Last week brought two revelations about the national children’s hospital that capture Ireland’s infrastructure dysfunction perfectly. The 18th missed completion deadline. And news that once the building is handed over, it will take seven months to complete readiness. These announcements came shortly after a Medical Council’s inspection report documented information technology failures at Children’s Health Ireland (CHI) that pose direct patient safety risks.
The details are dystopian. Doctors need six separate passwords to access clinical systems. One thousand discharge letters sit backed up at Tallaght. Blood test results are communicated by phone. Junior doctors borrow colleagues’ login credentials just to do their jobs. The Medical Council warned that such IT failures “pose a serious patient safety risk, particularly for cases requiring follow-up communication with GPs”.
Here’s what should terrify us. The organisation that cannot implement single sign-on across three hospitals due to “budget limitations” has committed €360 million to implementing Epic, the most complex healthcare IT system in the world. It is attempting this while managing a €2.2 billion facility that has missed 18 completion deadlines. This is institutional delusion on a scale that would be comic if children’s health weren’t at stake.
CHI operates three legacy hospitals that each developed their own ICT infrastructure independently over decades. At CHI Tallaght, doctors cannot access the Evolve patient records system used at the other hospitals. They phone the laboratory for blood test results – a regression to pre-digital practices with obvious risks. The Medical Council found the Evolve system “lacked adequate administrative support for scanning and organising patient records chronologically”. Patient records are filed under “Legacy”, with no retrieval mechanism.
READ MORE
Management’s response to documented patient safety risks? Wait several years for a building that may or may not be ready, when modern digital infrastructure will solve everything. Meanwhile, known safety risks persist daily.
In July 2022, Cabinet approved Epic as the successful bidder for the new children’s hospital electronic health records (EHR) system, making the NCH “truly digital”. The vision is seductive. Seamless digital infrastructure, patient portals, clinical command centres, automated pharmacy systems. According to Dáil written answers from June 2024, Government approved in February 2024 a total budget of €2.24 billion, with €362 million allocated for “the programme of integration and transition of services to the NCH, including commissioning, ICT, and the Electronic Health Record system”.
International experience suggests the final bill could be dramatically higher. Cambridge University Hospitals’ £200 million EHR implementation in 2014 developed “serious problems” requiring ambulance diversions. A Norwegian government report found their national implementation “puts patient lives at risk” and costs proved “more expensive than foreseen”. Denmark and Finland faced similar challenges. Even in the US, implementation costs routinely explode. One big Boston hospital system’s implementation started at $1.2 billion and reached $1.6 billion by 2018. The software itself accounted for less than $100 million. Real costs came from lost productivity, training, implementation, and ongoing support.
Critics have said these systems require clinicians to spend two hours on documentation for every hour with patients, often outside working hours, and were designed primarily for revenue optimisation rather than clinical quality. Yet CHI has committed Ireland’s largest healthcare IT investment to this system while unable to ensure doctors receive email addresses when they start work.
The Medical Council documented that CHI management acknowledged “the intense focus on CHI’s capital development projects may have diverted attention from workforce and operational priorities”. This is organisational euphemism for fundamental failure. CHI cannot issue employment contracts on time. Some doctors went unpaid for three months. It cannot provide ID badges, leaving new staff unable to access buildings. Single sign-on is deemed “not realistic due to budget limitations.”
[ Medical Council urges ‘immediate’ fix to HR problems at Children’s Health IrelandOpens in new window ]
Yet this organisation is expected to successfully implement the world’s most complex electronic health record system across all clinical services, deploy a platform connecting 70-plus systems, establish digital building management, clinical command centres, patient portals and integrate with external HSE and GP systems.
The gap between current operational capacity and required implementation capability is not a gap. It’s a chasm. The approved €362 million must cover licensing, implementation, customisation, training, technical support infrastructure, system integration, data migration and ongoing operational costs. International experience suggests actual costs will be multiples of initial estimates. We could be looking at €720 million or more. Nobody is talking about this.
CHI is now being subsumed into the HSE. The organisation that couldn’t manage three hospitals’ HR and ICT systems will attempt an IT implementation under even more complex governance. The HSE will oversee implementation of Ireland’s most ambitious healthcare IT project at an organisation it is simultaneously integrating, while attempting to move into a building that doesn’t exist. This is governance architecture designed for failure.
And here’s where it gets truly absurd. This week Minister for Health, Jennifer Carroll MacNeill announced Government approval to commence procurement for a national electronic health record. We haven’t yet proven we can implement a system of this scale in one brand new hospital, let alone across the whole of the health sector. What happens if the system selected at a national level is different to the one already being implemented by CHI? We’ll have created yet another island of incompatibility, requiring expensive middleware to connect systems that should talk natively. This is strategic planning by institutional amnesia.
Ireland doesn’t learn from infrastructure failures. We repeat them with impressive consistency. The national children’s hospital has already more than doubled in cost. Ireland’s children deserve a world-class hospital with modern digital infrastructure. Instead, they’re getting a €2.2 billion building paired with a €362 million digital gamble managed by an organisation that cannot ensure doctors receive their passwords on time.
Paul Davis is associate professor at Dublin City University Business School
