Digitisation & Integration of Healthcare Records, why do we lag so far behind?

Did a stint as a student at a hospital (back when they used take on secondary students for summers), the computer based system was awful, and learned that basically every individual hospital had paid for/developed their own system and there was pretty much no compatability from one hospital to another. That blew my mind 20 years ago at the lack of foresight, the waste of resources, and sheer idiocy. I suspect nothing has changed.

Hospitals 'owned' by many disparate bodies between voluntary boards, religious orders and various bits of the HSE; GPs and pharmacies all private contractors and the GMS contract being absolutely antique; regionalised IT budgets in the HSE prevent national planning (and yet the early NEHB and SEHB drives to digitise ahead of the rest of the country got centrally sat on after the HSE was formed); rudderless management running to fix the latest scandal and either unable, unwilling or not allowed to fix structural issues; the surreal situation that Healthlink (the messaging and referral interlink system) was formerly a private company.

Pick one. Or pick all, they're all valid reasons why stuff has barely advanced in 25 years compared to what the NEHB could do then.

Aer Lingus doesn't run a hospital and they barely run an airline. I can think of better ways to operate an emergency medical facility

Not sure who we are being compared with to say we are lagging behind on digitisation but I have heard that the logic for keeping printed patient charts in the past was that the printed version was seen as a backup store of information on a patient that would still be usable in an emergency situation when computer based systems are not accessible. When I was told this I had the image of a hospital working in a power cut but it's not that long ago that there was an encryption virus introduced to the HSE computer systems and going into work I was faced with a machine on the desk where I work with a sign posted on it from the hospital IT team saying that in no circumstances were any of the hospital computers to be switched on or used. All the computers were later replaced and I imagine all the old machines became scrap as there could be no guarantee that the old PCs did not keep some of the damaging software they were infected with.

I can see improvements have been made with patient information being accessible online when proper access permissions are granted but there is often information in printed charts that has never been put on a digital system and some that were on IT systems that are no longer active and printouts from them in the patient's paper chart is all that is left to say a particular test for example was carried out at some point in the past. At times there can be some of the records from other hospitals for that patient if they had been requested but it would be unusual for this work to be taken on and there simply is not the spare capacity in hospital administration staff to do this for anything more than a small portion of patients. Its only a few weeks ago I heard some radio presenter ranting about how the health service needed more doctors and nurses and less administration staff. I'm not sure how they came to get this information that the health service was so weighted against doctors and nurses but they seemd fairly confident with their claims that more expenditure on administration in the health service was not what their listeners wanted to hear.

To improve the integration and digitisation of health records would require a lot of work and employing lots of accurate diligent workers to insure no mistakes were made in getting the information on every health service patient records from multiple sources 100% correct. It would also require a system that is completely secure from unwanted external access to confidential records and a durability in the system that would mean all the work would not need to be repeated again when it was realised that a more up to date IT system should be employed. There are already IT systems used in patient administration and sharing of information on patients but this is very different from having a digital only record for patients. Developing this concept could see a large portion of the health sevice budget going to build a system that might end up failing and the risk of getting such a system wrong are huge for anyone who decided to implement it. I could go in to further detail on some of the complications that could arise particularly for more complex patients and ones who have a longer and more detailed medical history but to keep my post to a reasonable lenght I would just like to say that I would be very concerned about patient health care records going completely digital and think there are potentially very serious consequences if this was not handled well.

Just on the off chance that anyone is actually interested in the scope and complexity of the challenges facing the HSE around digitalisation, this would be a good starting point.

The idea that Linux directory and file permissions would form some kind of basis for Electronic Health Records is crass in the extreme.

It’s a bit like saying bricks are the solution to our homelessness crisis.

Public and private insututions can be integrated much easier under a universal insurance healthcare system, there every individual has a unique health insurance chipped card which is used to access the data from hospital/GPs side when you visit and plug into payment and hospital reservation systems.

All the hospitals and GPs will be forced to conform to the universal health insurance standards otherwise they won't get paid (public or private) as universal insurance is patient centric, the money follows the individual patient who becomes more like a customer. Countries such as Taiwan have had such a system for over 20 years.

Make it about access to patient fees and they will confirm quickly.

If things like banking can be done totally digitally and work, surely medical records can.

Again, this isnt rocket science.

You could have a centralised highly regulated point of storage, and individual hospitals/GP practices can make requests for records from that, with their own credentials. They would not be kept in sync or stored locally, only request a patients records as you need them. I'm sure there are ways to idiot proof the whole thing also to protect against end-user ransomware, such as 2FA for any requesters.

This is a very solvable problem, that has been solved in numerous ways all over the world. There is no excuse for reliance totally on paper records in this day and age.

"This is a very solvable problem, that has been solved in numerous ways all over the world. There is no excuse for reliance totally on paper records in this day and age."

As someone working in a HSE hospital there is not total reliance on paper records. There are IT systems with patient information available for a number of years and these systems can be accessed through the internet. The paper records do often contain additional information that is not available on the online IT systems but this is often older and less relevant to the current patient treatment.

Are we back in 2012? FG came to power in 2011, leading a Government with a strong majority, with a clear policy for Universal Health Insurance as one of the pillars of their campaign. Their Labour partners were broadly supportive. When the rubber hit the road, they couldn’t make it work. The Irish market is too small to support competing UHI insurers.

Taiwan has 23 million people. We have 5 million. It’s a big difference.

The poster made no suggestion about FORTRAN being created at TCD, only that someone in TCD used it.

Aer Lingus may have fallen behind in the 60 years since, but that in no way devalues the usefulness of their early work.

The lack of a computer record is shocking. Across Europe there surely are examples of systems that can be modified for Irish needs, issues likes different ownership of hospitals etc exist elsewhere. There may be isolated progress, but this needs to be fully integrated.