Digitalising healthcare delivery

Digital for Care: A Digital Health Framework for Ireland 2024-2030, published in May 2024, identifies electronic health records (EHRs) and integrated care systems as core priorities, while questions about the State’s capacity to deliver such complex systems remain unresolved.

Ireland has faced a historical lag in digital health compared to EU peers, ranking near the bottom of the EU Digital Economy and Society Index (DESI) for health infrastructure in recent years. The framework sets an ambitious vision for transforming healthcare delivery through digital innovation. While its goals of improved patient care, workforce enablement, and data-driven services are laudable, achieving these aspirations will require overcoming systemic challenges that have historically hampered progress in the State’s health sector.

While the Government’s target of providing every citizen with access to a digital health record by 2030 aligns with EU targets under the European Health Data Space (EHDS), progress to date has been limited. The HSE’s rollout of EHRs has seen delays and cost overruns. Although St James’s Hospital has provided a notable exception, replicating such success nationally will require addressing systemic challenges, including fragmented IT systems, underinvestment in infrastructure, and insufficient digital literacy among both staff and patients.

Martin Curley, former Chief Information Officer of the HSE, noted in 2022 that Ireland has “the opportunity to leapfrog legacy systems seen elsewhere in Europe”, but that this “requires bold decision-making, substantial investment, and a national digital-first mindset”.

A digitally enabled workforce

A digitally enabled workforce is cited as “critical” for the success of the Digital for Care framework. The document envisions a healthcare environment where professionals are empowered with interoperable systems, secure digital identities, and real-time access to patient information. While this represents progress, current realities suggest the road ahead is steep.

The Irish Medical Organisation (IMO) has consistently cited resource strain on healthcare workers. In 2023, Ireland had fewer than 3.3 doctors per 1,000 people, below the EU average of four. Therefore, the introduction of new digital tools could exacerbate, rather than alleviate, the workload unless properly integrated and supported by robust training.

The Government’s focus on digital literacy will be welcomed by decision-makers, however, as the European Court of Auditors warned in 2022, poorly executed digitalisation risks alienating frontline workers, particularly in systems where legacy processes still dominate.

Therefore, the framework stipulates that the Government must engage directly with frontline workers to co-design systems that complement existing workflows and simplify administrative burdens, rather than creating additional complexity.

Data-driven decision-making

The framework commits to leverage data for policy and service optimisation. The emphasis on dashboards, predictive analytics, and real-time monitoring has the potential to revolutionise health service delivery.

However, the State has historically struggled with data governance. A lack of centralised data standards and oversight has led to inconsistent reporting and limited utility of collected data. According to the Health Information and Quality Authority (HIQA), only 42 per cent of Ireland’s health datasets are interoperable across systems. Without clear national standards and stronger legislative backing, such as the long-delayed Health Information Bill, data-driven ambitions may fall short.

To build confidence in this area, the framework states that government should prioritise:

• accelerating the adoption of international interoperability standards like FHIR (Fast Healthcare Interoperability Resources) and SNOMED Clinical Terms;
• publishing regular, independent audits of health data systems to ensure compliance and transparency; and
• proactively communicating with the public about how their data will be used, addressing privacy concerns head-on.

Digital inclusion

Digital health transformation risks widening existing inequities if vulnerable populations – particularly older adults and rural communities – are not adequately supported. According to Eurostat, over 23 per cent of Irish adults lack basic digital skills, with rural areas disproportionately affected.

The framework acknowledges these risks, committing to preserving non-digital service access while fostering digital literacy programs. Yet there is limited detail on how these programmes will be resourced or delivered at scale.

Therefore, the framework asserts that digital literacy efforts must be accompanied by investment in physical infrastructure, as rural broadband access remains inconsistent, undermining the potential of telehealth and remote monitoring solutions in such areas.

Governance and accountability

The framework emphasises the need for robust governance to oversee digital health projects, yet Ireland’s track record in this area remains mixed. High-profile failures, such as the 2021 cyberattack on the HSE, highlighted vulnerabilities in governance and cybersecurity readiness.

Furthermore, while the establishment of regional health areas (RHAs) is a step forward for localised accountability, their integration with national systems remains under-defined. Niamh Brennan, a governance scholar, has warned that “fragmented oversight structures risk creating silos rather than the integrated care the government envisions.”

To mitigate these risks, the framework states that government must ensure:

• clear lines of accountability between RHAs and national bodies like HIQA;
• a centralised project management office for national digital health initiatives, equipped with technical and clinical expertise; and
• dedicated funding streams that are insulated from political cycles.

While Ireland has a long way to go to achieve digital health maturity, the Digital for Care framework represents an opportunity to fundamentally transform Irish healthcare, but its success hinges on sustained political will, careful planning, and transparent execution.