Report from the Ecosystem on the 4th September 2017

eHealth Ireland Ecosystem hosted its Mental Health and Wellbeing event on the 4th September at the DCU School of Nursing. In attendance were representatives of the wide range of stakeholders who are interested in developing integrated care across Ireland.

Jim McGrane wrote a detailed report of the day: 

"The meeting began with Yvonne Goff , the Chief Clinical Information Officer of the HSE welcoming everyone to the eHealth Ireland event, outlining the structure of the day, and introducing the first of the day's speakers, Dr Seamus MacSuibhne Consultant Psychiatrist and member of the CCIO and clinical lead from the Bipolar Lighthouse Project.

Dr MacSuibhne outlined the challenges faced in dealing with mental health issues from the fact that mental health itself is highly contentious, to the tendency of the healthcare profession to deal with mental health based on the fashion of the day, be it medicinal or technology based. He warned that the World Health Organisation tell us that Mental Health is increasing as a global issue and while more and more companies are signing up to work with mental health we need to be wary of the idea that someone can sell us a quick fix to what is an extremely complex problem. He advised that eHealth offers us great opportunity but should never be considered as a replacement for human interaction.

Following on from Dr MacSuibhne, the Deputy President of Dublin City University Professor Daire Keogh welcomed us to DCU and explained the importance of working with mental health and wellbeing to Dublin City University, its staff and all its students.

see-change-logoThe patient’s perspective was the title of the next presentation and this was given by Rick Rossiter. Rick has lived with anxiety and depression since he was 12 and he spoke openly and honestly about the effect this has had on his life and on the people around him. He described his first attempted suicide at the age of 15 when he jumped off a 69-storey building in Newfoundland, Canada where he was born and raised. This left him with a broken back and legs but while his physical ailments were treated straight away it was four months later before anyone thought to ask him why he had jumped. Rick has found people find it hard to speak about mental health issues and he explained the stigma of mental health he has felt from people’s lack of knowledge, negative attitude and hostile behaviour. He explained the hurt it causes to be just labelled as bipolar, in his own words “I have feelings and emotions, Bipolar is a small part of who I am “ When Rick's daughter entered secondary school he heard of four suicides in her school and he decided that as someone who understood the stigma and struggle of mental health he could reach out to people, and he is now a high-profile ambassador for See Change, Ireland’s national stigma reduction programme. Rick told us he believed that knowledge is the key to everything with mental health, and he was really encouraged to see the commitment from Clinicians and Technicians in working with eHealth Ireland. He finished by asking us all to keep up the battle with mental health problems and to take it further.

Our next Speaker took us on a journey from Procurement to go live with a Mental Health EHR system. This presentation was delivered by Orla Gogarty, Director of ICT, St Patricks Mental Health Services. St Patricks is the largest mental health service organisation in Ireland and is spread over 2 campuses. They cater for between 14,000 and 15,000 appointments per year and have over 3,000 admissions yearly with an average stay of 28 days. They decided to move to Electronic Health Records in order to have access to records anywhere, any place at any time. This was done in order to support clinicians to work more effectively and seamlessly. They realised they had a serious problem when they found that they were competing with their medical records department for service space, and with the huge printing costs they were incurring. The move to an EHR system involved an upgrade of their infrastructure including their ICT network and over 4000 devices. The overall implementation roadmap consisted of approximately 30 projects running concurrently and required strict corporate governance and buy in from the Board, Executive, ICT, Management and clinicians. They embarked on a three phase training program of pre-EHR, EHR and post EHR training. One of the issues they had was some staff had never used computers before so the pre EHR training was critical but by using a self-evaluation system where staff managed their own training they have everyone up to the required level to use the system. St Patricks are three weeks away from go-live but are quietly confident in the new system and the benefits it will bring to clinicians and service users.

Can the psychiatrist ever be successfully replaced by a robot? .

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This was the question posed next by Dr Anthony McCarthy, Consultant Psychiatrist at the National Maternity Hospital. Dr McCarthy told us the question came to him after he had a robot perform surgery on him for cancer (the robot, he assured us was guided by a human surgeon). He challenged the audience to decide if a purely rational, evidence based; non-empathetic method of dealing with mental health by reducing the humanity of the patient was a viable way of treating them. When he spoke of the robot he did not only mean an ICT construct, but a state of mind where people were treated purely based on formulaic answers to structured questions . Dr McCarthy argued that in order to really help someone we need to understand the story of their life, their personal history and their all too human irrationality as these components are the essence of who they are. He finished with a quote from Jim Watson which showed how far from robots the psychiatrist needs to be

“Psychiatrists have to tolerate partial knowledge uncertainty and ambiguity. They always needed to be aware, that all they were doing was making a best guess about what the trouble is, what caused it, what should be done about it and what was going to happen in the future”

The International Working Group on Mental Health and Wellbeing was next up with Brian O’Connor , Chair of the European Connected Health Alliance and Kumar Jacob representing the EHCAlliance Mental Health working group. The EHC Alliance is an international network of Ecosystems whose members develop innovative solutions around mobile health, chronic diseases, active & healthy ageing, Internet of Things, wearables, personalised medicine, genomics and Big Data. The group is expanding all the time and invited interested parties to meet with them to join their international community and have their projects and activities showcased on an international scene and to have a say in the direction of the evolving mental health working group

Dr Briege Casey was our second last speaker. Dr Casey is the programme co-ordinator for the Certificate in Homeless prevention and intervention in DCU. She spoke of the fact that 70% of people in need don’t access mental health services and the possible deployment of IT solutions to reach out to some of these people. She also discussed face to face interaction versus the anonymity of online interaction and the benefits and drawbacks of both .

The group took time out for three Breakout Sessions on Service User Engagement, Use of Technologies in the Treatment of Mental Health and Connecting for the future. Each group had a lively engaged session and all had a similar story to tell in that clinical engagement was the key to the success of eHealth and the needs of the patient have to be the anchor to technology if we are to succeed.

When we returned the final speaker was Richard Corbridge who gave details of the upcoming Health Innovation week and promised the ambitious agenda he set the HSE would be maintained into the future.

It was a hugely enjoyable day and at the end of it the clinicians, technicians and service users had all a better understanding of each other’s perspectives regarding how eHealth can best drive innovation and how to get the best outcome for all .

I leave the final work to what Rick Rossiter had to say about the work we are doing:

“eHealth is not the answer, medication is not the answer, therapy is not the answer. They are all the answers if we can just get them working together”.

With thanks to Jim McGrane.