Ireland is experiencing a health crisis, failing to reduce and manage waiting lists and currently falling to the bottom of global health systems ranking lists.

The shortcomings of the Irish healthcare system are not fair to patients or staff. Great care is often given when you get into the Irish Health System. There are many fine and passionate staff who work for the HSE and across the broader health system, but they are equipped with very substandard tools.  

This hampers productivity and morale, but more importantly means that clinicians have to provide care without complete information — and this means, sometimes, the wrong decisions can be made.  

Upgrading health 

There are significant issues with healthcare availability, affordability and accessibility. It’s surprising how a country with so many other strengths is performing poorly in health. I believe we have an opportunity to transform our Irish health system through the use of digital technology.   

The human lifespan has doubled within 1.5 centuries due to public health and clinical advances. With this consideration, it’s essential for health systems to keep up with the demand and ensure people receive effective care at every stage of their life.  

The human lifespan has doubled within 1.5 centuries due to public health and clinical advances.

Shifting beliefs 

Key answers are embedded in the Manhattan Manifesto released following the United Nations General Assembly 77 Science Summit Digital Health Symposium.  

I believe there are three massive shifts to be made: from treating illness to promoting wellness, including the earlier identification of rare diseases and chronic conditions; from treating people in the hospital to treating them in the community, ideally their own homes; and from ‘doctor knows best’ to ‘patients know best,’ which can be adopted to rapidly improve our healthcare system. 

Invest in healthcare 

The Manhattan Manifesto, developed by 50 global digital health leaders describes 12 guidelines for governments to adopt to drive the transition to a digital healthcare system, not least raising digital spending to 6% of total spend.  

But this is not the main problem, Ireland is already an outlier in how much it spends on healthcare compared to other countries. The issue is culture and whether the will exists to transform the system.  

Many effective and clinically proven digital solutions were developed in Living Labs in Ireland with clinicians and patients alike but experienced extreme resistance from a small group of senior administrators. 

The Irish Digital Health Leadership Steering group comprises committed leaders across the spectrum in Ireland who want to transform healthcare. If we can’t scale Everest, we can go around it. 

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Today, it is clear that digital health works. The Health Tech Innovation Awards have featured proven digital solutions to improve people’s health; speed up treatments; shrink administrative delays and burdens; and free up medics to be medics.

At the 10th Health Tech Innovation Awards, patient speaker Gary Boyle described how a group of fellow Parkinson’s patients moved online during the Covid-19 pandemic despite challenges with technology and their circumstances. This is an example — in a microcosm — of the challenges our health system is now facing up to. 

Embracing the new world 

Knowing digital solutions work is not enough. The pandemic has accelerated a process that had been underway for some time. We have moved from old certainties in all sectors, like the five-day week, office-based employment and discrete, predictable business sectors.  

This new normality can understandably be unnerving. Organisations are worried about making a terminal strategic decision, and with so much uncertainty and complexity, governments move cautiously in committing taxpayer money. What is positive is organisations are recognising that creating a roadmap and removing blockers together while accepting some level of calculated risk is necessary to ultimately ensure we, as a society, reap the benefits.

We have moved from old certainties in all sectors, like the five-day week, office-based employment and discrete, predictable business sectors.  

New era for leadership 

Another important factor, widely recognised globally in delivering success and tangible outputs in this new world, is effective leadership. Clay Christensen, distinguished Harvard Business school professor, provides insights on leadership when moving to a new state for any industry.  

One challenge to adoption is around existing proven, learned management principles. These principles can hinder reaching organisational innovation goals because they favour the existing established processes.  

Managers are not rewarded for taking small risks, and to realise that failing and learning within defined boundaries is essential. This is further exacerbated when the system in question is health.  

Collaboration for delivery 

A critical shift in delivering digital transformation is the state and private sector meeting these challenges together. Sharing information and insights, cooperating on finding solutions and focusing on connecting the dots to improve every citizen’s experience. In Ireland, this is already actively underway. HealthTech Ireland continues in its 41st year to support these conversations, promote innovative solutions and work in a spirit of trust and openness with stakeholders across the sector to support this evolution.  

We particularly welcome the consultative work being carried out currently in the drafting of the HSE National Digital Strategy and the HSE Evaluation Framework for Innovation initiatives, as well as the funding pathways being put in place to deliver solutions for patients. This work and its outputs will deliver a more transformative, resilient and equitable healthcare system for all of us.  

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Healthcare in Ireland is an expensive business. Consistently, public expenditure for the health vote of the budget overruns initial estimations.

According to Ireland’s fiscal watchdog, the Fiscal Advisory Council, €0.6 billion of €2 billion in overspends in 2022 are related to health. The health system is hitting limits, and their solution is to spend more. Even before Covid-19 in 2019, acute hospital beds were running at 90% occupancy (safe = 85%).  

Spending more to achieve little to no improvement in health outcomes has turned the health sector into the favourite ‘bête noire’ of the Government. Health spending, in terms of GNI*, stood at 8.3% in 2019. This is in line with the EU average. Ireland is a big spender, coming sixth in the OECD. Despite Ireland’s famously youthful population (14% over 65), Ireland spends more than Japan (29% over 65).  

Theory of economic growth 

Digitalisation is an essential part of reform. It transforms healthcare from a low-productivity cost centre into a locus of economic growth. Working with my colleague Dr Aida Garcia-Lazaro, as part of the MSI: People-Led Digitalisation EPSRC research programme, we looked at case studies from the living labs and pilot projects led by Martin Curley at HSE Digital Transformation.  

An interesting conclusion emerged: when specifically designed, miniaturised digital technology, combined with highly skilled human capital, resulted in massive cost reductions, better outcomes and a very high ROI.  

Combining well-educated and trained labour with smart capital created a complementarity effect.

We took a deeper look into the theory of economic growth and adapted it to what we were seeing in the data. We came up with a new explanation about how technology, capital and labour interact.  

We called this type of capital ‘smart capital’ — being devices with advanced software (machine learning). Combining well-educated and trained labour with smart capital created a complementarity effect. This capital-labour complementarity can drive productivity growth and ultimately economic growth.  

Where do these positive outcomes come from?   

Two sources: technological improvement and capital complementarity. We argue that the digital transformation of the healthcare system is about delivering both. Capital complementarity will become the economic engine. Productivity improved as work is reallocated to critical thinking and decision-making and away from the mundane. 

A necessary condition for rethinking our relationship with the healthcare system is to embrace digitalisation and the power of Curley’s Law. It is necessary but not sufficient. Ultimately, to achieve the necessary and sufficient conditions, we require transformational leadership. 

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Professor Jared Auclair

Director of Biotechnology, Director of Bioinformatics,
Vice Provost for Research Economic Development and Director of Bioinnovation at NU

Technology is driving major advances in healthcare and health outcomes for people at all stages of life, in many domains such as AI, biologics and robotics.

Through renewed partnership in 2023, University College Dublin (UCD) and Northeastern University, Boston (NU) are driving technological breakthroughs across four core strands: Digital Rehabilitation and Independent Living; Biologics and Advanced Manufacturing; Enhanced Post-Cardiac Surgery Outcomes; and Maternal Health. 

AI and maternal health 

Professor Patricia Maguire, UCD Professor in Biochemistry and artificial intelligence (AI) evangelist, leads the AI_PREMie team that combines cutting-edge biomedical, clinical and machine-learning research to develop a new solution for preeclampsia.  

“AI will revolutionise healthcare by enabling earlier diagnoses and promoting personalised treatment, giving back valuable time for healthcare professionals to focus on patient care,” she says.  

AI_PREMie has developed a prototype risk stratification tool for preeclampsia, a serious pregnancy complication that causes one expectant mum to lose her life every seven minutes. “Integrating AI into maternal care will enable effective, efficient clinical decision-making, leading to better outcomes for both mother and baby. This will ultimately prevent premature birth and save lives, having a huge impact on societal good,” adds Maguire.  

The team aims to collaborate with NU researchers to create new, AI-powered solutions to transform maternal health across the globe. 

AI will revolutionise healthcare by enabling earlier diagnoses and promoting personalised treatment.

Robotics and biomanufacturing  

Professor Jared Auclair, Biologics and Advanced Manufacturing (biomanufacturing) expert, says robotics can positively impact patients’ lives. “UCD and NU bring unique capabilities in robotics to address digital rehabilitation and independent living, but that only scratches the surface of what is possible. They both have expertise in robotics and automation which can impact healthcare.”  

He believes biomanufacturing will be key in the future of healthcare. To this end, NU’s Biopharmaceutical Analysis Training Laboratory (BATL) engages in real-world research in biomanufacturing to end-product testing. UCD also hosts the National Institute for Bioprocessing Research and Training (NIBRT), which is committed to providing training and research solutions for the biopharma manufacturing industry. 

“There are opportunities to drive towards continued manufacturing strategies that include interactions across robotics, advanced manufacturing and other areas,” Auclair says. Biomanufacturing doesn’t only apply to innovations in biological drugs. By using it to develop environmentally friendly processes — such as biomaterials — and solutions to food insecurity, biomanufacturing can ultimately improve patient health and outcomes.  

“We are taking a holistic approach to global challenges in healthcare that leverage new technologies and data to drive learnings while focusing on quality of life for patients,” he adds.  

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Cross-border collaborations in Ireland can transform pools of medical data into new research opportunities and possible treatments for patients with rare and complex diseases.

Data and technology have changed healthcare dramatically over the last few years, says Aedín Culhane, professor of cancer genomics at the University of Limerick. “The tools we have now are very different to what we had five years ago,” she says. “We need to use that technology in Ireland.  We need to connect patients across borders and use information from international studies to improve care and treatment.” 

This transformative digital shift has led to new possibilities in the realm of cancer and cell research, reveals Culhane. “Now, we can get highly detailed molecular data on every, single cancer cell. It means we can take the molecular portraits of that cell and direct medicines more precisely.” 

Managing large data volumes 

Translating the immense volume of available data into effective treatments and research opportunities requires collaborative partnerships, says Culhane. The Limerick Digital Cancer Research Centre, for example, is a partner with several organisations in support of the Genomic Data Infrastructure (GDI), a project that aims to enable access to over 1 million European genome sequences for research. 

Translating the immense volume of available data into effective treatments and research opportunities requires collaborative partnerships.

“It will allow us to identify a genetic or genome marker that could be very rare in an Irish context,” says Culhane. “It helps us find a way to leverage the fact there are over 400 million people in Europe where that variant may not be so rare. We can use that information to better direct clinical decisions.” 

Allowing new information to emerge 

Connecting diversified data allows new insights into treating Irish patients affected by cancer, says Culhane. The eHealth-Hub for Cancer, led by University of Limerick with the Queen’s University Belfast and five other institutions across Ireland, aims to train students in best international practice of securely sharing and analysing federated clinical data to further understand the scale of cancer. 

“We can connect cancer data, so we can better know the distribution of disease on the island,” says Culhane. “The aim is to harmonise Irish data according to international standards so it can be compared to global data because having access to a large data pool brings valuable benefits to patients. When you have large cohorts, you can ask questions that you couldn’t ask before,” she adds.  

“Data opens up new and exciting cancer research opportunities in Ireland and can connect us to ground-breaking international research projects, bringing deeper insights and potentially driving discovery of life-changing treatments.” 

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It is now commonplace to manage healthcare at home with the aid of digital health technologies, many of which provide relief to patients while they await their next in-person appointment.

During Covid-19, 44% of patients used new devices or apps to help manage conditions remotely, according to data gathered by Accenture. This is a habit that has stuck. To aid this trend, an abundance of mobile health applications flooded onto the main app stores — approximately 350,000, according to IQVIA, with 5 million downloads recorded daily.

Regulating technologies

Amid such a crowded market, we must ask: how safe are these unregulated technologies? And how can patients differentiate high-quality solutions that could make a positive impact on their health from those that don’t?

The first answer to this came in 2019 when Germany passed the Digital Healthcare Act (DGV) and created a dedicated regulatory approval and reimbursement pathway for CE-marked digital health applications.

Under this legislation, clinicians can prescribe an approved digital health solution (locally known as a ‘DiGA’) to patients. Developers of those solutions then get reimbursed by the insurer.

Benefits for users

These health apps or web-based platforms are used to support a patient’s treatment — not replace seeing a doctor. Patients are empowered to take control of their rehabilitation by self-monitoring their recovery and completing a course of therapy at home. This could create greater access to care.

For clinicians, digital therapeutics could bridge the gap while patients await in-person appointments, alleviating pressure on hospital waiting lists. This affords them more time to manage the most complex cases.

Both patients and clinicians gain access to a directory of certified solutions, taking them away from the overwhelming options available on the consumer app stores. They may discover a safe treatment that’s right for them.

These health apps or web-based
platforms are used to support a patient’s
treatment — not replace seeing a doctor.

Local implementation

For the health innovators developing these digital solutions, the prospect of entering a market that offers a standardised pathway to reimbursement is an incentive to commercialise there earlier. For example, in Ireland, entrepreneurs nurtured here may be less inclined to take their products overseas first and instead, sell locally, creating benefits for local patients.

France and Belgium have already followed suit, with several Member States choosing to include telemedicine, AI solutions and robotics into their reimbursement frameworks. It is important now for Europe to set guidelines to avoid increasing fragmentation in the future. At EIT Health, we have established a pan-European task force which is setting recommendations for consistency in clinical trial protocol design across Member States for faster reimbursement.

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Amanda Creane

Healthcare Manager, GS1 Ireland

Barcode technology can bring numerous advantages to healthcare — but hospitals need the right guidance and support.

The Scan4Safety initiative builds on barcoding standards to offer increased traceability of items such as medical devices, assets and medication right to the point of care. If implemented properly, it will lead to the delivery of better patient care, supply chain efficiency and clinical productivity.

Benefits of barcode technology in hospitals

“Several Irish healthcare organisations are adopting the approach as a way of embedding barcode scanning into their day-to-day processes for traceability and stock management,” says Amanda Creane, Healthcare Manager with GS1 Ireland, not-for-profit traceability standards licensing organisation.

As an adopter, Tallaght University Hospital (TUH) has already seen the benefits. Previously, clinical staff were spending hours managing inventories and re-ordering stock with little visibility into what item was used with which patient.

TUH CEO Lucy Nugent says: “Scan4Safety is demonstrating real benefits by improving patient safety and giving time back to patient care.”

At its core is patient safety and making sure the right product gets to the right patient at the right time.

Amanda Creane

However, it can take time to get Scan4Safety up and running. The linking of the barcodes to existing data can also take time, so we recommend hospitals get started with traceability standards designed-in as it can be costly to do afterwards.

“Clinical buy-in is also key, and the TUH project is an excellent example of clinical leadership which resulted in a very successful implementation,” says Siobhain Duggan, Director of Innovation and Healthcare with GS1 Ireland.

Success and challenges of traceability

With traceability, the barcode technology can minimise lags and mistakes — and frees up time for healthcare professionals to make faster, data-driven decisions for patient care as they spend less time on administrative tasks.

Amanda Creane says: “At its core is patient safety and making sure the right product gets to the right patient at the right time.”

Moreover, it offers transparency and enables sustainability by reducing waste of medical materials as staff can easily keep track of them.

Why traceability is important

From a regulatory perspective, all medicines must have traceability details including expiry dates and serial numbers, Similarly, all devices need Unique Device Identification (UDI). With all this data to keep track of, GS1 is supporting the Scan4Safety programme to provide healthcare providers with the right traceability standards.

Siobhain Duggan adds: “Captured information is integrated into core end-patient systems. Linking items to patients comes with patient safety and efficiency benefits and in the event of a product recall, all information is accessible at the click of a button.”

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Due to an ageing population, healthcare provision needs to reform to become accessible and sustainable.

Patients living longer means there is a greater onus on patients to actively engage with their care. “We call this relationship the ‘Therapeutic Alliance,’ in which the healthcare professional is the recognised expert, but the patient — or their carer — is the expert in his or her understanding of their medical condition,” explains Eugene Canavan, Healthcare Design expert at PA Consulting.

Care-centred healthcare

This relationship lends itself to a data-driven insight approach which PA Consulting products and services support.

“Data becomes a bridge between a patient managing their condition and healthcare professionals who interpret data to tailor healthcare approaches that are preventive and therapeutic. Empowering patients allows for improved outcomes as well as reducing total healthcare cost,” adds Canavan.

Impact of patient monitoring devices

“Patient engagement relies on the usability of products and an understanding of the value that it is achieving,” explains Canavan. “For example, Viscero — an easy-to-use heart monitoring vest which is worn like a T-shirt and is truly wearable, monitors abnormal heartbeats — could provide months of clear and reliable data to a cardiologist.”

According to Canavan, World Health Organization (WHO) research demonstrates that the quality data approach engenders a more inclusive and empowering culture for patients.“Better data enables medical professional insight to evidence health trends to the patient. The patient can then receive that information and, working together, they can create a quality care programme.”

Patient engagement relies on the usability of products and an understanding of the value that it is achieving.

Why data is meaningful

“As a healthcare community, we are at the thin edge of the wedge in realising what digital healthcare can do, it has the potential to be truly transformative,” he says. “The uptake of healthcare technology is quite sporadic; not all healthcare providers have the same access to data or the means to manage and utilise large quantities of data,” explains Canavan.

“I hope this changes because, for a medical professional, having data over time is golden, as it is far more meaningful, providing the necessary insight to take preventive care approaches that benefit patients but also reduce cost and provision burden.”

Health providers can help drive digital healthcare forward

There may be hesitancy due to security concerns, data protection issues or lack of infrastructure. “For example, some healthcare systems have electronic records, but not everyone has access to them,” Canavan says.

He concludes: “As healthcare costs escalate, the system requires a different provision model, and we need to be part of a discussion whereby the value of data-driven healthcare is understood as part of greater investment in heading off illnesses.”

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The future of medicine lies in using data analytics and human-centric artificial intelligence (AI) to deliver personalised, precise and effective treatments to patients. Collaborative research efforts are currently finding new ways of applying human-centric AI in healthcare.

Technological innovations such as AI and machine learning have the potential to transform the Irish health industry. The challenge is to find new ways to leverage data to empower healthcare professionals to make the best decisions, based on the best available evidence. Interdisciplinary collaborative research focused on human-centric AI in healthcare therefore has the potential to make a powerful impact.

Improving health data

There’s an enormous opportunity to bridge the gap between disparate datasets in Ireland and effective healthcare decision-making. “There’s all this untapped intelligence in silos around the country,” says Declan McKibben, executive director at ADAPT, the world-leading SFI Research Centre for AI-Driven Digital Content Technology. “The low adoption of electronic health charts in hospitals hinders real-time, concurrent access to data.”

Research focused on improving data can prompt a quicker adoption rate of data-driven technologies, helping to bolster Ireland against future health crises and fuel human-centric innovations.

The low adoption of electronic health charts in hospitals hinders real-time, concurrent access to data.

Finding complex solutions

Taking an interdisciplinary research approach helps find robust solutions to complex problems in the health industry. Based across eight universities, ADAPT brings together leading academics, researchers and industry partners to address severe medical problems by using quality data and human-centred technology.

“Our interdisciplinary approach to research ensures a holistic approach, and our unique structure allows us to marshal the full breadth of AI expertise and deploy that into the health domain,” says McKibben.

Collaborative research success

Collaborative research and AI can make a transformative impact on healthcare professionals and patients in many ways. Using multidimensional, data-driven predictive simulation computer models, the researchers on the Precise4Q project aim to improve the lives of stroke patients by developing personalised treatment.

There’s also PrecisionALS, a project led by ADAPT, which will provide an interactive platform for all European clinical research in ALS (a motor neuron disease). By making large datasets accessible and creating a space for collaboration, the project produces better clinical outcomes for patients and reduces economic costs.

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Focusing on preventive care, improving working conditions and investing in technology are key strategies for building a brighter future for Ireland’s healthcare system.

It’s no secret that the current healthcare system in Ireland is under tremendous strain, admits Lana Kane, director at Medforce. “It’s all over the media that there’s a medical workforce shortage, from healthcare assistants to consultants.”

Ireland healthcare shortages

The ageing population has increased by 22% since the early 2000s, reveals Kane, and about 70% of this demographic has at least one chronic illness. “It’s increasing the demand for healthcare services. The Government is trying to invest in infrastructure and staff to meet it.”

Attracting and retaining talent is a huge challenge. “There isn’t enough staff in Ireland to meet demand,” says Kane. “Many are being enticed abroad by attractive packages. We try to recruit from other countries, but they have to do time-consuming specialised exams to work in Ireland, which can put off potential candidates.”

Medical professionals are working 80 hours
a week, which isn’t sustainable.

Restrategising healthcare

Reducing the strain on Ireland’s healthcare will take more than increasing the number of staff, warns Kane. Instead, an integrated strategy is required. “Long-term sustainability requires a multifaceted approach,” she says. “Investments in primary care and a focus on prevention are required to cut back on treatment costs.”

Accessibility and technology play key roles in improving healthcare. “By making information more accessible, patients can receive more coordinated care,” says Kane. “Technologies can improve medical delivery, such as telemedicine which frees up emergency departments for patients in urgent need.”

Improving working conditions

Despite challenges, healthcare will look different by 2050, says Kane. “Medical professionals are working 80 hours a week, which isn’t sustainable,” she says. “Shorter working hours are being looked at for a better work-life balance, such as reducing 12-hour shifts to six-hour shifts.”

The future will see more empowered patients who can manage their health from home. “Patients will be able to use community devices to collect data and send it to doctors to diagnose virtually,” Kane says. “It’ll reduce the burden on hospitals and move some primary care into people’s homes. The way forward is technology-driven.”

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