HSE: Transforming Ireland's healthcare into a digital leader
Martin Curley is the Director of Digital Transformation and Innovation for Ireland's Health Service Executive, also known as the HSE. His team have ambitious plans for the country's healthcare to significantly transform so that Ireland becomes a digital leader that other healthcare systems can follow. "Healthcare is around 10 years behind other industries in terms of digital technology, and Ireland is behind the rest of the OECD countries," Curley explains. "We're trying to transform Ireland to go from being a digital laggard to a digital leader in five years."
Curley leads a small team of people he describes as catalysts whose goal is to use digital technologies to innovate and transform the healthcare system. "Our ambition is that by 2025, we will be one of the leaders in Europe for digital health, we will have significantly transformed the HSE and our health service for our citizens, our clinicians, and indeed, for business staff."
The HSE's digital innovation strategy, which they launched in 2018, is called Stay Left, Shift Left and extendedthe concept of "Shift Left" which was first introduced by Intel Corporation's Doug Busch and Andy Grove. . It is an approach to using solutions to make people's health better. "It's very aligned with Ireland's National Health Policy called Sláintecare," Curley explains. "Essentially, we're looking for digital interventions or solutions that in the first case help keep well people well or help them manage their conditions in their homes. That's the "Stay Left" part."
"Shift Left is about moving patients as quickly as possible from an acute to a community to a home setting. Every time we make a digital intervention, or an innovation intervention, we're looking for four characteristics, sometimes called the quadruple aim: improvements in the quality of care, in quality of life, reduction in costs, and improvement in the clinician/patient experience."
He adds that Stay Left Shift Left is a way to state the direction of HSE's innovation strategy. "Thankfully, we've been able to mobilise the ecosystem that works with us - large multinational companies as well as smaller SMEs - to help find solutions that help us Stay Left Shift Left."
HSE's digital transformation journey started in early 2019, and Curley explains that it had to begin slowly. "Our first efforts were to create a digital academy to start building digital capability and capacity in the Irish health service. Working with eight Irish universities, we co-designed and launched a Masters in Digital Health Transformation. We used a paradigm called design science research, where instead of students writing a 30,000-word dissertation, they actually have to develop and deliver a digital change project."
This approach has had remarkable success, as in the first year, 18 out of the 20 projects delivered were found to be viable and are either fully implemented or in development.
Given that Ireland lags behind OECD countries in terms of digitalising, Curley and his team developed a Leap Frog strategy to move the healthcare system forwards. "Many countries have installed monolithic electronic health records into their hospitals over the last 15 years or so," Curley says. "Ireland didn't do that, even though that was the intention. What we propose instead is moving to a healthcare system that, instead of being paper-based and presence-based oriented around acute hospitals, is mainly home and community-based, is proactive, predictive, mobile and cloud-enabled, leveraging open-source where possible.”
Curley says there is a real opportunity for Ireland to lead in this space. "We have this really unique point in time where we have all these disruptive technologies available in the cloud-like machine learning and the Internet of Things, that enable us to do things that weren't possible five years ago."
One example of this is remote monitoring via pulse oximeters and apps, which they deployed during the pandemic. This led to an innovative platform for remote respiratory management developed in a 'Living Lab', which today has 850 patients with chronic respiratory conditions being monitored remotely while they're at home.
"A Living Lab is where a technology or solution is actually tested in context, in a clinical setting and quickly co-designed in an agile way. We have four phases of innovation: exploration, proof of concept if that's successful we move to demonstrator, proving the business value and clinical efficacy of a solution, and lastly, broad adoption," Curley explains.
"We try to develop a consistent innovation pathway, a place where good ideas and embryonic solutions can be generated and evaluated, and if we feel there's significant value, we can deploy these in a living lab."
Members of the government, industry, academia and patients or citizens themselves participate in these labs, with the benefit of utilising patients as co-innovators in the process, rather than treating them as research objects. "We're getting really good results," Curley says. "We're able to speed up projects, and we're usually hitting all four elements of our quadruple aim - reduced costs, improved care, improved quality of life, and improved clinician experience."
The Digital Transformation and Innovation team has set up over thirty living labs across Ireland, for example a virtual rehab lab in Drogheda, an emergency general surgery living lab in Letterkenny hospital, and a distributed heart care at home lab working with patients with heart failure conditions. This lab, set up in conjunction with Centric Health and Roche is in the demonstrator phase. The early results are very promising - in a cohort of one hundred patients who are being monitored remotely, thirty two early interventions have been made which have avoided the need for a hospitaliszation.
In the near future, HSE hopes to roll out a solution called Vital Signs Automation, which will automate the process of collecting the observations nurses do to monitor vital signs. "This will also automatically compute something called an early warning score, which detects whether a patient is deteriorating so that an intervention can be made. We're testing it in a Living Lab in Cavan General Hospital, and the nurses really love it - it's transforming their role. It's eliminating much of the paperwork they have to do and giving them back more time for caring.”
Another solution called RespiraSense has also proven to be very effective, in this case for patients with COVID-19. RespiraSense wirelessly transmits a person's respiration rates while they're lying in bed, using innovative piezoelectric technology and advanced processing algorithms. "Historically, it has been very difficult to actually measure the respiration rate of a patient; nurses monitor it subjectively. In a trial in one of our Living Labs, we found that 80% of nurses reported respiration rates were incorrect, so we were making care decisions based on information that wasn't quite right."
RespiraSense, which was co-introduced with PMD Solutions, gives accurate rates as well as a 12- hour notice if a patient is going to deteriorate, which has helped move people to the ICU quickly when needed. "Typically, it enables shorter lengths of stay and better results for the patient," Curley says. It helps identify to clinicians which patientswho might need more care in a busy ward.
PMD Solutions also helped them integrate RespiraSense into the vital signs solution, enabling all vital signs, including blood pressure, pulse oximetry, and respiration rates, to be automatically recorded. "We think this is a global first, that we could be the first hospital system in the world that has automated respiration rates as the standard of care in our non-ICU wards."
Another key partner is Irish software-as-a-service company RedZinc. HSE worked with RedZinc on a new video conferencing solution for St. James's Hospital, Ireland's largest teaching hospital and HSE’s mental health division. "It works very simply. The consultant that needs to speak to a patient sends them a text, the patient clicks on the text, and it immediately opens a secure two-way video conferencing solution. At the start of the COVID-ovid 19 pandemic we had the solution in place in a matter of weeks before we started to see some of the more mainstream solutions become adopted."
He attributes the speed at which they've been able to innovate to their partner ecosystem, which includes large companies, universities, policymakers and SMEs. The stakeholders work with an approach called Open Innovation 2.0. "Open Innovation has been around for a while," Curley explains. "It was popularised in 2003 by Henry Chesbrough. I had the privilege of working with the European Commission and leading a group focused on Open Innovation over the last nine years or so. We were tracking what was happening with Open Innovation and recognised a new paradigm has emerged: Open Innovation 2.0.”
"Where Open Innovation is a collaboration between two parties, Open Innovation 2.0 is a multi-party collaboration with many actors from different areas all coalesced around a shared vision. Through working together based on a shared vision, we're able to deliver far greater impacts than we could if we just innovated on our own. We've worked with a pipeline of around 15 different SME’s to co-innovate solutions in the last year alone."
One company that mobilised really quickly was Trimedica, which created the TRITEMP thermometer. This uses infrared technology to measure the temperature of a patient and requires no contact - it can even be used while a patient is sleeping without needing to wake them up. "This was also very important in terms of COVID-19 when we knew very little about the disease. The limited contact between the clinician and the patient reduces the risk of COVID-19 spreading, so it's very beneficial."
Curley adds that another benefit that is often an afterthought is the total cost of medical equipment or medical devices, which in the case of TRITEMP is around a fifth of a conventional device because it doesn't have disposable parts. "It's a very sustainable solution. Once we identified this solution, TRITEMP had shipped hundreds of these devices to us within a couple of days, and they were deployed immediately by public health nurses going out to people's homes and in our hospitals."
The overarching aim of building HSE's digital capacity to transform healthcare is to improve the lives of patients, as well as those of the clinicians. "Ultimately, if we're successful, Ireland will be a really healthy society. The focus of the healthcare system will move from recovering from illness to maintaining wellness. We'll use techniques like social prescribing rather than always prescribing pills as the solution. It will be a proactive, predictive system and is based primarily in the home and community - we will still have acute hospitals, but they will be highly digitised.
"We think using this new digital-based, home-based approach to healthcare can be transformational," Curley adds. "Every healthcare system in the world is struggling and has budget and service challenges. We think we can provide a design pattern for other health systems to copy. Most importantly, we hope patient experiences and outcomes will be better, clinician experiences and outcomes will be better, and people will live longer and more fulfilling lives."