Irish Government HSE EHR Strategic Business Case

1. EHR Strategic Business Case
Briefing Deck V1.4
10/03/2016

2. Delivering eHealth Ireland | Office of the Chief Information Officer
What are the objectives of this briefing?
 Create understanding of the National EHR as a critical enabler of healthcare
reform – its rationale, scale, benefits, costs, dependencies and timeline
 Outline the proposed approach for progressing the programme and
requirements it will place on each area of the health service
 Gather feedback on work done to date and the strategic direction

3. Delivering eHealth Ireland | Office of the Chief Information Officer
What is the National Electronic Health Record?
Moving from paper records
locked in organisations to a
digital patient record shared
across care settings
4 Components
Examples:
• Order Communications /
Results Reporting
• Medicines Management
• Clinical Notesstems
Examples:
• Single MPI
• Scheduling
• Clinical Notes / Records
• Screening & Surveillance
National
Shared
Record
Community
Operational
Systems
Acute
Operational
Systems
Individual Health Identifier
The “glue” that binds all this together
and maintains integrity and security
across the system
eHealth Blueprint
National EHR Registries and Domains
Stakeholders
Clinical Management / Point of Care Environment
National EHR Integration and Access Layer
Communication
Layer
Core
Capabilities
I.A.A.A.
Layer
ProviderHealthPortal
National EHR Registries
Client Registry Provider Registry Location Registry
National EHR Domains
Medical Imaging Laboratory Results Pharmaceutical
History
Clinical Document
Repository
Encounter History
Message
Queuing
Message Data &
Transformation
Message
Encoding
Service
Management
Identity
Management
Authentication Access Secure Audit
Single Sign On Exception Handling Context Management Terminology Services
Record Locator
Services
Orchestration ETL Privacy
Certification and
Integration Toolkit
Secure
Messaging
Logging
Immunization
History
Infectious Disease
History
National Analytics
Performance
Management
Population Based
Analytics
Business Intelligence
Registration
National eHealth Blueprint
Healthcare Providers Patients Corporate Administrators and Managers
Legitimate Relationship
Services (LRS)
Corporate Setting
FinanceManagement
Procurement
HumanResourcesand
PayrollManagement
AssetManagement
Health&Safety
ContractManagement
FacilitiesManagement
RosteringTimeRecording
ProgramManagement
CustomerRelationship
Management
Consumer Health & Wellbeing
PatienttoProvider
SecureMessaging
Self-Health
Management
Schedulingand
Administration
NationalPatient
Portal
VirtualCare
Education&
Awareness
Community Healthcare Organisations
PatientAdministration
CaseManagement
ElectronicDocument
Management
ClinicalNotesandRecords
PatientTestResults
CarePathwaysandDecision
Support
ReferralManagement
MobileClinicalManagement
PopulationHealth
Management
ComputerizedPhysicianOrder
Entry
ePrescribing
Hospital Groups
HospitalPatient
Administration
HospitalMedicalImaging
HospitalLaboratory
HospitalPharmaceuticals
CaseManagement
DiseaseManagement
CarePathwaysandDecision
Support
ComputerizedPhysicianOrder
Entry
ReferralManagement
PopulationHealth
Management
ElectronicDocument
Management
ePrescribing
ElectronicClinicalNotesand
Records
The Individual Health Identifier
Programme is a key enabler that
allows information to be shared about
a patient

4. Delivering eHealth Ireland | Office of the Chief Information Officer
The ‘fourth utility’ in healthcare
International eHealth investment Estimates
• €15.8Bn England – NPfIT over 10yrs
• €1.6Bn Canada, Southwest Ontario – 2013-2017
• €25Bn – USA – HITECH Act / Meaningful Use
• €1.6Bn – Australia – predicted over 10yrs
• €5.4Bn – NHS – predicted in next 5 yrs
The history of technology as it enters industries is
that people say ‘this is going to transform
everything in 2 years’ And then you put it in and
nothing happens and people say ‘why didn’t it work
the way we expected it to?... . And then lo and
behold after a period of 10 years, it begins
working.
— Robert Wachter
UCSF
Technology has transformed hotel,
transport, retail, banking, communications
………healthcare?
More than 80%
of US providers
use an EHR
Ireland lags most developed countries but
can learn from the investments and
initiatives elsewhere The goals of Reform cannot be
delivered without a National EHR
Globally, there are
more than 400
EHR vendors on
the market
DENMARK
99% discharge
letters,
orders/results,
prescriptions are
electronic
FINLAND
100% health centres
with EHRs
NETHERLANDS
All prescriptions
electronic
US – VHA
$3.09Bn in
cumulative net
benefits
US – VHA
100% primary
care /
hospitals EHR
!

5. Delivering eHealth Ireland | Office of the Chief Information Officer
Public increasingly demand ‘digital first’ experience

6. Delivering eHealth Ireland | Office of the Chief Information Officer
The Irish Public Expect Digital Access and Services
eHealth Ireland conducted a 2 month public consultation on EHR
Source: eHealth Ireland EHR Public Consultation

7. Delivering eHealth Ireland | Office of the Chief Information Officer
Benefits are varied and context specific
Patient Experience
Patient Safety &
Care
More Efficient
Delivery of Health
Services
↓ 9.66% cost per patient (advanced EHR hospitals)
↓ 28% in transcription costs (Primary Care)
↓ 11% reduction in drug costs
↓ 32% reduction in Sepsis mortality (early intervention)
↓ 76% reduction in errors in discharge summaries
↓ 68% reduced likelihood of medication errors
↓ 7% reduction in inappropriate testing
↓ 37% reduction in preventable hospitalisations
↓ 20% reduction in LOS (Sepsis clinical pathway)
A variety of studies provide evidence of benefits in specific care
settings, disease groups, conditions, and care processes
100,000 yearly inpatient adverse
drug events could be avoided
through Computerised Physician
Order Entry and Clinical Decision
Support. This would in turn free up
700,000 bed-days yearly, an
opportunity for increasing throughput
and decreasing waiting times,
corresponding to a value of almost
€300 million.
— Gartner
eHealth for a
Healthier Europe
2009
!

8. Delivering eHealth Ireland | Office of the Chief Information Officer
Building engagement and direction
The eHealth
Strategy
identified the
EHR as a key
requirement
The Knowledge
and Information
Plan through
extensive
stakeholder
engagement
identified EHR
capabilities
The EHR
Vision and
Direction set
out the case for
change and
rationale for
introducing and
EHR received
ministerial
support
The HSE conducted
an intensive
engagement with the
global eHealth
industry. This
informed the HSE on
the feasibility of
creating a National
EHR and the
optimum approach for
Ireland
The publication of
the National EHR
Strategic Business
Case in Q1 2016
will set the direction
of travel and define
the overall delivery
programme
Dec 2013 Q4 2014 – Q1 2015 May 2015 August 2015 Q1 2016
Significant
ongoing public
engagement

9. Delivering eHealth Ireland | Office of the Chief Information Officer
We worked with stakeholders to define our approach
EHR Vision and Direction
National Integration
Workshop
Community Focused
Workshop
Acute Focused Workshop
KeyQuestionsAddressed
ateachworkshop
• Policy Drivers
• Strategies
• Issues
• Benefits
• Constraints
• Practicalities
• Funding Phase
• Current Suppliers
• Available Suppliers
• Supplier Models
• Procurement Approach
• Organisation
• Pathways
• Existing Systems
• Available Systems
• “Steeping Stones”
Priorities
What are HSE trying to
achieve? Why?
What trade-offs are they
prepared to make?
Plan
How long? How much?
And When?
Solution
Building Blocks
How to divide up the overall
solution into deliverable
chunks. What interim steps
might be needed.
Procurement /
Commercials
What commercial model is
preferred. How to drive
competition and value.

10. Delivering eHealth Ireland | Office of the Chief Information Officer
The National EHR Suite
National
Core
Solutions of
Record
Innovative Solutions
National Extended
Solutions
Key capabilities based on minimum viable
solution for all organisations from a single
vendor
Enhanced capability of core solutions are
extended from the core in first instance
unless there is a strong rationale for an
alternative
Emerging and innovative solutions from
the marketplace introduced in a controlled
manner
The implementation of a National Shared Record can progress
in single implementation but solutions for Hospital Groups and
CHOs must be phased given the scale and complexity
National Children’s
Hospital will have a
focused core based on
paediatric requirements.
!

11. Delivering eHealth Ireland | Office of the Chief Information Officer
Core Solutions of Record
COMMUNITY CORE
• Patient Administration System (PAS)
• Referral Management
• Population Health Management (Screening and
Surveillance)
• Mobile Clinical Management
• Test Results
• Clinical Notes and Record
ACUTE CORE
• Patient Administration System (PAS)
• Order Communications
• Medications Management (ePrescribing,
Medications Administration and Pharmacy)
• Clinical Notes and Records
Community
Operational
Systems
Acute
Operational
Systems
NATIONAL SHARED RECORD
• A national portal with key patient summary
care data drawn from the operational
solutions within the health service
• A longitudinal view of the patient’s care
• Access to specific elements of records for
different user groups
Existing Primary Care-GP Systems
National
Shared
Record
Community
Operational
Systems
Acute
Operational
Systems

12. Delivering eHealth Ireland | Office of the Chief Information Officer
Features of our approach
 Focused on digital services for the provision of care to the public, not tied to
organisations
 A phased and modular approach delivers benefits at each phase
 Detailed deployment planning will take into account the particular and/or
urgent needs of any specific area
 Differentiating between core and extended capabilities allows us to leverage
investments made to date including NIMIS, MEDLiS and MN-CMS
 Leverages the existing and pan-government infrastructure while recognising
need for additional investment
 Based on a ‘cloud first’ policy
 Supports innovation whilst maintaining the integrity and stability of the core
National EHR

13. Delivering eHealth Ireland | Office of the Chief Information Officer
Dependences, pre-requisites and risks
Pre-requisites
 Stakeholders Engaged (CCIOs,
HGs, CHOs, etc.)
 Privacy Impact Assessment(s)
 Strategic Business Case
 National Approach
 Building Baseline Data
Dependencies
 Reform Alignment
 Individual Health Identifier
 Resources – funding and
people (clinical, technical, etc.)
 Lighthouse Projects
 Readiness assessment
 Policy alignment
Risks
 Privacy Concerns
 Size and complexity of
Programme
 Resources
 Expectations
Key Success Factors

14. Delivering eHealth Ireland | Office of the Chief Information Officer
Indicative Costs and Resources – 5 Year Delivery Scenario

15. Delivering eHealth Ireland | Office of the Chief Information Officer
Indicative Costs and Resources – 9 Year Delivery Scenario

16. Delivering eHealth Ireland | Office of the Chief Information Officer
Implementation
There are key preparation activities that must be completed over the next 12
months including:
 Defining the requirements
 Confirming the readiness to proceed
 Securing funding and completing procurement activities
As per the outline schedule in the Strategic Business Case, delivery of
elements of the National EHR would commence in Q2 of 2017. The roll-out
across the CHO’s and HG’s would be as per the deployment strategies agreed
during the preparation phase. The National Children’s Hospital will be a priority
implementation within the roll-out plan.
Design Delivery
Preparation Implementation and Maturity
Readiness Procurement

17. Delivering eHealth Ireland | Office of the Chief Information Officer
June 2016 Jan 2017 June 2017 Jan 2018
Programme
Governanc
e
National Requirements
Business Cases
Procurement
Office
Portal & integration Requirements
Acute Requirements
Deployment
StrategiesCommunity
Requirements
Prepare to deployCHO Readiness Assessment
HG Readiness Assessment Prepare to deploy
Portal & Integration ImplementationPortal & Integration Procurement
Community Procurement Community Implementation
Acute Procurement
Acute Implementation
Privacy and Data Sharing
Strategic
Business
Case
Programme Management
Communications and Engagement
CHG Implementation
Decision point involving
agreement with party outside
HSE, e.g. DoH, DPER
Decision point involving
agreement with HSE
stakeholders such as Hospital
Groups or CHO’s
EHR Programme Roadmap 2016 - 2018

18. Delivering eHealth Ireland | Office of the Chief Information Officer
June 2016 Jan 2017 June 2017 Jan 2018
Business Cases
Implementation (Portal, Integration, Community, Acute)
Privacy and Data Sharing
Programme, Communications and Engagement Management
CHG Implementation
Requirements Definition
(National, Portal, Integration,
Community & Acute)
Stakeholder Readiness and Preparation
Procurement (Portal, Integration,
Community, Acute)
EHR Programme Roadmap 2016 - 2018

19. Delivering eHealth Ireland | Office of the Chief Information Officer
Path to a Single Solution Set
19

20. Delivering eHealth Ireland | Office of the Chief Information Officer
Proposed Programme Governance – HSE / SRG
 Clinical representation at EHR Programme Board level will be provided through a senior CCIO
representative, two clinical representatives for Acute and a clinical representative for Community
 In addition to the EHR Programme Board, clinical leadership and guidance will be a core
component to the constituent project boards operating under the EHR Programme Board
 eHealth Ireland has input to advisory groups - to include clinical, technical, information governance
EHR
Programme
Board
EHR
Programme
Team
EHR
Programme
Design Authority
Acute
Programme
Board
Acute Project #1
Project Board
Acute Project #2
Project Board
….
Community
Programme
Board
Community
Project #1
Project Board
Community
Project #2
Project Board
EHR Portal
Project Board
EHR Integration
Project Board
….
….
Project Teams
EHR Programme
Advisory Groups
(CCIO, eHI Committee)
SRG Leadership

21. Delivering eHealth Ireland | Office of the Chief Information Officer
What are the next steps?
The key next steps are:
 Gain agreement on this strategic direction
 Agree the governance relationship with SRG
 Mobilise the programme fully with active governance and stakeholder
engagement to gain broad support
 Develop national requirements and standards that underpin the National
EHR – resources will be required across the health system to help with the
definition
 Conduct readiness assessments in CHO’s and HG’s to identify and progress
any actions required to ensure everyone is on a firm footing for success
 Create outline and full business cases for each of the four elements in order
to secure funding
 Commence procurement activities

22. Appendix
Briefing Deck V1.4
10/03/2016

23. Delivering eHealth Ireland | Office of the Chief Information Officer
 The Vision and Direction for a National Electronic Health Record published in
August 2015 outlined the ambition and imperative to act strategically in the
delivery of a long term transformation in the delivery of care.
 The delivery of reform is fundamentally dependent on a transformation in
how we use technology – we can not deliver on Clinical, Structural and
Financial reforms in the absence of a National EHR.
 The National EHR programme is envisaged as a 15 year journey to move
from a position where Ireland is at a low level of technology adoption and
maturity to one where it compares favourably with other developed countries.
 Delivering on such an ambitious programme of work presents significant
challenges to the HSE and a significant emphasis on the preparatory work
has been focused on how to deliver this in a way that delivers discrete
benefits in a phased manner, minimises risk, and recognises the constraints
across the Irish health system
 The Strategic Business Case provides more detail on this journey including,
the target end stage, the benefits that will be delivered, the approach to
delivery, and the outline costs
Context

24. Delivering eHealth Ireland | Office of the Chief Information Officer
What is the National EHR Solution Strategy?
 Progress with four distinct elements
• National Shared Record – delivered via a portal
• Community EHR Operational Systems – to provide the core functions
necessary to deliver modern community services
• Acute EHR Operational Systems – to provide the core functions necessary
to deliver modern acute services
• Integration Platform – to securely share information between all the
systems, maintain integrity of information and integrate across care settings
 The National Shared Record, Community System and Integration Platform are
new elements on the eHealth landscape. There will only be one national
version for the core components of each solution
 There are some existing EHR capabilities in the acute setting. The strategy
aims to evolve to a situation over several years to a point where there is only
one solution for the core EHR components
 All four elements need to be underpinned by national requirements and
standards to ensure that they achieve the ambition of the National EHR

25. Delivering eHealth Ireland | Office of the Chief Information Officer
What is the National Electronic Health Record?
The National EHR
comprises:
What does the National EHR do?
• Transforms patient experience
• Delivers greater patient safety and more
effective care
• Drives efficient delivery of health services
• Makes the wider reform programme
possible:
- Underpins integrated care
- Provides the information for
proactive health and wellbeing
initiatives
- Provides the operational systems to
realise CHO’s and Hospital Groups
- Captures accurate information on
activities that show the true cost of
treating a patient
!
The National EHR is a fundamental cornerstone for the delivery of high quality,
comprehensive and accurate information in a timely manner for the provision of
patient centred, effective and efficient care

26. Delivering eHealth Ireland | Office of the Chief Information Officer
Indicative Costs and Resources – 5 Year Delivery Scenario
Costs Include:
• VAT at 23%
• National Programme Management including Requirements Definition, Business Case and Procurement activities
• Programme Management for each pillar
• Deploying the core Community and Acute Capabilities
Not Included in Costs:
• Infrastructure upgrades (network, PCs and mobile devices for e.g. Community Nurses)
• Cost of additional non core capability deployment
Key Assumptions:
• Costs based on a Community roll-out over 5 years and an Acute roll-out over 5 years
• Estimates based on supplier market intelligence and experience from other jurisdictions

27. Delivering eHealth Ireland | Office of the Chief Information Officer
Indicative Delivery Timeframe – 5 Year Delivery Scenario
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Acute HG 1 - CHG
CHO 1
CHO 2
CHO 3
CHO 4
CHO 5
CHO 6
CHO 7
CHO 8
CHO 9
National Shared Record (Portal)
Integration
Acute HG 2
Acute HG 3
Acute HG 7
Acute HG 4
Acute HG 5
Acute HG 6
Indicative Delivery Timeframe – 5 Year Delivery Scenario

28. Delivering eHealth Ireland | Office of the Chief Information Officer
Indicative Costs – 5 Year Delivery Scenario Cost Profile Per
Annum
0
20
40
60
80
100
120
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Indicative Cost Profile 2016 – 2026
5 Year Deployment Scenario
Programme Cost Operational Cost Total Cost
Cost
Element
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Programme
Cost (€M)
6-8 42-56 86-116 68-92 64-86 54-74 22-30 1 1 1 1
Operational
Cost
(€M)
0 1 11-15 21-29 24-32 37-51 41-55 42-56 42-56 42-56 42-56
Total (€M) 6-8 43-57 97-131 89-121 88-118 91-125 63-85 43-57 43-57 43-57 43-57

29. Delivering eHealth Ireland | Office of the Chief Information Officer
Indicative Resources – 5 Year Delivery Scenario
0
50
100
150
200
250
300
350
400
450
500
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
EHR Programme Resource Usage 2016 - 2026
Portal Integration Community Acute

30. Delivering eHealth Ireland | Office of the Chief Information Officer
Indicative Costs and Resources – 9 Year Delivery Scenario
Costs Include:
• VAT at 23%
• National Programme Management including Requirements Definition, Business Case and Procurement activities
• Programme Management for each pillar
• Deploying the core Community and Acute Capabilities
Not Included in Costs:
• Infrastructure upgrades (network, PCs and mobile devices for e.g. Community Nurses)
• Cost of additional non core capability deployment
Key Assumptions:
• Costs based on a Community roll-out over 5 years and an Acute roll-out over 5 years
• Estimates based on supplier market intelligence and experience from other jurisdictions

31. Delivering eHealth Ireland | Office of the Chief Information Officer
Indicative Delivery Timeframe – 9 Year Delivery Scenario
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Acute HG 1 - CHG
CHO 1
CHO 2
CHO 3
CHO 4
CHO 5
CHO 6
CHO 7
CHO 8
CHO 9
National Shared Record (Portal)
Integration
Acute HG 2
Acute HG 3
Acute HG 4
Acute HG 5
Acute HG 6
Acute HG 7
Indicative Delivery Timeframe – 9 Year Delivery Scenario

32. Delivering eHealth Ireland | Office of the Chief Information Officer
Indicative Costs – 9 Year Delivery Scenario Cost Profile Per
Annum
Cost
Element
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Capital Cost
(€M)
6-8 28-38 67-91 60-82 44-60 49-67 37-49 28-38 26-36 7-9 1
Revenue
Cost
(€M)
0 1 5-7 17-23 20-28 26-35 31-43 32-44 40-54 41-55 42-56
Total (€M) 6-8 29-39 72-98 77-105 64-88 75-102 68-92 60-82 66-90 48-64 43-57
0
10
20
30
40
50
60
70
80
90
100
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Indicative Cost Profile 2016 – 2026
9 Year Deployment Scenario
Programme Cost Operational Cost Total Cost

33. Delivering eHealth Ireland | Office of the Chief Information Officer
Indicative Resources – 9 Year Delivery Scenario
0
50
100
150
200
250
300
350
400
450
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
EHR Programme Resource Usage 2016 - 2026
Portal Integration Community Acute