(HealthTech Wire / Interview) - Acceptance among doctors is a key issue in the digitization of healthcare system. Quite a number of projects run into problems here. The IT company Tieto is currently being engaged in several national EPR projects and receives good feedback from doctors. Arto Ryymin, Executive Vice President of Tieto’s healthcare and welfare business, talks to HealthTechWire about what he considers to be success factors in health IT both in institutional and in regional or national projects.
Doctors tend to say that their only interest is to provide best possible care to their patients. How can healthcare IT contribute to this goal?
There are four key elements through which IT-solutions help to improve quality of care, either directly or indirectly. First, they improve the utilization of capacity and knowledge. This is what patient administration solutions are there for. Second, IT-solutions can increase the accuracy of diagnosis and the probability of correct decisions. This is because doctors simply have better access to all decision-relevant data in a digital environment. Third, IT facilitates collaboration between care providers. And finally, IT makes care and care organization more independent from time and place.
Can you give some examples of how these considerations found their way into Tieto’s product ?
Let me give you a good example for the first aspect, a better utilization of resources. Automated and optimized resource planning solutions like appointment scheduling and bed site or ward management applications have been available for decades. But excellent planning doesn’t solve the problem of missed appointments which are quite costly and common in healthcare, especially in ambulatory and dental care. We have introduced a simple but very advanced solution that utilizes mobile messaging to reduce this waste of resources. Electronic patient records are another example: They increase the probability of having the right information at the right time immediately. Europe is quite advantaged in this area and e.g in Finland there is 100 per cent EPR coverage by now.
How about better collaboration and independence of time and place?
Better collaboration is very obvious. If we start with a simple case and take a patient who needs laboratory diagnostics or is referred to an imaging centre. In a digital environment, all necessary information is transferred digitally and is available before the patient even arrives. This means that preparations can be made well in advance, making life easier both for staff and for patients. And vice versa when the tests have been analysed, results and warnings of abnormal results receive the necessary units and specialists immediately. As far as independence of time and space is concerned: You just have to take a look around to see how things have changed already. Consulting a remote specialist digitally has become commonplace in many places. In a bigger picture regional and National solutions enable fully patient centric services and all necessary service providers can participate into shared service chain. This would have been completely unthinkable without IT solutions.
Still, there remains an issue with what is promised and what becomes reality in healthcare IT. Many doctors say that bureaucracy increases in spite of or even because of ever more IT solutions. How can this pitfall be avoided?
Bureaucracy is a word that we hate as much as doctors hate it. We all should try to avoid bureaucracy in all the possible ways. How can this be done? The first thing is to always have in mind what the main purpose of the work is. In healthcare IT, it is to make life easier for healthcare providers and patients. We should always focus on practical life and focus on the most relevant and important issues as well as continuously improve and develop further based on practical experiences.
What is also important is to have a certain willingness to adopt change when introducing a new IT solution. It is not always the best strategy to simply transform a scenario one by one into the digital world. When we work on new implementations, we always try to break down big processes into small steps and then eliminate as many steps as possible. And we have to try to automate whatever can be automated.
Regional or even national electronic patient records have become an issue in many countries in recent years. There are not too few projects of this kind that get into difficulties because doctors simply don’t use the EPR that is on offer. What factors will make a regional or national EPR a success?
In this particular situation, the key is to focus on needed information and usability.
This is not an easy issue and one key element is to offer the needed information in different situations on a right format. And here is a challenge: There are differences in the way information needs to be displayed and what information is needed in different treatment situations and in different patient cases. The core elements and information is the same in many cases but a doctor in an emergency department, for example, might have only 10 to 15 seconds to check basic patient data. In outpatient case it can be that there is 3-4 minutes and in other department, this time can be considerably longer. For IT systems this means that they should be flexible to these different situations in order to make them as user friendly as possible. Another big issue is the completeness of the information. It doesn’t mean that all the possible and thinkable information has to be available in all the cases but doctors must be certain that the most essential information is available and visible. This brings big challenges to the interoperability of systems.
Tieto is currently engaged in the national electronic patient record rollout in Sweden. What feedback have you received so far from doctors?
We started with the implementation in summer 2009. And the feedback that we have received so far is really very good. Doctors tell us that the fact that relevant patient information is available immediately has reduced lead-times and increased patient safety. And they also tell us that the EPR has helped to reduce administrative burden since there is less calling around for documents.
A recent trend is to increasingly integrate “quality relevant” modules like clinical pathways or medication safety software into health IT solutions. Is this really relevant already?
Quality relevant modules like medical interactions, exception warnings on laboratory results and critical information warnings have been on our offerings for quite some time already. We also have a number of very advanced customers who have been using clinical pathway software for some years already. Right now we are in the process of distributing these solutions more widely. The new coming elements are intelligent algorithms to support clinical decisions even more . I am convinced that these will certainly increase IT acceptance among doctors further. And these solutions should indeed have a measurable effect on medical quality of care, too.
Mr. Ryymin, thank you for your time and answers. (HTW)
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