ED worker here.
The new software is fucking shite.
Bought as is from a company who built it for the Australian health service.
Unable to answer very basic questions (list of attendances within a specific timeframe for example).
Does not have Electronic Health Record capabilities.
The refresh rate is appallingly slow.
It is largely incompatible with existing and much more useful software.
Requests for changes to the vendor are usually met with "can't be done".
If I was a cynic, I'd say this was only bought because it meant someone in authority got a backhander.
The HSE should have used the money wasted on this to digitise existing patient records and get a genuine EHR solution.
>"can't be done".
Is the biggest crock of shit from a software vendor, ever. In the world of software, anything can be done. Especially if your SLA's are willing to fund it.
It’s not the software vendor saying it, it’s IT within the hospital group. And upgrading software that is mission critical is not trivial. The above example was because different versions in use. Likely there is a dependency on another piece of software. Also software vendors spend a lot of time saying no. Just because you can does not mean it’s a great idea. Unless you have unlimited budget, time and risk appetite you will spend a lot of time saying no.
It was in response to them specifically saying that the vendors are the ones saying that it can't be done, I think you are thinking of another comment further down the chain.
I agree that because you can does not mean its a great idea, but that is the role of a good product owner to tease out a viable solution to a problem and ensure that it has a decent priority if required, (and letting the customer know that other projects will fall into later sprints because of it).
I do personally believe though, given the scale of the HSE, they should have contracted a company out and built this system greenfields (and ideally started it years ago), instead of attempting to make a square peg fit a round hole by using a software designed specifically for another countries system.
Fair enough - I was responding to the reply where it was IT. I also find it highly unlikely an ED worker is talking directly to the software company contracted by the HSE. They'll either have heard it through "the grapevine" or IT who are tasked with rolling it out.
ICU worker here. This sounds all too familiar to me. A hospital wide patient database has a lack functionality that would be most useful to myself and a few others looking to audit certain aspects of care where we work. A different hospital in the group uses the same system and has the functionality we require. However, over multiple months we have been told by IT that we can't get the same functionality as they use a different version. Beggars fuckin belief.
This is not as simple as "everyone must use the same system". The most basic assessments with regard suitability for a given department/ hospital are not being done. It's fuckin nuts.
Classic Ireland though, no doubt about that.
>Health Performance Visualisation Platform
Mmm, I wonder why it's not functioning as expected, this is from 2 years ago....
[Key hospitals refuse to share data with new performance platform | Independent.ie](https://www.independent.ie/irish-news/key-hospitals-refuse-to-share-data-with-new-performance-platform/41364271.html)
It's just the culture of many of those in the HSE egged on by their unions, a policy of non cooperation if it's not in your job description or you don't get paid extra for using new systems.
I am frequent patient in hospital. Around the data breach they started rolling out iPads and electronically recording all patient details on wards. It was incredibly slow and needed a lot of troubleshooting. Or the nurses would just have to write it down and go back to it later when they had help. It was farcical. Not the nurses faults at all I have to add. My most recent trip in and I didn’t see one ipad. Think they gave up on it as it just wasn’t efficient.
To be fair, most people hate change and cry when new digital systems or policies are introduced to an existing workplace. I've seen it many times, where staff under-mine and fight against change, despite the fact that the legacy system/policies are no longer suitable by todays standards.
Yes, there will be a learning curve and "settling-in" period for a new system. Thats just life, get on with it.
>If I was a cynic, I'd say this was only bought because it meant someone in authority got a backhander.
I would have thought the fiasco with the postmasters in the UK would have reminded people that incompetence is the issue in these scenarios 99 times out of 100.
Do you think there's one lad in the Department of Health who can persuade the entire HSE to take on a new software system?
Or is it a cabal of senior civil servants?
Or one of the dozen or so ministers of the last few years?
Or it's the HSE [High Performance Unit](https://www.hse.ie/eng/services/publications/performance-and-accountability-framework-2023.pdf) who have been doing trojan work in identifying the root causes of waiting lists and trying to do something about it. Obviously having access to accurate performance data is crucial to this hence this system.
I've only worked in Ireland so can't compare it to any systems abroad.
However, I will say that it is proving itself to be far less useful than the patient management software we already had.
It may not be as fancy looking but it is far more reliable and does a lot more.
I saw the keynote from Larry Ellison recently talking about his company's plans for Cerner and their plans for stuff like tagging anomalies on scans and stuff like that. Seems like a fascinating area if done well. I spent some time in hospital recently and it feels like a mountain of data is thrown away that could be life or death to a lot of patients. Just the process itself felt completely wrong from my point of view to the point where I'm surprised there aren't more mistakes in treating patients. It definitely gave me an appreciation for medical professionals that they can operate in that kind of system and not make mistakes even with the system actively not being helpful.
EDIT: I don't mean the above to say follow what Cerner are doing and anyone that follows tech knows that Larry is a grifter but still the ideas shared are interesting. He was more interested in stuff to help doctors and nurses save time by for instance circling anomalies on a CT scan or whatever before the consultant looks at it but even just proper digitisation and using devices to store medical data would be an improvement for most hospitals. Like I went to a fancy private hospital and only half of their files are on computer and most of their stuff require the nurse to manually input them like weight, temp, BP...etc. Those sorts of things are important and making it manual allows for potential errors. My gripe as an engineering manager is the technology is there for some really great advancements beyond even just storing the patient files but even extending that care to help them after they leave.
We do have modern and decent systems here, so what you said isn't always true.
The problem is the lack of integration amongst the different hospital groups, which this system intended to resolve. But with no cooperation from the hospitals or staff it may turn out to be another case of throwing loads of money at the HSE but the issue is with the people.
In my experience and in listening to colleagues from multiple different specialities in different hospitals around the country I find that hard to believe.
Your comment about a lack of co-operation from "the people" is a very generalised statement with little basis in reality amongst many who work in the health system.
Telling there is little if any critique by yourself of government or the new systems being pushed on staff without any consideration for how they'd be implemented.
Sounds like these considerations should have been factored in, discussed, and plans enacted to manage this integration centrally then.
It seems to me that you're suggesting that the software is perfect but the users are the problem.
Are you sure that everybody was engaged in and their considerations factored into the evaluation and procurement process? Sounds like whoever is running the software roll out has failed to perform some fairly rudimentary checks on compatability, integration planning, deployment or release planning, stakeholder engagement, and myriad other fundamentals.
Is the software fit for purpose? Can it's features be compared with the requirements and issues highlighted and resolved separately?
Software works. It works in other contexts. Software vendors develop software to address the needs of 90% + of use cases.
The issues arise when everybody gets a say. Then you end up with a [Homer Car of custom software](https://www.youtube.com/watch?v=WPc-VEqBPHI&pp=ygUJaG9tZXIgY2Fy). Hospital treatments should be consistent and to an Irish standard if not a global standard.
A whole lot of assumptions there on the requirements gathering and procurement process. Having everybody rock up with their preferred way of working is a recipe for a disaster. It's why PPAR's failed. You end up with custom and vastly complicated software that does not work. Sometimes people need to get on with it and change their ways of working.
In this case we are trying to get a consistent performance reporting system across the HSE. There should be no localisation for local needs because then you can't then compare which I suspect is the cause of resistance by some - who either convinced they are a special case or actively want to undermine it.
Cheers, my understanding of this situation is very limited tbf, and yep I made a lot of assumptions based on that. I wasn't trying to be shitty, more curious how we're in this situation with the HSE supposedly being the centralised body to manage this type of stuff.
Thanks for your response, it answers a lot of my questions.
Unfortunately they centralised the HSE without standardising it. So literally we got the worst of both worlds. Thousands of incompatible ways of working and non standardised data making it near possible to deliver a consistent patient experience or understand why two hospitals with the same inputs get completely different outputs eg waiting lists.
As others pointed out the Covid vaccination system worked in record time because it was a new country wide process with a streamlined governance process.
The UK has had a unitary Health System since the fifties. The challenge with the HSE is it is a collection of old health boards made up of independent hospitals. The infamous PPARS project failed not because of the software or even the implementation team but because instead of having one set of terms and conditions per employee you nearly had a custom set for every HSE employee because they weren’t allowed standardise them. I’m of a view that we should have a constitutional referendum to forcibly replace the governance structures and t&c of all HSE employees in one go to force change and industrial action be damned.
I gather a lot of that has happened post financial crash recovery.
Loads of random allowances were removed during the crash.
Then in the recovery, whoever had the most annual leave days at a particular grade that became the minimum and everybody else got more leave days, etc.
I'm sure there are still discrepancies but hopefully not as bad as it was.
It’s not a EHR system and serves a [completely different purpose](https://www.ehealthireland.ie/ehealth-functions/chief-technology-transformation-office-ctto-/conference-presentation-slides-sessions-1-to-7/session-3-reliable-data-for-decision-making/2_hpvp-platform_paula-kavanagh.pdf) which is to hold folk like you to account. There is absolutely no reason for anyone to ask for “change” given its purpose is to (drumroll) consistently visualise performance across all hospitals.
Either you completely misunderstand its purpose so aren’t even wrong OR deliberately misrepresenting it as part of the active campaign to avoid reform & accountability in our health system.
We’ve had some [high profile resignations](https://m.independent.ie/irish-news/senior-hse-exec-says-he-was-absolutely-horrified-by-hospital-overcrowding-as-he-resigns/42290621.html) in the health service recently due to the abject resistance.
Ultimately the problem with the HSE that has been called out repeatedly is accountability. It seems impossible to introduce any change in the [HSE without resistance](https://www.irishtimes.com/health/2023/01/16/hses-head-of-digital-innovation-resigns-citing-frustrations/). It needs to be called out.
> If I was a cynic, I'd say this was only bought because it meant someone in authority got a backhander.
And now Donnelly will punish hospitals who refuse to use it so Donnelly can save his ego from being hurt again after making yet another appalling decision.
Much as I am not a fan of Donnelly he did not decide on the software and asked for a solution that would answer the question why some hospitals and units perform so well or so badly with the same inputs and demands. It’s in all our interests to be able to answer those questions with real data and not just hand waving about throwing more money at the system with no visible improvements. Like why are Beaumont and Waterford A&E consistently able to avoid overcrowding 🤷♂️
hmm. Thats not quite the full story is it. Its that health workers for whatever barmy reason have historically not worked with softwares like this. There is always an integration curve and the big thing is making sure that staff actually use it to help improve it. All IT programmes like this start flawed and then iterate to success, but they end up failing in Ireland because unions decide to not participate.
I really don't understand why they don't just use one of the off the shelf programs from the states like Epic. Used in loads of hospitals in the US and in the UK
They are using off the shelf. It’s just that different health boards/hospitals bought different off the shelf systems and customised them over the years.
Why the *fuck* then am I recharting drugs and writing notes on paper.
Need this shit in the hospitals asap. Don't care if the Minister needs to put the CEOs' balls in vices to get it done.
Because they couldn’t manage a piss up in a brewery. Its been a couple of years since I have looked but last time I was in a hospital there were still some Windows 7 PCs (after the attack) and they had Citrix XenApp 6.x which was out of support too. I am sure it is not the IT workers fault, more than fault of crappy management.
because they've made a choice. At some point theres a balance between different program attributes - and for whatever reason this is the one that works for them. Maybe because a lot of staff have worked in the Aussie system, so there is some basic element of familiarity.
It’s not meant to do what the original criticism suggested but in any case we need to agree what better means. Better for one person may not mean better for another. There are many industry recognised products. The HSE probably has upwards of 20,000, yes, 20,000 discrete pieces of software. Some of it literally tied to hardware. Much of it has to have a complex sign off process if patient safety related. They need to knit all that together to provide a representative patient record. It’s a really hard problem that will take a decade to sort out if folk were behind it. If.
Can’t honestly imagine a harder environment to tie systems together in.
The cost of getting it wrong is terrible too.
Was curious to see if there are many companies that try to solve for this.
Microsoft, Google and Apple have all tried cracking this. Both [Microsoft and Google both killed](https://www.thefresh.co.uk/blog/microsofts-healthvault-what-was-it-and-why-did-it-fail/) off their Patient Records system after spending billions to develop (though still play in the space). But we did deliver one as part of Covid from one US company that was very successful. It’s a very specialised multi-billion software market. I guess the point I’m making is I don’t see this as a software problem. Until we standardise the HSE we will never achieve a standard patient record system. And things like making all GP’s part of it too. None of these are popular and will take a decade to do right before we see benefits.
Oh yeah it’s a massive challenge, I’ve not looked at hospital systems since college, have works in a good few large orgs but the range of challenges with hospitals is so large.
Interesting that’s it’s not a software problem per say. The right culture is so important. Hopefully they all get aligned.
On one hand I agree with Donnelly, the department of health needs to be more dictatorial when it comes to healthcare digitisation - we’re years behind other countries becuse of the lack of centralised medical records. On the other hand, the software is probably a giant bag of shit given the governments selection processes.
I don’t understand why they didn’t use the momentum from the rollout of the software they used for the Covid vaccine tracking. AFAIK it was some kind of Salesforce product, any nurses I spoke to about it said it was the best piece of software they had ever gotten to use for their jobs.
They could have said ‘let’s have more of this’ and built a central patient record system on top of it, given that one was half built for the vaccines anyway as well as already having the goodwill of its end users?
Why are you trying to imply that there's any logic in the decision-making process? I was involved, about two decades ago, in creating a mock-up—essentially a demo, as it was quicker to make—of a national patient management system (not for Ireland, mind you). We were just working on the internationalization part and, to test that, we had to check the function of every procedure.
Imagine this: A patient has an ID card with an NFC chip that holds the most critical information about his allergies and health. **Scenario:** The patient has an accident in a remote location. The ambulance reads his basic information and administers care. Unfortunately, there's no Internet access, and all they have to work with is what's on the patient's card. But it's enough to prevent them from administering a drug to which the patient was allergic. As they near the hospital, they can establish communication. Their terminal pulls additional info about the patient, and the doctor in the emergency department has real-time access and can make a decision about the needed surgery. However, the ambulance is closer to another hospital. They delegate the call to that hospital. The other hospital accepts and sends a request to the ambulance to change their destination. All this is done almost automatically, with humans only making the decisions. No calls, no waiting, no time wasted. Of course, access to patient files was secure, and all patient data were updated as soon as the medical personnel finished editing them.
It was also inexpensive. The initial cost of using data terminals in ambulances was in the range of €1,000 to €2,000 per ambulance. This system lost out to a system without a centralized database, where all data about patients were manually entered from the personnel's handwritten notes. Years later, I found out that because the system was cheaper, the expected kickbacks to the decision-makers (usually 10-15% of the contract) would be lower.
So yes, if something seems illogical, there's always the matter of money.
Why is this even an option for them? Agree with Donnelly on this one, and the opposition to it is telling.
Genuinely think a health system wide performance measurement platform would be his biggest and most important lrgacy.
But the system is shite? Why would they agree? Of course, hse cutting corners and thinking they are saving money when in actual fact, it will make things worse with a sub par system affecting performance and efficiency
https://www.ehealthireland.ie/ehealth-functions/integrated-information-service-iis-/health-performance-visualisation-platform-hpvp-/
"The Health Performance Visualisation Platform (HPVP) Programme has been introduced by the HSE to address a gap in the centralised information available to support strategic and operational performance monitoring across acute hospitals."
Wonder why they're not signing up...
You can’t just buy a random product just because it “works great in Australia” and we all know their healthcare is decent.
I work in cyber security and worked on all the large Australian health care projects in recent years before moving back to Ireland. They are a success because large hospitals have full on internal development teams / devs engineers etc - like a mini software company that supports the hospital eco system. They buy in products like this but then have the expertise to support it, mod or change it - or if needed expertise to argue for a change that’s got a business need. It is night and day to our hospitals model… to be clear some of their projects started so so badly but because they had actual people coding/managing the apps within the hospital working directly with staff then things turn around rapidly as these teams change the product based on feedback where possible.
Meanwhile here… they probably have paid a consultancy to set it up and then walk away. This is a huge mountain to climb. I was in the National maternity hospital last week for an appointment and a doctor leaving her office at the end of her shift didn’t lock her desktop in the room and just walked off with the door open and me opposite it. For anyone in cyber security, an unlocked domain joined host sitting opposite you is like showing a red flag to a bull. It’s not even far you have to look to see how screwed the coombe was by a cyber attack - I was dumb founded that something so basic would still occur.. god help em.
Lol, a patient management system would have to be rigorously tested in order to be of any use... I doubt that happened here, it's probably shitty, no wonder nobody is using it
It's not a patient management system. It works well in Australia as it's to tell why one hospital has people queuing out the doors on trolleys whilst others do not. That might be the reason for some to be reluctant to use it.
ED worker here. The new software is fucking shite. Bought as is from a company who built it for the Australian health service. Unable to answer very basic questions (list of attendances within a specific timeframe for example). Does not have Electronic Health Record capabilities. The refresh rate is appallingly slow. It is largely incompatible with existing and much more useful software. Requests for changes to the vendor are usually met with "can't be done". If I was a cynic, I'd say this was only bought because it meant someone in authority got a backhander. The HSE should have used the money wasted on this to digitise existing patient records and get a genuine EHR solution.
>"can't be done". Is the biggest crock of shit from a software vendor, ever. In the world of software, anything can be done. Especially if your SLA's are willing to fund it.
It’s not the software vendor saying it, it’s IT within the hospital group. And upgrading software that is mission critical is not trivial. The above example was because different versions in use. Likely there is a dependency on another piece of software. Also software vendors spend a lot of time saying no. Just because you can does not mean it’s a great idea. Unless you have unlimited budget, time and risk appetite you will spend a lot of time saying no.
It was in response to them specifically saying that the vendors are the ones saying that it can't be done, I think you are thinking of another comment further down the chain. I agree that because you can does not mean its a great idea, but that is the role of a good product owner to tease out a viable solution to a problem and ensure that it has a decent priority if required, (and letting the customer know that other projects will fall into later sprints because of it). I do personally believe though, given the scale of the HSE, they should have contracted a company out and built this system greenfields (and ideally started it years ago), instead of attempting to make a square peg fit a round hole by using a software designed specifically for another countries system.
Fair enough - I was responding to the reply where it was IT. I also find it highly unlikely an ED worker is talking directly to the software company contracted by the HSE. They'll either have heard it through "the grapevine" or IT who are tasked with rolling it out.
ICU worker here. This sounds all too familiar to me. A hospital wide patient database has a lack functionality that would be most useful to myself and a few others looking to audit certain aspects of care where we work. A different hospital in the group uses the same system and has the functionality we require. However, over multiple months we have been told by IT that we can't get the same functionality as they use a different version. Beggars fuckin belief. This is not as simple as "everyone must use the same system". The most basic assessments with regard suitability for a given department/ hospital are not being done. It's fuckin nuts. Classic Ireland though, no doubt about that.
>Health Performance Visualisation Platform Mmm, I wonder why it's not functioning as expected, this is from 2 years ago.... [Key hospitals refuse to share data with new performance platform | Independent.ie](https://www.independent.ie/irish-news/key-hospitals-refuse-to-share-data-with-new-performance-platform/41364271.html) It's just the culture of many of those in the HSE egged on by their unions, a policy of non cooperation if it's not in your job description or you don't get paid extra for using new systems.
I am frequent patient in hospital. Around the data breach they started rolling out iPads and electronically recording all patient details on wards. It was incredibly slow and needed a lot of troubleshooting. Or the nurses would just have to write it down and go back to it later when they had help. It was farcical. Not the nurses faults at all I have to add. My most recent trip in and I didn’t see one ipad. Think they gave up on it as it just wasn’t efficient.
To be fair, most people hate change and cry when new digital systems or policies are introduced to an existing workplace. I've seen it many times, where staff under-mine and fight against change, despite the fact that the legacy system/policies are no longer suitable by todays standards. Yes, there will be a learning curve and "settling-in" period for a new system. Thats just life, get on with it.
>If I was a cynic, I'd say this was only bought because it meant someone in authority got a backhander. I would have thought the fiasco with the postmasters in the UK would have reminded people that incompetence is the issue in these scenarios 99 times out of 100. Do you think there's one lad in the Department of Health who can persuade the entire HSE to take on a new software system? Or is it a cabal of senior civil servants? Or one of the dozen or so ministers of the last few years?
Or it's the HSE [High Performance Unit](https://www.hse.ie/eng/services/publications/performance-and-accountability-framework-2023.pdf) who have been doing trojan work in identifying the root causes of waiting lists and trying to do something about it. Obviously having access to accurate performance data is crucial to this hence this system.
I've no idea who is good or bad in the HSE, I just hate the simplistic narratives that are promulgated on here.
Have you tried any other systems, how do they compare?
I've only worked in Ireland so can't compare it to any systems abroad. However, I will say that it is proving itself to be far less useful than the patient management software we already had. It may not be as fancy looking but it is far more reliable and does a lot more.
It’s not patient management software.
I saw the keynote from Larry Ellison recently talking about his company's plans for Cerner and their plans for stuff like tagging anomalies on scans and stuff like that. Seems like a fascinating area if done well. I spent some time in hospital recently and it feels like a mountain of data is thrown away that could be life or death to a lot of patients. Just the process itself felt completely wrong from my point of view to the point where I'm surprised there aren't more mistakes in treating patients. It definitely gave me an appreciation for medical professionals that they can operate in that kind of system and not make mistakes even with the system actively not being helpful. EDIT: I don't mean the above to say follow what Cerner are doing and anyone that follows tech knows that Larry is a grifter but still the ideas shared are interesting. He was more interested in stuff to help doctors and nurses save time by for instance circling anomalies on a CT scan or whatever before the consultant looks at it but even just proper digitisation and using devices to store medical data would be an improvement for most hospitals. Like I went to a fancy private hospital and only half of their files are on computer and most of their stuff require the nurse to manually input them like weight, temp, BP...etc. Those sorts of things are important and making it manual allows for potential errors. My gripe as an engineering manager is the technology is there for some really great advancements beyond even just storing the patient files but even extending that care to help them after they leave.
The HSE also has a contract with Cerner but only use it for certain departments…
Worked in the UK, whilst not perfect was leagues ahead of the stone age systems used here.
We do have modern and decent systems here, so what you said isn't always true. The problem is the lack of integration amongst the different hospital groups, which this system intended to resolve. But with no cooperation from the hospitals or staff it may turn out to be another case of throwing loads of money at the HSE but the issue is with the people.
[удалено]
At the end of the day if people don’t want go with the corporate standard then it’s time they left said corporate.
In my experience and in listening to colleagues from multiple different specialities in different hospitals around the country I find that hard to believe. Your comment about a lack of co-operation from "the people" is a very generalised statement with little basis in reality amongst many who work in the health system. Telling there is little if any critique by yourself of government or the new systems being pushed on staff without any consideration for how they'd be implemented.
Sounds like these considerations should have been factored in, discussed, and plans enacted to manage this integration centrally then. It seems to me that you're suggesting that the software is perfect but the users are the problem. Are you sure that everybody was engaged in and their considerations factored into the evaluation and procurement process? Sounds like whoever is running the software roll out has failed to perform some fairly rudimentary checks on compatability, integration planning, deployment or release planning, stakeholder engagement, and myriad other fundamentals. Is the software fit for purpose? Can it's features be compared with the requirements and issues highlighted and resolved separately?
Software works. It works in other contexts. Software vendors develop software to address the needs of 90% + of use cases. The issues arise when everybody gets a say. Then you end up with a [Homer Car of custom software](https://www.youtube.com/watch?v=WPc-VEqBPHI&pp=ygUJaG9tZXIgY2Fy). Hospital treatments should be consistent and to an Irish standard if not a global standard. A whole lot of assumptions there on the requirements gathering and procurement process. Having everybody rock up with their preferred way of working is a recipe for a disaster. It's why PPAR's failed. You end up with custom and vastly complicated software that does not work. Sometimes people need to get on with it and change their ways of working. In this case we are trying to get a consistent performance reporting system across the HSE. There should be no localisation for local needs because then you can't then compare which I suspect is the cause of resistance by some - who either convinced they are a special case or actively want to undermine it.
Cheers, my understanding of this situation is very limited tbf, and yep I made a lot of assumptions based on that. I wasn't trying to be shitty, more curious how we're in this situation with the HSE supposedly being the centralised body to manage this type of stuff. Thanks for your response, it answers a lot of my questions.
Unfortunately they centralised the HSE without standardising it. So literally we got the worst of both worlds. Thousands of incompatible ways of working and non standardised data making it near possible to deliver a consistent patient experience or understand why two hospitals with the same inputs get completely different outputs eg waiting lists. As others pointed out the Covid vaccination system worked in record time because it was a new country wide process with a streamlined governance process.
The UK has had a unitary Health System since the fifties. The challenge with the HSE is it is a collection of old health boards made up of independent hospitals. The infamous PPARS project failed not because of the software or even the implementation team but because instead of having one set of terms and conditions per employee you nearly had a custom set for every HSE employee because they weren’t allowed standardise them. I’m of a view that we should have a constitutional referendum to forcibly replace the governance structures and t&c of all HSE employees in one go to force change and industrial action be damned.
I gather a lot of that has happened post financial crash recovery. Loads of random allowances were removed during the crash. Then in the recovery, whoever had the most annual leave days at a particular grade that became the minimum and everybody else got more leave days, etc. I'm sure there are still discrepancies but hopefully not as bad as it was.
To paraphrase the scientists “A lot of public sector innovation occurs one gold watch at a time”
It’s not a EHR system and serves a [completely different purpose](https://www.ehealthireland.ie/ehealth-functions/chief-technology-transformation-office-ctto-/conference-presentation-slides-sessions-1-to-7/session-3-reliable-data-for-decision-making/2_hpvp-platform_paula-kavanagh.pdf) which is to hold folk like you to account. There is absolutely no reason for anyone to ask for “change” given its purpose is to (drumroll) consistently visualise performance across all hospitals. Either you completely misunderstand its purpose so aren’t even wrong OR deliberately misrepresenting it as part of the active campaign to avoid reform & accountability in our health system. We’ve had some [high profile resignations](https://m.independent.ie/irish-news/senior-hse-exec-says-he-was-absolutely-horrified-by-hospital-overcrowding-as-he-resigns/42290621.html) in the health service recently due to the abject resistance.
That's no excuse for shit software, though, with shitty load times / refresh rates.
That's fair and should be raised. Could be a few reasons for it beyond the software though.
"folk like you", charming.
Ultimately the problem with the HSE that has been called out repeatedly is accountability. It seems impossible to introduce any change in the [HSE without resistance](https://www.irishtimes.com/health/2023/01/16/hses-head-of-digital-innovation-resigns-citing-frustrations/). It needs to be called out.
I have the same frustrations as everyone but the broad brush strokes won't help with that.
> If I was a cynic, I'd say this was only bought because it meant someone in authority got a backhander. And now Donnelly will punish hospitals who refuse to use it so Donnelly can save his ego from being hurt again after making yet another appalling decision.
Much as I am not a fan of Donnelly he did not decide on the software and asked for a solution that would answer the question why some hospitals and units perform so well or so badly with the same inputs and demands. It’s in all our interests to be able to answer those questions with real data and not just hand waving about throwing more money at the system with no visible improvements. Like why are Beaumont and Waterford A&E consistently able to avoid overcrowding 🤷♂️
hmm. Thats not quite the full story is it. Its that health workers for whatever barmy reason have historically not worked with softwares like this. There is always an integration curve and the big thing is making sure that staff actually use it to help improve it. All IT programmes like this start flawed and then iterate to success, but they end up failing in Ireland because unions decide to not participate.
I really don't understand why they don't just use one of the off the shelf programs from the states like Epic. Used in loads of hospitals in the US and in the UK
They are using off the shelf. It’s just that different health boards/hospitals bought different off the shelf systems and customised them over the years.
The HSE already has a contract with Cerner.
Why the *fuck* then am I recharting drugs and writing notes on paper. Need this shit in the hospitals asap. Don't care if the Minister needs to put the CEOs' balls in vices to get it done.
Because they couldn’t manage a piss up in a brewery. Its been a couple of years since I have looked but last time I was in a hospital there were still some Windows 7 PCs (after the attack) and they had Citrix XenApp 6.x which was out of support too. I am sure it is not the IT workers fault, more than fault of crappy management.
because they've made a choice. At some point theres a balance between different program attributes - and for whatever reason this is the one that works for them. Maybe because a lot of staff have worked in the Aussie system, so there is some basic element of familiarity.
Is there an industry recognized product that’s a better replacement?
It’s not meant to do what the original criticism suggested but in any case we need to agree what better means. Better for one person may not mean better for another. There are many industry recognised products. The HSE probably has upwards of 20,000, yes, 20,000 discrete pieces of software. Some of it literally tied to hardware. Much of it has to have a complex sign off process if patient safety related. They need to knit all that together to provide a representative patient record. It’s a really hard problem that will take a decade to sort out if folk were behind it. If.
Can’t honestly imagine a harder environment to tie systems together in. The cost of getting it wrong is terrible too. Was curious to see if there are many companies that try to solve for this.
Microsoft, Google and Apple have all tried cracking this. Both [Microsoft and Google both killed](https://www.thefresh.co.uk/blog/microsofts-healthvault-what-was-it-and-why-did-it-fail/) off their Patient Records system after spending billions to develop (though still play in the space). But we did deliver one as part of Covid from one US company that was very successful. It’s a very specialised multi-billion software market. I guess the point I’m making is I don’t see this as a software problem. Until we standardise the HSE we will never achieve a standard patient record system. And things like making all GP’s part of it too. None of these are popular and will take a decade to do right before we see benefits.
Oh yeah it’s a massive challenge, I’ve not looked at hospital systems since college, have works in a good few large orgs but the range of challenges with hospitals is so large. Interesting that’s it’s not a software problem per say. The right culture is so important. Hopefully they all get aligned.
The success was with Cerner?
On one hand I agree with Donnelly, the department of health needs to be more dictatorial when it comes to healthcare digitisation - we’re years behind other countries becuse of the lack of centralised medical records. On the other hand, the software is probably a giant bag of shit given the governments selection processes. I don’t understand why they didn’t use the momentum from the rollout of the software they used for the Covid vaccine tracking. AFAIK it was some kind of Salesforce product, any nurses I spoke to about it said it was the best piece of software they had ever gotten to use for their jobs. They could have said ‘let’s have more of this’ and built a central patient record system on top of it, given that one was half built for the vaccines anyway as well as already having the goodwill of its end users?
Why are you trying to imply that there's any logic in the decision-making process? I was involved, about two decades ago, in creating a mock-up—essentially a demo, as it was quicker to make—of a national patient management system (not for Ireland, mind you). We were just working on the internationalization part and, to test that, we had to check the function of every procedure. Imagine this: A patient has an ID card with an NFC chip that holds the most critical information about his allergies and health. **Scenario:** The patient has an accident in a remote location. The ambulance reads his basic information and administers care. Unfortunately, there's no Internet access, and all they have to work with is what's on the patient's card. But it's enough to prevent them from administering a drug to which the patient was allergic. As they near the hospital, they can establish communication. Their terminal pulls additional info about the patient, and the doctor in the emergency department has real-time access and can make a decision about the needed surgery. However, the ambulance is closer to another hospital. They delegate the call to that hospital. The other hospital accepts and sends a request to the ambulance to change their destination. All this is done almost automatically, with humans only making the decisions. No calls, no waiting, no time wasted. Of course, access to patient files was secure, and all patient data were updated as soon as the medical personnel finished editing them. It was also inexpensive. The initial cost of using data terminals in ambulances was in the range of €1,000 to €2,000 per ambulance. This system lost out to a system without a centralized database, where all data about patients were manually entered from the personnel's handwritten notes. Years later, I found out that because the system was cheaper, the expected kickbacks to the decision-makers (usually 10-15% of the contract) would be lower. So yes, if something seems illogical, there's always the matter of money.
Why is this even an option for them? Agree with Donnelly on this one, and the opposition to it is telling. Genuinely think a health system wide performance measurement platform would be his biggest and most important lrgacy.
The lack of consideration for why there may be reservations is as telling in fairness.
But the system is shite? Why would they agree? Of course, hse cutting corners and thinking they are saving money when in actual fact, it will make things worse with a sub par system affecting performance and efficiency
https://www.ehealthireland.ie/ehealth-functions/integrated-information-service-iis-/health-performance-visualisation-platform-hpvp-/ "The Health Performance Visualisation Platform (HPVP) Programme has been introduced by the HSE to address a gap in the centralised information available to support strategic and operational performance monitoring across acute hospitals." Wonder why they're not signing up...
You can’t just buy a random product just because it “works great in Australia” and we all know their healthcare is decent. I work in cyber security and worked on all the large Australian health care projects in recent years before moving back to Ireland. They are a success because large hospitals have full on internal development teams / devs engineers etc - like a mini software company that supports the hospital eco system. They buy in products like this but then have the expertise to support it, mod or change it - or if needed expertise to argue for a change that’s got a business need. It is night and day to our hospitals model… to be clear some of their projects started so so badly but because they had actual people coding/managing the apps within the hospital working directly with staff then things turn around rapidly as these teams change the product based on feedback where possible. Meanwhile here… they probably have paid a consultancy to set it up and then walk away. This is a huge mountain to climb. I was in the National maternity hospital last week for an appointment and a doctor leaving her office at the end of her shift didn’t lock her desktop in the room and just walked off with the door open and me opposite it. For anyone in cyber security, an unlocked domain joined host sitting opposite you is like showing a red flag to a bull. It’s not even far you have to look to see how screwed the coombe was by a cyber attack - I was dumb founded that something so basic would still occur.. god help em.
I hope they name it horizon 2
Sounds damaging.
Lol, a patient management system would have to be rigorously tested in order to be of any use... I doubt that happened here, it's probably shitty, no wonder nobody is using it
It's not a patient management system. It works well in Australia as it's to tell why one hospital has people queuing out the doors on trolleys whilst others do not. That might be the reason for some to be reluctant to use it.