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5.2 Use of Resources
On foot of a review of internal processes three years
ago, the HRB made significant changes to how
staffing resources are utilised in relation to its health
information systems. The emphasis of the review
was the move from a system of organisation where
staff work on only one information system to one in
which they could use their skills across all five of
the information systems; and 2) the development of
an ICT solution within the HRB that would provide
a single technological platform for the five systems
to enable staff working in this area to develop a core
set of computer and analytical skills that are more
widely applicable within the organisation.
These two factors represent the critical success
factors needed for the ongoing operation of the
HRB’s health information work and by implication,
better use of its existing resources. Both of these
objectives were identified as core to the integration
and streamlining of the health information systems
work, which is consistent with the overall
framework for health information here in Ireland
(HIQA, 2017a) and internationally (OECD, 2013).
5.3 Assessment of People Dimension
The research shows that ICT redevelopment and
staff reorganisation were two key change areas for
the HRB health information systems. The socio-
technical approach suggests that both of these
changes are inextricably linked; staff need to be part
of the early consultation about a new ICT system
and have to be involved in all stages of its design
and development. While this takes considerable
time, it is supported by much of the literature on
socio-technical theory around the importance of
people in the development and implementation of
new ICT systems (see Goldberg et al., 2011;
Cresswell and Sheik, 2014).
The focus on a shared ICT platform for the
HRB’s five health information systems, combined
with a sharing of staff resources across the systems
is important not only for its emphasis on better use
of resources but also as a move towards an
integrated approach, which is part of the national
agenda (HIQA, 2014). As noted earlier, HIQA
identified the HRB’s work in this area as an example
of good practice (HIQA, 2014). Work is ongoing in
the roll-out of the new ICT platform training of all
HRB staff and system users is under way.
6 CONCLUSIONS
This review of the HRB’s health information
systems shows that there is a broad range of
processes at play within and between the 5 systems
in achieving their goals and objectives in the
delivery of key national health data. The five
systems vary significantly in how they collect,
organise, manage and disseminate data. Each
system developed in response to a particular
information need and without reference to the other
systems in the HRB. This mirrors what happened
nationally in relation to decisions about the
establishment of health information systems. Over
the last two to three years, however, there has been
increased recognition of the need to develop a
greater coherence within and between the five
systems. This is in line with the need to develop
integrated approaches to health information, which
is consistent with views nationally and
internationally.
In relation to policy, there is some evidence to
suggest that over the last decade, the implementation
of policy in relation to health information in Ireland
has been slow largely because it has not been
afforded any priority at national level. As a result,
the 5 HRB systems reviewed developed in a
piecemeal fashion without reference to any national
standard.
With regard to infrastructure, the HRB systems
also exhibit patchiness in how they have addressed
issues such as governance and accountability,
quality, evaluation and audit and standardisation.
An examination of the systems showed that very
little attention was given until recently to measures
designed to achieve integration within the HRB. In
this respect, the HRB’s systems can be viewed as
examples of how health information systems in
Ireland have grown up over time. The findings of
the research suggest, however, that slow progress is
being made towards a more coherent approach to the
data held by the HRB.
In relation to people, the analysis acknowledges
that changes in the use of staff resources in the HRB,
combined with the development of a new ICT
solution, have been important to the organisation’s
work in recent years. At a broader level, efforts are
in train to skill up a more generic health informatics
workforce which will be able to work across systems
and apply a generic set of skills and expertise.
This documentary analysis was organised based
on national guiding principles and standards set out
by HIQA. The experience of the HRB’s systems
suggests that there is still some way to go to develop
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