Roadmap for Delivering the New Capabilities
“Safe, high quality cancer care is based on commercially available technology, including clinical information systems, providing controlled access to data for care providers, management and funding agencies. The National Cancer Control Programme relies on activity and key performance indicator data from the designated cancer centres to monitor and develop cancer services. Therefore, in the transition to a data-driven and knowledge-based culture, we are strongly committed to the goals of the Knowledge and Information Strategy.”
-Dr. Jerome Coffey, Director, National Cancer Control Programme
The delivery of the target capabilities represents an unprecedented scale of transformation for the Irish health system. Successful delivery will require programmatic approach, dedicated resourcing, and commitment to funding. The benefits are dramatic and far reaching – to patients, the health system, and the Irish population and economy at large.
The reform must be managed as a programme, with clear vision and dedicated leadership from Knowledge & Information, HSE Leadership and Clinicians. Additionally resourcing, funding, strong change management, clear targets and governance must be in place to enable predictable, effective deliveryThe delivery of the target capabilities represents a transformation of scale and ambition unprecedented in the Irish health system to date. Experience from other countries that have embarked on similarly comprehensive reform programmes, such as Canada, Norway, Singapore and Spain have been researched and embedded into the roadmap as well as operating model and architecture principles, highlights some key success factors:
- Robust information and technology architecture is critical, with particular focus on standards-based interoperability, coherent design and strong governance
- Extensive staff and subject matter expert involvement is the proven way to ensure delivery of designs that are pragmatic, allow and facilitate local flexibility and innovation, and have the buy-in of practitioners across both front line care delivery staff as well as management and administration
The high level roadmap is anchored in the five priority focus areas outlined earlier. The current view of the high level roadmap represents an indicative, pragmatic but aggressive delivery vision, and will be refined in line with the evolving overall health reform programme and its timelines and priorities. The execution of the plan is in parts dependent on new legislation being passed. It is also subject to the appropriate funding to be made available in a structured and informed manner. A more detailed Business Case & Planning Phase is therefore required as a first priority, with close involvement from key stakeholders in the HSE, Department of Health and other critical parties to ensure creation of, and joint agreement on, a feasible, appropriately balanced, outcome-focused delivery programme.
The highlights of the current view of the roadmap include:
- The core of the programme will be delivered over the next five years, with the national rollout activities for electronic medical record and some of the clinical programmes expected to stretch beyond this
- There are some key enabling capabilities, particularly related to information integration, which are critical to support the benefits realisation from other areas
- While new strategic capabilities are being built over a period of time, an ongoing stream of more tactical enhancements is required to address the shorter term priorities within care delivery
- Transformation of the Knowledge & Information function itself is crucial to enabling the delivery of this programme. A significant capability and capacity uplift is necessary to create the ‘delivery engine’ that will power the programme in an effective, controlled and predictable manner, and support these new business capabilities efficiently in a live service environment once they have been deployed. This uplift can be achieved through a combination of additional internal resourcing, appropriate increased external sourcing, resource backfilling for short periods (especially clinical expertise) and cooperation across the system between implementation teams. A phased approach that first focuses on making the transition to new structures and then defining and executing against transformation plans for each function.
The creation of business cases and detailed planning will deliver a refined, more detailed view of the roadmap and the associated investment case for the overall programme. Based on international experience, it is expected that the total investment required for this programme will be significant, measured in hundreds of millions of euro. The magnitude of the required investment in Ireland is compounded by the chronic underinvestment during past years, illustrated by technology ICT spend as a portion of the total healthcare spend (approx. 0.85% in Ireland compared to EU norm of 2-3%, per annumi).