Martin Daly urges digitalisation and warns on data protection

I have to ask your forgiveness. I do get animated about this because I just see the benefits of digitalisation. I've seen the benefits in general practice, which was largely funded by general practitioners. I also want to reflect on some of the really good developments that happened within the general practice family, which was, with the help of the HSE and the department, which was getting lab results electronically, which was the development of e-prescribing during COVID. And I remember there was one particular issue around data protection because, as Mr Tierney knows, I've had this discussion with him before, we're reliant in the GP community on one provider for 95%, and I'm going to come back to that in a second. But there was a patch produced within 48 hours to make sure that the data was protected. It was about the protection of privacy of prescription data, and it wasn't going to be available to third-party commercial firms. who were obviously quite interested in it, which is interesting in itself. They probably put their hands up and said they weren't, but yes, we know they were. But anyway, so I want to just reflect on that and also getting the radiology results down on that. And I suppose, you know, I'm not particularly computer literate. I've been dragged screaming into the electronic world of banking because you can't bank without being electronically connected. Revenue, a whole range of different things. Booking a holiday, hiring a car. You know, we just can't. So we really need to bring it. And I suppose in one respect, coming to the game late, and this is why I was really interested in what you were saying about the learnings from other systems. We have the opportunity. We have the opportunity to do something really great here. You know, because we have the expertise in this country, and we have the opportunity to do something great. I suppose a couple of things, and Mr. Tierney, I was delighted when you said, because I've written down a couple of times here, perfection is the enemy of progress. And I think sometimes we've gotten into situations where we've ended up navel-gazing and postulating and producing reports, always looking for the perfect system. I think what we've realized is that in the electronic world, there is no perfect system. There is an evolution of development, and we just have to dive in and do that. Obviously, with the safety nets, I suppose some of the things that I just wanted to sort of come back to were I was reassured by, Mr. Tierney, what you were saying about interoperability, because I think that's a big thing that concerns a lot of clinicians, but also members of the public, that the idea that there would be different software systems for different hospitals, and I'm not going to ask you about that in particular, because that is probably commercially sensitive when we're dealing with a national product. But I am reassured that it is an issue that you and the HSE are considering, because we now have the maternity, and I'm going to come back to that in a second, we have the maternity system going. I'm hoping that there aren't different systems. I did make the point that in my information would suggest there's going to be a different system between Children's Hospital and St. James'. I don't, you know, that the maternity one is different than that, and I think we need reassurance that there's interoperability. I think that that's for patient safety, but also too, just in terms of exposure for litigation and all the rest of it. The data piece is important as well, and I think Senator Nicole Ryan made a really good point about the protection of data, that it is not used surreptitiously for commercial gain. By the way, she's absolutely right to be concerned about it, because in the NHS there was a big, big war over this. The NHS were looking to commercially use data that had been collected from patients in the NHS and sell it to third-party companies, and I really think that is something I would be utterly opposed to. And then the, yeah, and back to the GP, like, I'm not going to name the company, but the GP community is dependent on, and the system is dependent on one particular company, and if it fails for any reason, then we are in a really big mess, because, as you know, the volume of work that happens in that setting is massive, and I just would like to, you know, this again is, is there any consideration given to the idea of the HSC department owning the GP software space? There would be value, I think, for general practitioners, but it would be value to the state and the health service. And I don't think it would cost that much in the overall envelope of what you're going to have to invest. I suppose I might start with Mr Tierney and see, these are only reflections now. That's fine, Deputy. First, I'd like to acknowledge Nile Sinit, who's here with us today, so Nile would have been elbows deep in trying to make things happen during COVID, and particularly around getting access to lab results and e-prescribing and putting them into an electronic format. So I just want to acknowledge Nile's work on that. Look, even the European Union has recognised that interoperability between EHR systems now is a must-have, and they're going to be regulating in that space. So I don't think that's a choice anymore. That's going to become option. And I think we would be wise within our procurement strategy to definitely anticipate that and go after it. In our current landscape, we already have EHRs, whether it's in forensic, national rehab, children's and maternity. But in time, our challenge is to make sure that they're interoperable in terms of daily share, and that's on our agenda. On the data piece, look, we have GDPR as a legislative provision to protect and to safeguard and provide privacy in the context of personal data and how it's used, and we live by that every day. And the Health Information Bill, while it reinforces the need to share data, it also has to live in that context. So that protection is provided for, and I take the comment on the NHS's, I suppose, considerations around commercialising data. That is not on our agenda, and I fully take the comments behind that. In terms of the reliance on GP vendors, look, the state puts a lot of support into GPs, into GP practice systems, and of course we recognise that that is a consideration. That's a fact today, and that's something that we're going to have to work our way through in the future. So I don't have any definitive anything to say on that. Maybe Damien and Fran can reflect on it. They're closer to it, so that's fine. Thank you. Yeah, I wouldn't add a huge amount. I mean, what I'd say, it is something we're conscious of. So, I mean, the main thing is that the GP, pharmacy, primary care contractors, dentists, and so on, ophthalmologists can connect into the system and out, and the shared care record is one aspect of that, but also, as you mentioned, the ability to exchange information through something like HealthLink today, but obviously we'll have to grow that even further. It'll become more important. I think we are looking at how do we make sure that from a GP perspective that works well, because they're effectively 95% of the access into the system. That's where most patients go. The shared care record, I do think, will be a lot of the glue in that when we get more information into that. And so the Waterford-Wexford go live just in the last week means, take the chair's question, like, if I went to Waterford today and I did keel over, they would have access to certain information about me, the medications I'm on, any discharge letters from hospital procedures I've had, and that which they wouldn't have, you know, yesterday since that went live. So those things will help and will grow. But it is something we're conscious of in terms of our strategy around, not just in the GP world, but in other parts of the system as well. I mentioned our imaging earlier, our laboratories and other parts, because it won't just be one system. And even CHI, where they will have one electronic health record, will still have several hundred other systems to do all sorts of things, from their catering, their security, you know, there'll be all sorts of other systems that you have to have there as well. Mr Tierney, just come back in. One more point, just to round out the question. So, look, a patient shouldn't have to be worried about who a vendor is, ultimately, within our supply chain. That's not the patient's concern. And what we're trying to do within the health information bill, no matter where you are receiving care, your health care provider and or their vendors provide data to support that care. So that's the primary provision we're going after in the health information bill, because why should a patient have to start worrying about the knots I get into with my vendors? I've got to figure that out. But the purpose of the bill is to give comfort and assurance to a patient that their patient information travels with them on their care journey, ultimately. I know the Deputy used a non-negal allergy earlier, and I'm taking it in terms of where it's there. I'd remind him, I think it's Wrexham with some investment have moved up into nearly the top division in recent years, so we'll hope to mirror that, just we'll use that as an allergy. That's a fair rebuttal. It's not a rebuttal, that's just where we're at. But I do take the point. I do take the point. It's a fair observation. It's all right. For a good one night.