Sir, – Prof Orla Hardiman ("Health reform requires data-driven approach", Opinion & Analysis, August 7th) touches on many issues but primarily advocates an Irish national institute for health research, mirrored on that developed in England in 2006.
While endorsing the importance of data collection and its interrogation, we think it is fair to report that this exercise has already begun in this country not just through the National Cancer Strategy but also through the National Clinical Programmes, which are partnerships between the training bodies (for example, the Royal College of Surgeons and the Royal College of Physicians) and the HSE.
In addition, a National Office of Clinical Audit (noca.ie) has been established which is growing but is, at present, limited to collecting data in such areas as major trauma, hip fractures and intensive care units.
There are also other datasets mostly built on national HIPE (Hospital Inpatient Enquiry) data such as those of the National Quality Assurance Intelligence System (NQAIS), which is a suite of quality assurance applications both in operation and under development by the HSE and National Clinical Programmes. The NQAIS for surgery can already display activity on certain surgical performance and outcome measures for hospitals, specialty groups and individual surgeons, providing information as recently as three months previously.
While all this is perhaps overly hospital-centred, it is nevertheless moving in a positive direction.
There are two kinds of data. The first, emphasised by Prof Hardiman, is clinical data based on clinical outcomes to inform improvements in patient care (clinical research); the second concerns what is required to better inform administrative management and clinical services about patient processes and flow and which is required both at national and local level on a day-to-day basis for health service improvement). Both are important and inform the system as to how to provide better care for the patient.
The forthcoming Health Information Bill will, in this context, be important as it seeks to ensure an acceptable balance between the legitimate requirements and protection of healthcare providers to create and share personal health information for the care and treatment of patients and the rights of individuals to control the use of their information.
Managing and reporting of medical data can be complex and requires a greater understanding of the issues involved so that the information can be put to best effect.
There are good systems out there at present, and this is why Prof Hardiman’s article is so timely because these developments are functionally separate at present.
They badly need to be brought together under one roof either as a national institute for health research or, as we would prefer, a national institute for health information. This would in turn be multifunctional, informing practice, health strategy, clinical practice and guidelines and much else besides.
This should be well resourced and set up under a sound, independent governance structure so that decisions could then be reached based on solid information rather than on political and other vested interests whose ambitions very often do not act in the best interests of our patient population as a whole.
The dividends could be very great. – Yours, etc,
Mr KEN MEALY,
Prof FRANK KEANE,
National Clinical
Programme in Surgery,
St Stephen’s Green,
Dublin 2.