The Electronic Health Record (EHC) being introduced in Northern Ireland is aimed to transform the health and social care service with data driven healthcare and facilitate virtual wards and admission avoidance, Dr. Dermot F Hughes FRCPath, told a HMI meeting in May. Maureen Browne reports.
Dr. Hughes is Visiting Professor, Ulster University and Senior Responsible Owner for the Health and Social Care programme, encompass, which is being used to create the single digital health care record for every citizen in Northern Ireland who receives health and social care.
He said this unique and comprehensive approach to Electronic Health Record would cover secondary care, mental health, community care, social care and social work.
“It covers all areas of health, including health in prison. Access to information for patients and service users will be through a portal and its objective is to improve access to care, improve experience of care, reduce risk and improve outcomes.
“It should transform how we deliver care while empowering patients and clients. It aims to provide patients and service users with the safest, highest quality of care that was possible.
“It will give patients and service users the ability to view and update their health information online wherever and whenever they like. It will also make it easier for Health and Social Care staff to view important information about their patients and service users both in a clinical setting and while working in the community.
“Variation in care is a recognised risk. patients do not routinely have access to their data/information and, without this, cannot be partners in care.
Dr. Hughes said digital care enabled radical transformation. While there were differing implementation strategies for differing cultures, programmes and methodologies were aligned.
The Northern Ireland project involved developing life-long electronic care records, standardisation of patient and client pathways, with patients receiving best care irrespective of geography.
He said encompass used “Epic” as the specific software system to create and manage the electronic record.
“Epic makes it possible for every patient to have a single, comprehensive medical record that informs and is informed by their health experiences. The goal is higher-quality, more personalized care that’s simpler for patients, medical professionals, and everyone who makes healthcare happen.”
Highlighting the work involved, he said Northern Ireland had 1.9m citizens, over 6,000 hospital beds, an overall Health and Social Care budget of around 6.5Bn. of which around 4.5bn was spent by the Trusts. There were over 80,000 staff members , 321 GP practices, 368 dental practice and over 500 community pharmacies.
Before the start of the HER, Health and Social Care in Northern Ireland (HSCNI) had 70 plus digital systems which did not connect, one system reduced duplication and miscommunication.
Inpatient and outpatient work was largely on paper, many digital systems were near ‘end of life.’ Variations in care delivery and procurement led to an inefficient health system
Dr. Hughes said encompass had been implemented in the South Eastern Health & Social Care Trust (SEHSCT) in November 2023, Belfast Health and Social Care Trust (BHSCT) in June 2024 and Northern Health and Social Care Trust (NHSCT) in November 2024. They were preparing for the final implementation phase when ECR would go live in the Southern Health & Social Care Trust and the Western Health & Social Care Trust on May 8, 2025.
“We have colleagues around the world who are already using this system and we have close personal relationships with Holland and Denmark where is has been implemented, so we can consult with them if necessary.
“There are over 100 million client portal users and more than 250 million patient and service user records. It is used in the top 20 performing hospitals in the US and in the UK, was used in CUH, UCLH, GOSH, RDE, MFT, Frimley, Guys & St Thomas’, King’s College.”
Dr. Hughes said we must recognise there was never a perfect time for the kind of change involved in moving to HER It was about a set of behaviour which was agreed and managed. Staff would buy into the process if they saw benefits for patients and professionals. It could be difficult to manage a workforce under stress, especially as staff had to continue to provide services while change was being introduced.
“Everybody, including groups of hospital departments and their partners have to buy into governance. The Programme had to fund Trust clinical and managerial leadership for a while and that was very expensive.
There was, he said both clinical and managerial leadership involved. Leadership was very important. “When you get things wrong, apologise and move on. It is not possible to do this kind of transformation without making errors, so make sure there is an open and accepting culture of apology.
“We had a skeleton clinical leadership when we started we went from 65 to 205. Doctors and nurses are used to working with clinical risk. This is a clinically led transformation rather than a digital one. Digital literacy has not been a problem, staff seemed to enjoy the challenge. Records were manually migrated by clinical and social care staff. You need to be careful to bring the population with you. In reply to a query. he said that cyber security was a risk.
Dr. Hughes said encompass was for staff, the My Care portal was for patients and service users.
“There are now 100,000 people on MyCare. It belongs to the patient and helps to empower their healthcare journey. In the future there will be lots of opportunities to reduce bureaucracy. AI is with us, and we need to use the latest technology.: MyCare will be improved and more features will be enabled on an ongoing basis. Enhanced access will allow users to view specific parts of their health information via the click of button. There is also a dedicated My Care helpdesk
The meeting was chaired by Mellany McLoone, HMI Council and Integrated HealthCare Area Manager HSE Dublin North City and Dublin West.
The meeting was sponsored by GSK.
