Advancing Digital Access: The Future of Electronic Health Records and Citizen Engagement

Ireland faces significant challenges in enabling citizens to access their electronic health records (EHRs), a crucial component of modern healthcare digitalization. Implementing comprehensive legislation is essential to establish a robust legal framework for sharing health information, ultimately enhancing patient care and treatment outcomes. EHRs serve as a vital element in transforming healthcare delivery by replacing traditional paper-based records with digital systems designed for seamless sharing among healthcare providers and settings.

Despite the global push towards digital health solutions, Ireland’s progress remains slow. The Health Information and Quality Authority (HIQA) (2022) characterized the country’s healthcare information infrastructure as “immature, under-developed, and lagging behind other European nations.” A recent review highlighted that Ireland’s digital maturity is still low, with paper records predominantly in use. Currently, only five out of Ireland’s 47 public hospitals have implemented fully operational EHR systems, reflecting a significant gap in digital transformation. When compared across the European Union, Ireland is classified as a ‘beginner’ or an outlier in citizen access to health records, with the latter designation indicating notably limited engagement levels (European Commission, 2024; Department of Health, 2024).

About the author

Dr. Etaoine Howlett is a Senior Parliamentary Researcher at the Library and Research Service, specializing in social science research and policy analysis.

✉ library.and.research@oireachtas.ie

Harnessing Digital

The Digital Ireland Framework emphasizes the importance of a strategic approach to meet the eHealth target of ensuring all EU citizens can access their health records by 2030. EHRs are comprehensive digital summaries of a patient’s medical history, including diagnoses, treatments, medications, immunizations, diagnostic imaging, laboratory results, and clinical notes. Advancing these systems will significantly contribute to more efficient and patient-centered healthcare.

Potential offered by EHRs

EHRs can revolutionize healthcare systems by reducing errors through better documentation and tracking of patient interactions. The Health Service Executive (HSE) advocates that digitized records streamline workflows, decrease paperwork, and enhance communication among healthcare professionals. Public opinion studies reveal strong support for digital health records: approximately 90% of respondents wish to use EHRs to better understand and manage their health, track test results, and renew prescriptions. Overall, nearly 75% of individuals are interested in accessing their electronic health information.

However, concerns around data privacy and security remain significant among the public. An earlier engagement indicated that a majority of people want transparency regarding who has viewed their health data—82% expressed this preference—highlighting the importance of trust and confidentiality in digital health initiatives.

Access to EHRs internationally

The European Union’s Digital Decade sets ambitious goals for digital health. Benchmarking data from 2022 shows that all EU countries, except Ireland, already provide some form of access to electronic health records for their citizens. Ireland ranked the lowest, with a 0% score, indicating virtually no access at that time. By 2023, the EU average for digital health readiness rose to 79%, with Ireland improving marginally to 11%, yet still remaining the least advanced in the union (reference data from 2023).

Europe’s Digital Decade aims for universal online access to medical records by 2030. Countries such as Estonia have pioneered this effort, offering citizens portal access since 2008 that includes appointments, prescriptions, vaccination records, and access logs. The European Commission emphasizes that Ireland needs to expand access, include more data types, and onboard additional healthcare providers to meet these targets.

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Progressing patient access to EHRs in Ireland

The Irish government has prioritized digital health within its national policies. The 2013 eHealth Strategy identified patient access as a key goal, reinforced by subsequent frameworks like the Knowledge & Information Strategy (2015) and Sláintecare, which advocates for integrating digital tools into healthcare services. The current Digital for Care: A Digital Health Framework for Ireland 2024–2030 emphasizes empowering patients as active partners in their health management.

Several digitalization projects illustrate ongoing efforts:

The National Integrated Medical Imaging System (NIMIS), launched in 2011, now operates across 74 sites, allowing electronic storage of diagnostic images.
The Maternal & Newborn Clinical Management System (MN-CMS) provides a unified EHR for maternity, gynecology, and neonatal services, with coverage expanding across major hospitals.
Project Ogham features Epic, a new EHR platform, including the MyChart patient portal that will enable individuals over 13, along with their guardians, to access healthcare information such as medications, appointments, and hospital summaries.

In September 2024, a phased rollout plan was announced, introducing a new patient app scheduled for initial release in 2025. This app will facilitate appointment bookings, medication management, and referrals. Despite progress, the HSE’s Digital Health Strategic Implementation Roadmap acknowledges significant obstacles, notably the lack of interoperability between existing systems, which hampers comprehensive data sharing. Modernizing legacy systems and ensuring seamless integration remains a critical challenge.

Upcoming EU developments

The European Health Data Space (EHDS) aims to empower individuals with better access to their health information across member states. It also establishes frameworks for the secondary use of anonymized health data for research, policy development, and innovation, with implementation deadlines between 2026 and 2030. The EHDS envisions a unified digital health environment where citizens can access and share health data across borders via platforms like MyHealth@EU. This includes services such as ePrescriptions, enabling patients to obtain medication even when traveling within the EU.

Ireland’s National Strategic Roadmap aspires for 80% of citizens to access core elements of their digital health records, aligning with EU ambitions. However, the European Commission has noted that current national targets fall short of upcoming EHDS requirements. The framework emphasizes the need for Ireland to accelerate its digital health initiatives to meet EU standards.

Operational and legislative opportunities

Future developments in Ireland’s digital health landscape include regional deployment of EHR systems, with projects like ePharmacy and Project Ogham slated for 2026. The HSE is also developing a business case to expand these systems across regions over the next several years.

Legislation will play a vital role in enabling these advancements. The Health Information Bill 2024, which sought to establish a legal basis for EHRs and a ‘duty to share’ health data, completed its Second Stage before the dissolution of the 33rd Dáil. It must be reintroduced in the new parliament. Furthermore, legislation is needed to regulate the secondary use of health data, including establishing a national health data access authority and a permit system for wider data sharing.

The Department of Health (2024) reports that Ireland’s healthcare information infrastructure currently suffers from fragmentation, poor coordination, and limited digital maturity. Without decisive operational and legislative reforms, these issues are unlikely to be resolved, hindering progress toward accessible, interoperable digital health records.

Research Matters

Research Matters – Key Issues for the 34th Dáil and 27th Seanad provides valuable insights into the pressing topics legislators will face in the coming years. Compiled by expert researchers from the Parliamentary Research Service, these articles explore how Members of Parliament can actively engage with emerging health technology policies and reforms.

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