EHR Strategic Business Case Briefing Deck V1.2 22/02/2016 FOR INTERNAL USE ONLY 1

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  Outline governance proposal in line with SRG approach for discussion and agreement  Gain agreement to progress with the next steps including:  Acceptance of the overall roadmap and direction of travel  Proceeding with detailed next stages of requirements, readiness and business cases  Commitment to procure elements of the programme  Commitment to resourcing the programme FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer What is the National Electronic Health Record? Community Operational Systems Acute Operational Systems National Shared Record Integration 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 The “glue” that binds all this together and maintains integrity and security across the system Systems Examples: Single MPI Scheduling Clinical Notes / Records Screening & Surveillance eHealth Blueprint FOR INTERNAL USE ONLY

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 – €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 FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer Public increasingly demand ‘digital first’ experience FOR INTERNAL USE ONLY

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: Initial Findings from EHR Public Consultation FOR INTERNAL USE ONLY

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 FOR INTERNAL USE ONLY

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 Q will set the direction of travel and define the overall delivery programme Dec 2013Q – Q May 2015 August 2015 Q Significant ongoing public engagement FOR INTERNAL USE ONLY

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 Key Questions Addressed at each workshop 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. FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer The National EHR Suite 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. FOR INTERNAL USE ONLY

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 Integration 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 FOR INTERNAL USE ONLY

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 FOR INTERNAL USE ONLY

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 FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer FOR INTERNAL USE ONLY Indicative Costs and Resources – 5 Year Acute Delivery Scenario

Delivering eHealth Ireland | Office of the Chief Information Officer FOR INTERNAL USE ONLY Indicative Costs and Resources – 9 Year Acute Delivery Scenario

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 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. DesignProcurementDelivery PreparationImplementation Readiness FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer June 2016Jan 2017June 2017Jan 2018 Programme Governanc e National Requirements Business Cases Procurement Office Portal & integration Requirements Acute Requirements Deployment Strategies Community Requirements Prepare to deploy CHO Readiness Assessment HG Readiness Assessment Prepare to deploy Portal & Integration Implementation Portal & 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 FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer FOR INTERNAL USE ONLY June 2016Jan 2017June 2017Jan 2018 Business Cases Implementation (Portal, Integration, Community, Acute) Privacy and Data Sharing DRAFT – FOR INTERNAL USE ONLY 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

Delivering eHealth Ireland | Office of the Chief Information Officer Path to Single Solution Set 5 Years10 Years Critical Tactical Solutions Innovative Specialist Solutions National Solutions PAS Replacement Initial National Shared Record Haemophilia Lighthouse Project Epilepsy Lighthouse Project BiPolar Lighthouse Project Portal (Organisation) Other Future Projects Order/Comms Other Future Projects FOR INTERNAL USE ONLY NCH Implementation Other Single Solution Set Evolving to a single solution set will require agility and a governance approach that supports a dynamic environment Innovative Specialist Solutions Other Future Projects National Shared Record Development MEDLis MN-CMS NICIS Acute Operational Components – Phased Implementation in HG’s Community Operational Components – Phased Implementation in CHO’s NIMIS National Solutions Other

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 FOR INTERNAL USE ONLY

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 FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer Discussion – Programme Leadership and Support  What people need to be committed?  Clinical  Managerial  Project Resources  Business Change  How do we recognise this is not simply an ICT Programme and that active collaboration with Reform (SRG) is needed to optimise resource demands on the system and coordinate change?  How do we create cross-system “Sponsorship” and the need for whole system “Ownership”?  Do we all agree to be involved in helping to overcome barriers (e.g. policy around the sharing of information)  What is the optimum vehicle for delivering this programme?  Who can pose barriers to the programme and how do we engage them? FOR INTERNAL USE ONLY

Appendix Briefing Deck V1.2 22/02/2016 FOR INTERNAL USE ONLY 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 FOR INTERNAL USE ONLY

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 FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer Context FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer Context FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer 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. What is the National Electronic Health Record? National Shared Record Community Operational Systems Acute Operational Systems Integration 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 FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer Evolving focus of IT Governance Rationalize/ Innovate Run & maintain IT the new world I. Run & maintain ‘traditional IT’ II. Rationalise ‘traditional IT’ III. ‘Maintenance ‘digital Healthworld IT’ IV. Innovation ‘digital world’ Suppliers Long Term focus Stable Base Product Self supporting Traditional ‘core’ IT (CTO) Broker Integrator Orchestrator Governance focus Plan Build Run Partnerships Short cycles Patient driven Health specific Co-sourcing Governance focus FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer FOR INTERNAL USE ONLY Indicative Costs – 5 Year Acute Delivery Scenario Cost ElementCapital (2016 – 2022)Revenue (2016 – 2026) Costs to Deliver the Acute Capability €219M - €297M€216M - €292M Costs to Deliver the Community Capability €75M - €101M €51M - €69M Costs to Deliver the Integration Capability €31M - €43M€18M - €24M Costs to Deliver the Portal Capability €20M - €26M€17M - €23M Total€345M - €467M€302M - €408M INDICATIVE AND UNDER REVIEW 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 Indicative Costs – 5 Year Acute Delivery Scenario

Delivering eHealth Ireland | Office of the Chief Information Officer FOR INTERNAL USE ONLY Indicative Delivery Timeframe – 5 Year Acute Delivery Scenario 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 Acute Delivery Scenario

Delivering eHealth Ireland | Office of the Chief Information Officer FOR INTERNAL USE ONLY Indicative Costs – 5 Year Acute Delivery Scenario Cost Profile Per Annum Cost Element Capital Cost (€M) Revenue Cost (€M) Total (€M)

Delivering eHealth Ireland | Office of the Chief Information Officer FOR INTERNAL USE ONLY Indicative Resources – 5 Year Acute Delivery Scenario

Delivering eHealth Ireland | Office of the Chief Information Officer Indicative Costs – 9 Year Acute Delivery Scenario Cost ElementCapital (2016 – 2025)Revenue (2016 – 2026) Costs to Deliver the Acute Capability €227M - €307M€171M - €231M Costs to Deliver the Community Capability €75M - €101M €50M - €68M Costs to Deliver the Integration Capability €31M - €43M€17M - €23M Costs to Deliver the Portal Capability €21M - €28M€17M - €23M Total€354M - €479M€255M - €345M INDICATIVE AND UNDER REVIEW 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 9 years Estimates based on supplier market intelligence and experience from other jurisdictions Indicative Costs – 9 Year Acute Delivery Scenario FOR INTERNAL USE ONLY

Delivering eHealth Ireland | Office of the Chief Information Officer FOR INTERNAL USE ONLY Indicative Delivery Timeframe – 9 Year Acute Delivery Scenario 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 Acute Delivery Scenario

Delivering eHealth Ireland | Office of the Chief Information Officer FOR INTERNAL USE ONLY Indicative Costs – 9 Year Acute Delivery Scenario Cost Profile Per Annum Cost Element Capital Cost (€M) Revenue Cost (€M) Total (€M)

Delivering eHealth Ireland | Office of the Chief Information Officer FOR INTERNAL USE ONLY Indicative Resources – 9 Year Acute Delivery Scenario