Digital Public Health in Ireland

Abstract

Abstract Before COVID-19 Ireland had a very limited digital health infrastructure. There are no unique health identifiers, and it is common for patients to be on the books of multiple providers, be that general practitioners, or hospital waiting lists, so capacity analysis beyond actual hospital admissions, is very limited. There are separate systems used to manage child development and vaccine delivery. Infectious disease reporting is done, feeding into a 25-year-old central system. General practice (GP) is the only sector that uses electronic records widely, which support a messaging system, to return hospital test results to the GP. Prescriptions were commonly handwritten on paper or typed, specifically on three-layer fan-fold paper, using obsolete printers for fully state-funded prescriptions. The patient transferred these to the pharmacist. COVID-19 shook this system to the foundation. It became necessary to set up contact tracing systems and vaccination systems for the entire population. These were built very quickly as free-standing systems. In addition, hospital activity data, which had been typically available a month after the date of discharge, was needed daily to manage bed capacity. Pharmacists had to receive prescriptions online, and e-prescribing was brought in. All of this worked and often worked well. More embarrassingly, as COVID-19 case numbers rose, the recording system did not scale, and reported case numbers were substantially too low for a time. Now that the acute pandemic response is over, very little has changed. Hospital prescriptions are still paper-based, although GP prescriptions use the new system. Contact tracing is shut down, and the vaccination system is scaled back. There is still no health identifier in use. Few of the lessons of the pandemic response have been learned, and the opportunity to make more significant changes in public health systems has been missed. A ‘good’ crisis was wasted.