A new nationwide Hospital Medicines Management System (HMMS) is being rolled-out by the HSE as part of overall plans to improve e-health service delivery in Ireland. Irish Pharmacist looks at how the new system will improve efficiencies in hospital pharmacy departments
A myriad of factors, not least among them the increasingly complex nature of healthcare delivery in recent decades, have resulted in the need for more efficient, labour-saving and streamlined ways of working in hospitals.
Our ageing population and the rise in chronic diseases are challenges that have contributed to a rapid increase in the cost of healthcare services and medicines.
Because of this, electronic or ‘e-health’ solutions are now more important than ever before in helping healthcare services meet patient demands while ensuring patient safety and the delivery of high- quality services.
The World Health Organisation (WHO) defines e-health as “the cost-effective and secure use of information and communications technologies in support of health and health-related fields”.
The eHealth Strategy for Ireland, published in 2013, led to the establishment of eHealth Ireland in 2015, an entity within the HSE charged with the digitisation of health processes and services. eHealth Ireland is managed by the HSE’s Office of the Chief Information Officer.
According to the eHealth Ireland website, ehealthireland.ie, e-health has the ability to deliver many benefits in the health service, improve efficiencies in hospital pharmacy departments especially within the areas of patient safety and quality of care.
E-health will enhance information by “providing for increased level of information flow, transparency, customisation, patient choice and responsibility-taking”, according to eHealth Ireland.
It is within this sphere that the HSE has embarked on the development of a new national Hospital Medicines Management System (HMMS).
Visibility
Under e-pharmacy initiatives at eHealth Ireland, which include the national e-prescribing project and the national medicinal product catalogue, the HMMS proclaims to be “an efficient and reliable technological solution to provide visibility of drug usage and costs, from procurement to drug administration”.
It is perhaps worth taking time to digest the last sentence to help understand the mammoth undertaking ahead of the HSE is achieving this aim.
Outdated systems undoubtedly pose a risk to patient safety and it is evident that effective medications management ensures medication safety.
Technology and automation are among one of the main challenges facing pharmacy. Many pharmacy departments in Irish hospitals have outdated information technology (IT) systems. Investment has
been lacking and communication between different IT systems within hospitals has been deficient. Hospital pharmacists store, dispense and procure medicines as well as providing advice and information on medication safety. They also provide learning and teaching to medical and nursing students in hospitals. According to the HSE, some 1,636 pharmacy workers were employed by the HSE in 2024.
The HSE has stated: “Hospital pharmacists work with patients and other healthcare professionals to optimise the use of medicines and to deliver safe, effective and cost-effective care.”
Hospital pharmacy teams routinely procure, store and supply medication for patients in busy environments.
The HMMS aims to make these processes much simpler. The 2025 HSE National Service Plan states that implementation of the new HMMS in acute hospitals and HSE community pharmacy departments will continue nationally.
Initiatives
The Plan outlines that several digital initiatives, including the HMMS, will cost €22.7 million in total funding in 2025 and €22.7 million in 2026.
According to the HSE: “Ireland’s health services have been challenged for many years on how to integrate care better, how to deliver better values, and how to ensure better safety and quality for patients. The biggest enabler of that right now, and into the future, is digital health”.
The HMMS is part of overall plans to improve e-health infrastructure nationally. The Department of Health ‘Digital for Care 2030’ plan, launched in May 2024, outlines plans to use digital technology to improve health services for patients.
The HMMS is part of efforts, outlined in the Sláintecare Report 2017, to put in place a modern e-health infrastructure to “improve data, research and evaluation capabilities”.
The HMMS will, according to the HSE, enable hospital pharmacies to effectively manage medication inventories, ward medication supply, patient-specific supply and “associated procurement processes”.
A HMMS project proposal was made in 2018 and the following year a business case was prepared. The first phase of the project officially commenced in October 2019.
In October 2020, the HSE issued a tender proposal seeking a provider to deliver the system and in 2021 a vendor was selected, it is understood.
The project contract was signed in 2022. Since then the system has been introduced in just two hospitals nationally: Galway University Hospital, and Merlin Park Hospital.
The system is currently being rolled-out on a “phased basis” across the country, according to the HSE. A HSE spokesperson told Irish
Pharmacist that “upcoming implementation sites over the next few months include the Rotunda Hospital, St Vincent’s University Hospital, Tallaght University Hospital, CHI Crumlin, Connolly Hospital Blanchardstown, Phoenix Pharmacy Dublin, and South Infirmary Victoria University Hospital”.
“Phoenix Pharmacy on the campus of St Mary’s is a pharmacy department that supplies medicines and clinical pharmacist services to a number of public facilities and the staff are employed by the HSE…
“The scope of the HMMS project does not include community pharmacies.”
Key features
“Some key features offered by HMMS include comprehensive stock control, order processing, label printing, reporting, and integration with dispensary robots and automated dispensing cabinets. HMMS interfaces with several other HSE systems; hospital finance systems including IFMS, hospital patient administration systems enabling single data entry and seamless data-flows between pharmacy, finance, and other hospital information systems.
“By leveraging global medication data standards, HMMS will enhance patient safety through standardised datasets, catalogues, and semantic interoperability. It will also support e-prescribing and e-discharge to create a modern, efficient medicines management ecosystem in Irish public hospitals.”
According to tender documents outlining system plans, when all phases of implementation are complete (and it is not yet know when this will be) the system will be in around 74 sites nationally and have 1,500 users.
“The HMMS drug file will have over 15,000 items, and will eventually be interoperable with the National Medicinal Product Catalogue (NMPC),” tender documents, which outline in great detail the benefits of the system, note.
“The system will provide real- time information to support the operational control and enhanced performance management of services within the hospital pharmacy. It will have enhanced functionality
in key areas such as systems integration, ward-based work, drug procurement, inventory management and finance. It will provide readily accessible, reliable data to inform medicines management in acute and non-acute hospitals.”
Fionnuala King, Chief Pharmacist, HSE Access and Integration Drug Management Programme, told Irish Pharmacist: “HMMS has improved efficiency and information flows in pharmacy departments through integration with other software systems. Integrated algorithms support live-stock control and ordering. Transition to a single national coded drug file in HMMS has vastly enhanced the data intelligence available to pharmacy departments.”
The HMMS will become the platform to support electronic prescribing and electronic medicines administration and will enable the management of all medications throughout the hospital system.
It will provide, according to eHealth Ireland, “eDischarge functionality that compares
the on-admission medicines to the discharge prescription and automatically generates a section on the discharge prescription/letter which identifies any modifications, suspensions, resumptions, or discontinuations. Any reasons given by the clinician for changes in status are also reported.”
The system will ensure greater oversight on medicines costs and processes in Irish hospitals at a time when the cost of medicines has increased exponentially and continues to increase.
A spokesperson for the Department of Health said that in 2023, a record €3.2 billion, nearly €1 in every €8 of public funding spent on health, went to medicines. In 2024, the spend was estimated at €3.4 billion.
Investment
“This is an unprecedented level of investment in supporting patients through the availability of the latest and wide range of medicines,” said the spokesperson.
“From January 2021 to November 2024, the State made an additional €128 million available for new drugs which has seen 204 new medicines, or new uses for existing medicines, approved for reimbursement by the HSE. This includes 74 medicines for oncology and 46 new drugs for rare diseases.”
The system is also being introduced following a major cyber-attack on HSE IT systems on 14 May 2021. The attack impacted more than 130 pharmacy applications and meant that all HSE sites were not fully operational again until September, 2021.
It is understood that if actions are not taken to upgrade all HSE IT systems nationally, this could leave the Executive vulnerable to another attack.
All of the challenges outlined above are being faced by countries internationally, with some having had more success than others in introducing e-health solutions.
In 2024, an eHealth Indicator Study from the European Commission on EU27 countries found that all member states except Ireland provided access to electronic health data though an online portal.
The study found that compared to an e-health maturity score of zero per cent in 2022, in 2023 the e-health maturity score for Ireland was 11 per cent. The EU27 average in 2023 was 79 per cent.
The findings illustrate that much has yet to be achieved to ensure digital health services are widely available in Ireland.
Notwithstanding the fact that the task in implementing a nationwide HMMS is considerable, the initial pace of developments has been slow.
It is yet unclear when all HSE hospitals will have a HMMS in place. Based on the speed of developments to date, this could yet be a decade, if not more, away.
According to a HSE spokesperson, the project is a multi-year endeavour and the pilot implementation phase has been completed. But the project has “not yet been scheduled beyond the current phase”.
