Digitizing health care - Why are we moving so slow?
My career has been centred around health IT for 30 years. When I was starting out, ‘punched cards’ were still in use; in business processes, I had to cope with a wide spectrum of data transfer media and I learnt and grew, together with the users, from black/white DOS solutions to state-of-the-art applications, cross-system data exchange, cloud storage, and mobile apps.
In recent years digitization is the magic word that is associated with many areas, and in health care it is present everywhere. Over the last 30 years, the world has seen tremendous technological advancements and I hope that with our solutions marketed under the HIPOKRAT brand we have managed to keep up, sometimes at a cruising speed, but other times thrusting ahead and setting the pace.
My visits to my GP are always specific. I want to know what kind of care the physician is able to provide, but I'm also checking what the staff is doing on their computers, where they go to search for information, where they enter their observations, what documents they give me.
Overall, I have observed that the work process has not changed much in all these years although the test results reviewed by physicians are available on the computer, and referrals, prescriptions and certain other forms are sent electronically, physicians still make handwritten notes, carry around printouts of test results, and the legislators require them to submit reports and summaries of data stored in centralized systems.
Are there no solutions available that would change this process?
I think there are, but the change of the process and its routine tasks that no one questions is a much greater challenge than technology. My colleague Aleš Štempihar provides an insightful analysis in his blog Digitality - informatization, and although the paper does not specifically target health IT, its relevance for the topic is undisputed.
So how can we empower (another buzzword) medical professionals and other stakeholders in the system to adopt IT solutions as an integral part of their process that generates added value in medical services, and to access data and information in paperless form wherever possible?
Pomembno je, da vsi deležniki v sistemu posodobimo svoje procese, jih prenovimo in na koncu digitaliziramo:It is crucial that all stakeholders in the system upgrade, redesign and, eventually, digitize the processes:
- THE STATE and its legislators in general (Ministry for Health, Health Insurance Institute of Slovenia, National Institute for Public Health):
- Promotion of existing solutions at the national level, informing citizens about the health data that is kept at the national level and should be accessible everywhere
- Collaboration among all stakeholders that leads to optimized exchange of data and information which is recorded where it occurs and used where it is needed.
- PHYSICIANS AND OTHER HEALTH CARE WORKERS:
- Redesigning the work process, implementing improvements that digitization may bring
- Acquiring competencies for a changed manner of work (physicians often have no time to attend IT-related training, have poor understanding of available solutions, and therefore use very few features)
- Active usage if national solutions such as eZdravje (eHealth) – sending own test results and using the documentation from the National Health Service Central Register (NHSCR).
- PATIENTS as stakeholders:
- We are not fully aware what the Slovenian health IT system is already able to do
- We walk around with papers in our hand, send documentation by email although the test results are in the NHSCR and the specialist should be able to access them
- We are not fully aware of our patients’ rights and we do not claim them (who wants to argue with a doctor, right?).
I have to tell you a funny story about a visit to the GP: After a routine surgery I had an appointment with my GP. The note said I should bring my discharge papers with me. Intentionally, I didn’t take the paper with me because I knew that the discharge was generated in a software solution. On reception, the administrator asked me for my discharge papers, sighed when I produced none, and then printed them out for me with just two clicks. The doctor checked my lab test results on her computer screen, and the discharge details on paper. What for?
DATA USERS (patients, doctors, legislators) are key to the success of the digital transformation, provided, of course, the solutions deliver what users require and provided they follow the standardized work flow.
We are also faced with similar challenges now, when we are getting ready to implement the InDocEDGE e-storage which we have successfully integrated into Hipokrat. The issue is not how to archive, but what.
What would a GP save into his private eArchive the results of a specialist examination that he can always access in the NHSCR? Why would he send there a prescription, referral, or a medical certificate that he had already forwarded electronically? Are we supposed to persuade physicians what to save and what not?
We will try to answer these questions, unify and simplify the process on implementing eArchive, and hopefully help all stakeholders understand that digitization is not just a change of the medium, but a change of mentality.
The article reflects the opinion of the author and not necessarily that of Mikrocop.