Martin Daly: Ireland 'Off the Chart' on Digital Health Records

Thanks very much everyone for coming here today. I'm sorry I'm late, we were next door at the Health Committee. I suppose we're here talking about data, AI and disability, but it's a broader question about data within our system. And it's my impression, well in fact it's a fact, and it was reported again in the news today, that as a health service we're one of the worst performers in the European Union in terms of digitalisation of our healthcare systems. And that's a matter of fact. The target in 2030, the European Union compass target will be that every citizen in the European Union will have a digitalised health record. Ireland is not just above or below the line, it is simply off the chart in terms of digitalisation of our health service. In fact when you look at the graphs, you've got to go searching for Ireland, it's so far off beam. So we have places like Malta, Estonia, Latvia, Slovenia, who are small countries like ourselves, so there are no excuses, who have completely and utterly digitalised their health services, have full patient records and have paperless systems. Parts of our system, such as general practice, which was funded by GPs themselves, interestingly, because it was in their interest to digitalise their systems, have been fully digitalised for almost 25 years. That's a fact. We know that from the chronic disease management programmes, because in order to participate in that, which 97% of GPs have done, you have to be fully digitalised and be able to transfer electronic information and returns back to the HSE. So my question is, to the HSE, what are the plans to digitalise our health services? Why are we so far behind? I spent in a previous role in a union 10 years talking about a personal identifier, 10 years from one assistant secretary in the Department of Health and we had a meeting 10 years later and we were still talking about the same thing. Now that's about 15 years ago. We have moved on, but we haven't moved on a lot. It does show that during COVID, when we were forced to come up with solutions in a national crisis, we were able to do that. And then the pedal came off, or the foot came off the pedal again. So I'm asking the question, will we be able to meet our European Union obligations under the European Compass 2030, digitalisation of our health service by 2030? Simple question. And this applies to disability, because I'll come on to that in a minute if I have to. This is a really fundamental question in a country that is the centre of information technology in Europe, perhaps the world. I'll ask Tom, my colleague, to respond. Deputy, thanks for the question. The HSE published in 2024, our digital for care strategy and a digital implementation framework along with that. In that strategy, I suppose there's definitely a clear recognition that we're behind the curve and behind where we want to be in terms of the digitisation of our systems in our capability across the organisation. We know there are some really good examples of work that has progressed. Our close collaboration with the GPs and the GP practice community and the vendors in terms of trying to integrate the well-developed systems that you have in the way you record and the way we integrate with your practice management systems has been a really positive example. Again, the use of the individual health identifier and the referrals process, and now the linking back in directly with GP systems into a single point of access is a really positive move. Can I ask you a question before I move? As a GP, you can confirm this, and I send in an electronic referral to a hospital system because I can't do it into community care. I can do it in some sections of community care. What happens then? Is it true that it's printed off in a physical copy and passed around the hospital? There are different ways. Would that be happening still? There may be some cases. No, no, no. I can tell you what the answer is. It still happens in HSE West Northwest. A physical copy is printed off, and a person in this day and age, we're talking about AI here. I don't even know why we're talking about AI because that's in another eon, physically goes around to an office and hands in something that has been sent electronically. And in some services, such as CAMS, we've been told that you can't do it through the health links referral, that instructions have been given to GPs, sorry, they've gone to so much trouble, they will reject the referral from health links and then tell people to come back and resubmit a referral and send it by a different email. I mean, it is chaotic. So, Deputy, it's a challenge in some cases. The referral in itself from an electronic perspective has to be able to integrate and seamlessly move from one system to the next. In some cases, because we have different systems across our environment and our service providers, it's difficult to enable that seamless integration. And again, you've made the point, if I could just, because I'm on a time, and I don't mean to be rude because I just want the answers. You've just made the point, different systems. So, in the children's hospital, which was what Deputy, our Senator had asked about, is it true that St. James' Hospital has a different information system to the new children's hospital? I mean, they will all have... No, no, no, no, it's either yes or no. Is there going to be a different system in the new children's hospital than there is in St. James' Hospital? There will be... Well, it's yes or no, because I know the answer. There's a combination of different systems. No, no, no, no, no, no, no, no, no, no. No, I'm not listening to that. Really, no, with all due respect, I know what the answer is. The answer is yes, there are two different systems. There's a system in St. James' Hospital, I'm not going to name the systems, and there's a new system in children's... What I can't understand is no one has explained why this is the case, and there is no suggestion that there's interoperability. Is that true? So, the first question is, is there two different systems? If you can't answer that question, there's no point in me asking the question. There are different systems that are going to... That's fine, so that's yes, there's two different systems. Is there interoperability? The focus is on trying to make sure that... Why is there two different systems on the same site? In some cases, it's never that straightforward to transition and integrate many different systems. But will anyone explain to us why this new system was chosen? Because there seems to be a veil of secrecy around why this new system was chosen under the guise of commercial sensitivity. That's my final point. Sorry, I just can't... You weren't able to answer the question yes or no. It was a very simple question, and this is not personal, but this is part of the system. We cannot get straight answers around these issues.