“We’re going to be what we call ‘born digital’. It’s easier to be born digital than trying to make some of the changes that are happening within the existing system.”
So says chief executive of Children’s Health Ireland Eilísh Hardiman. She is optimistic about the plans for the new children’s hospital, which is located next to St James’s Hospital in Dublin.
At the end of 2024 or early 2025, the new building is set to open its doors, bringing to an end years of construction and kicking off what is hoped will be a new era in children’s healthcare in Ireland. A key part of that will be digital technology, with everything from patient records to the systems controlling the hospital building being digitised.
This would represent a step-change for the health system in Ireland. Just last week The Irish Times reported that TDs are to quiz senior Department of Health officials over delays in introducing an electronic record for all patients after hearing the long-planned project was “only at the starting line”. HSE interim chief information officer Fran Thompson estimated that it would take five to seven years to introduce a national electronic patient record.
The new children’s hospital has had a rocky start, beset by controversies. There was the initial row over the siting of the hospital, with opponents to the St James’s Hospital co-location feeling access to the hospital would be made more difficult due to its proximity to the city centre – and the accompanying traffic.
Then there was the soaring costs, with the project ballooning from the initial €650 million budget to at least €1.7 billion, and the delays. The hospital was originally due to be completed in 2020 following the 2016 planning permission approval. Covid-19 helped pushed that timeline out further.
But while much of the focus has been on the bricks and mortar building, it is set to be a showcase for how Ireland’s health system could work. The national children’s hospital will be the first digital hospital that the country has implemented, and if the promises are realised it could help boost the provision of children’s healthcare in Ireland.
Hardiman describes it as a potential 10-year plan to transform the delivery of public health services for children in Ireland. That means targeting better outcomes and better experiences for parents, the children and staff who work there. “It’s not just about a building,” she says. “Digital is a key enabler to do that.”
While some hospitals and healthcare providers have elements of what the digital hospital will offer, this is the first time that it will be attempted to offer a fully digital hospital. That means everything from the digital healthcare record, provided by Epic, to the building itself, a state-of-the-art hospital where rooms can be digitally monitored. Each room in the hospital is a single room, with an en suite, and space for a parent to stay. And each of those rooms will be digitally monitored, including the air quality and temperature.
“It’s a hospital without walls. It’s all about information-sharing,” says Markus Hesseling, the chief medical information officer for Children’s Health Ireland.
Dr Hesseling is a consultant paediatrician by training, a role he worked in for more than 20 years. But in recent years he has taken his experience of working in hospitals and used it to help advance the role of technology in healthcare. He has overseen the successful implementation of the Epic digital healthcare record system in other healthcare settings, and has seen first-hand the benefits of digital hospitals.
“It’s all about maximising the data that we’re gathering and sharing that, and I include parents and families in that, to make sure that the best and safest care can be provided,” he says. “People talk a lot about patient-centred care but that’s what’s at the heart of it for me: in order to make a safe decision you have to have all the information possible available to you.”
Having all that information to hand has been more difficult under the current system, which is fragmented. Paper records could be held in different places, and are easier to misplace or misfile. They are also limited in how many people can access them at once.
Digital records, on the other hand, can be available to numerous health professionals, as needed, whether it is a physio in the community, a nurse on the ward or a doctor in a clinic.
The shift makes even more sense when put in the context of the hospital’s younger demographic. “We’re dealing with children who are very techno-savvy and their parents are of a generation that are also tech-savvy. So access to the records is part of the better parent experience for parents, but also for kids,” said Hardiman.
Children with chronic conditions such as cystic fibrosis or haemophilia could potentially use a range of devices to help manage their healthcare, and have that data available to their doctors.
There has already been some progress in this area. An app helps patients with haemophilia get medical advice on the appropriate steps to take should they have a bump or cut themselves. Before that would have required emergency care, but the app allows patients to treat the injury at home. Empowering patients is one thing that is often repeated when the new digital children’s hospital is raised.
Covid has helped to advance the case for tech In the medical industry, facilitating a new way of delivering healthcare under extreme circumstances. While not everything has stuck – and for good reason – there are some measures that were put in place during Covid that have helped patients. Digital prescriptions, for example, were not widespread before the pandemic; now many healthcare providers will use them routinely.
The digital plan itself hasn’t been without its issues. Concerns were raised after it emerged that security cameras being installed at the hospital could use facial-recognition technology, although Hardiman said at the time no decision to use the controversial technology had been made, and that remains the case.
But a legitimate areas of concern with digital systems is security. With the May 2021 HSE hack and the subsequent disruption to services still fresh in the mind of the public, the thoughts of a completely digital hospital may cause some to worry about the wisdom of adopting a “digital-first” system. For weeks, patients records were unavailable, clinics and appointments were cancelled, as the HSE struggled to regain control of files. And that was before the data was published on the dark web, putting people at risk from fraudsters seeking to exploit it.
But Hardiman says one of the key things about the digital hospital is the key strides it has made in cybersecurity. It also takes into account that paper records may still come in with patients. In the basement of the hospital the company will be able to convert paper to electronic records management. And should the worst happen, the ability to revert to paper records is there.
“I think one thing that is absolutely certain with technology is it will go wrong at some point. I’ve done this long enough now to no longer be under the illusion that it’s the panacea to all things; it will go wrong, it will fail at some point,” says Dr Hesseling. “But with Epic, the package comes with a backup so that every ward will be equipped with one terminal where even when the power is cut and everything else goes down, it will provide you with a copy of the latest, until that moment, record. There also will be a box somewhere where you have to go back to paper. That’s the beauty of paper. Paper is a very, very safe option. That’s why it’s done so well for such a long time because people are so used to it, people know it’s reliable. People appreciate you have to have a plan B when it goes wrong.”
Ultimately, the digital hospital means that it shouldn’t matter where you take your child to be treated – the doctors will have access to their medical records. And if you are unfortunate enough to require treatment abroad, the patient portal would allow you to share the relevant medical data with doctors outside Ireland.
But we may be a long way off that utopia. For that system to truly work effectively it will require everyone to be on board, and with so many institutions still to adopt digital systems that can talk to each other that scenario won’t arrive in the next couple of years.
Yet Dr Hesseling is optimistic that once the new children’s hospital is a success, the others will follow. “There’s no doubt in my mind that if we show this working it would be very difficult for the politicians not to support others to go the same way,” he says.
