Planning the Future of Ireland’s Healthcare

Sir,

I note your recent series of editorials on healthcare planning and the importance and difficulties of measuring outcomes. You warned us in May that “if a healthcare service is unplanned, it cannot hope or expect to advance and improve,” and that “the only way that hospitals can improve the healthcare value for patients is to measure outcomes.” In June, you convinced us of the benefits of measuring quality in healthcare systems, but warned that finding reliable measures remains a challenge and that there has been an absence of hard data.

Coded information gleaned from the medical record, while attractive for the purposes outlined above, vastly underestimates comorbidity and is notoriously unreliable,1 relying heavily on good documentation in patients’ notes, often by the most junior of the medical team. However, we have known for some time that the accuracy of the coded data improves when clinicians themselves, rather than professional coders, are responsible for recording patients’ diagnoses.2 An opportunity to improve data collection will present itself shortly, in form of the electronic healthcare record (EHR). EHRs will facilitate sharing of patient information, such as previous diagnoses and medication lists, between acute and community care, and between healthcare professionals and their patient. Once implemented widely, EHRs will be a rich source of data to help us “advance and improve” the Irish health service. Apart from the comprehensive national data that will result from full deployment of the EHR, patient care should immediately profit. The accuracy of medication lists generated by GPs on referring patients to the Emergency Department has been recently shown to increase markedly by populating lists electronically, when compared with those that are handwritten.3 If a patient has an easily-accessible EHR, both primary and secondary care clinicians will have access to the same list, making such comparisons redundant.

In spite of the obvious benefits of such a system, uptake from consumers is slow for an ‘opt-in’ system. In Australia, two years after the launch of the Personally Controlled Electronic Health Record, less than 10% of the population had registered.4 I would be concerned that the uptake in Ireland will be similarly sluggish; however, the greater the penetration, the greater the benefit.

The Individual Health Identifier, a cornerstone of any eHealth system, has begun its rollout. Implementation of the EHR will follow. Marketing and encouraging use of the EHR will be crucial to its success. Given the benefits for clinical practice, healthcare planning, quality improvement and clinical governance, we need to ensure the EHR is adopted by the majority, both for the sake of our patients’ immediate care and for a relevant, strategic future for Irish health.

T Gilbert

Royal Adelaide Hospital, Adelaide, SA 5000, Australia

Email: toby.gilbert@sa.gov.au

References

  1. MacIntyre CR, Ackland MJ, Chandraraj EJ, Pilla JE. Accuracy of ICD-9-CM codes in hospital morbidity data, Victoria: implications for public health research. Aust N Z J Public Health. 1997;21:477-82
  2. Yeoh C, Davies H. Clinical coding: completeness and accuracy when doctors take it on. BMJ. 1993;306:972
  3. McCullagh M, O’Kelly P, Gilligan P. Referral letters to the emergency department: is the medication list accurate? Ir Med J. 2015;108:38-40
  4. Hambleton S. NEHTA Annual report 2013/14. Sydney; Oct 2014. 59 p.

http://www.nehta.gov.au/component/docman/doc_download/1849-nehta-annual-report-2013-14?Itemid=

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