13th December) published the eHealth Strategy for Ireland, the Health Identifiers Bill 2013 and announced the recruitment of a Chief Information Officer for the health services.
“The eHealth Strategy will put Ireland in a position to fully exploit all of the many benefits which today’s information and communication technology has to offer in modernising the way we treat patients and particularly in providing care in the most appropriate setting and at the most appropriate level within the health services” said Minister Reilly. “From my perspective, the eHealth strategy could not have come at a better time because eHealth is a key enabler of change, the type of radical reform that we have put in train for our health services. I am also pleased by the proposals for cooperation with Northern Ireland in this area”.
The Health Identifiers Bill 2013, published today, provides the legal basis for Individual Health Identifiers for health service users and unique identifiers for health service providers. The identifiers will be used across the health service, both public and private.
First and foremost, Individual Health Identifiers are about patient safety and ensuring that the right information is associated with the right individual at the point of care. Individual Health Identifiers will also help in managing our health service more efficiently and will be a building block for health reform initiatives outlined in Future Health, including Money Follows the Patient.
A dedicated branded entity called ‘eHealth Ireland’ will be established, initially in the HSE. It will be headed by a Chief Information Officer for the health service who will be recruited through an open competition. Priority areas for initial development include ePrescribing, online referrals and scheduling, Telehealth (particularly relating to the management of chronic disease) and the development of summary patient records.
The Individual Health Identifier provided for in the Health Identifiers Bill will be essential to all of these developments and a programme for its rollout will be prepared as a matter of priority in tandem with the passage of the Bill through the Oireachtas.
eHealth Ecosystems will be a key mechanism for delivering on the eHealth strategy. These will involve partnerships between health service providers, academia, industry and patients. Such eHealth Ecosystems have been established in a number of EU countries and are amenable to cross border cooperation. The Irish Presidency Declaration at the EU eHealth Conference held in Dublin in May 2013 committed member states to developing eHealth Ecosystems.
Concluding the Minister said “I firmly believe that Ireland’s extensive IT and healthcare industry sectors make us very well placed to exploit eHealth, not just to radically improve our own health services, but as an emerging area within the wider ICT industry which will have a significant part to play in achieving this Government’s targets for jobs and economic growth.”
A copy of the eHealth Strategy for Ireland is available at http://www.dohc.ie/publications/eHealth_Strategy_2013.html
Notes for Editors:
Health Identifiers Bill
The Health Identifiers Bill 2013 which is published today provides the legal basis for Individual Health Identifiers for health service users and unique identifiers for health service providers. The identifiers will be used across the health service, both public and private.
First and foremost, Individual Health Identifiers are about patient safety and ensuring that the right information is associated with the right individual at the point of care. Individual Health Identifiers will also help in managing our health service more efficiently and will be a building block for health reform initiatives including Money Follows the Patient.
A National Individual Health Identifier Register will be established containing the Identifier and other identifying particulars relating to the individual. These are set out in the Bill. There are two key privacy points here. The first is that an Individual Health Identifier or IHI will be a number which in itself will contain no personal data whatsoever. The second is that no clinical information whatsoever may be contained in the IHI Register.
Access to the National IHI Register will be restricted to health service providers and other entities under the Bill. The Bill provides that measures must be put in place to help ensure that the National IHI Register is accessed only for relevant purposes and by people who are permitted to access it. There are offences and penalties set out in the Bill on inappropriate access.
Health service providers - health professionals, organisations and some employees - will also have a unique identifier. Again, providers will have to use their identifier on their patient records and in relevant communications. This will clearly identify the person and organisation involved at each stage of care. There will be a National Register of Health Services Providers Identifiers containing the identifier, name, business address and other relevant details. The Health Services Provider Register will be publicly accessible.
Assigning identifiers and establishing and maintaining the related registers are functions of the Minister for Health under the Bill. However, for operational reasons, the Bill allows for the possible delegation of these functions to the Health Service Executive (HSE).
A provision for health identifiers was included in the Health Information Bill and heads of a Health information Bill were approved by Government in 2009. More recently, in the context of a commitment given to the Troika in June to publish legislation to give a statutory basis to health identifiers, it became clear that it would not be possible to have all the provisions of that Bill ready in time to meet the Troika commitment; hence, it was necessary to fast track the identifier elements into a separate focussed Bill: namely, the Health Identifiers Bill. The formal drafting of this Health Identifiers Bill was approved by Government on 30th October 2013.
The Department was advised by a Health Identifiers Working Group representing all major stakeholders – D/Health, D/Public Expenditure and Reform, D/Social Protection, HIQA and HSE. The Department also consulted with the Data Protection Commissioner.
Individual Health Identifier
The Individual Health Identifier will rely heavily and be closely linked to the Public Service Identity dataset and the SAFE* Public Service Card infrastructure operated by the Department of Social Protection. In this way, the Individual Health Identifier will leverage the significant investment to date and the ongoing work by the Department of Social Protection (DSP).
*Standard Authentication Framework Environment designed to assign a level of certainty to the information held about an individual– e.g. information about a client is only assigned SAFE Level 2 after a face-to-face interview were the client is required to produce documentary, including photographic, evidence of identity
It is not intended to replicate the DSP data collection and verification process, except for a small fraction of cases where DSP does not have information about the individuals concerned (e.g. tourists or temporary residents who are not normally issued with PPS Numbers). This approach will ensure maximum leveraging of the public service dataset (operated by DSP) while enabling the health sector to operate a sectoral identifier. In many respects, the health service will operate from a carbon copy of the public service identity dataset and this will significantly reduce the cost of the initiative.
Health service providers will be required to identify patients and clients who present for service by requesting their Individual Health Identifier or, failing that, identifying particulars (such as name, date of birth etc.) which will enable them to search the register of Individual Health Identifiers. The Bill provides that health service providers must associate the Individual Health Identifier with records they create. However, a health service provider cannot refuse a service solely because an individual cannot, or refuses to, provide his or her Individual Health Identifier.
The proposed system will have features which will reassure the public about the use of health data
· the individual health identifier may not be used in any other sector of the economy or government unless its use relates to a health service e.g. psychological assessments carried out for the education sector
· no clinical information will be held in the Individual Health Identifier Register
· the Bill contains offences and penalties for misuse of the Individual Health Identifier and access to the Individual Health Identifier Register is controlled and limited with supporting criminal sanctions.
Organisational and Professional Identifiers
In line with HIQA recommendations, the Bill includes provisions for the establishment of identifiers for organisations providing health services as well as identifiers for professionals and other staff. These identifiers will strengthen patient safety, privacy, wider regulation and facilitate more robust accountability and audit.
The Bill compels health professional regulatory bodies, such as the Medical Council and Nursing and Midwifery Board of Ireland, to provide information to the Minister on registered professionals. It is intended to re-use the number assigned by these regulatory bodies in the Register of Professionals provided for in the Bill.
Operation of the Registers
The Bill provided that the Minister may delegate the main operational functions of the identifier registers to the HSE by Government order. It is envisaged that the HSE /PCRS (Primary Care Reimbursement Service) will operate the Individual Health identifier Register on behalf of the Minister. PCRS already has considerable expertise and systems in place which can be readily tailored for this purpose.
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