Health information systems, the current state of affairs and future challenges.

It’s a typically busy morning for David Vidal. In spite of a hectic schedule, he’s set aside some time between two meetings to talk to me. The door to his office opens and he welcomes me inside. We sit at a round table, covered in files and papers. After making the necessary introductions, a fascinating conversation begins:

• In terms of usability and functionality, how should we go about developing or improving IT systems in the health sector?

In terms of usability, speaking in general and keeping in mind the length of time I’ve been working in IT in our sector, there’s a lot of room for improvement. Obviously there are a lot of projects currently underway and we’re participating in many of them. Different initiatives in every organisation, institution and health centre to improve the usability of our systems. From my point of view, this approach isn’t particularly sustainable, however, since we end up with lots of different systems and the same investment is repeated N times. If I remember correctly, I believe that there are currently 26 different IT systems in hospitals in Catalonia, which means if we plan on improving their usability, we need to undertake 26 initiatives. In terms of usability we’ve been trying hard for many years now; here at the Clinic in particular from around 2008 IT specialists began to use web technology to build a layer which improves the users’ experience.

In terms of functionality we’ve undertaken an integration process in such a way that everything that happens in the hospital in relation to the care process has a thread of continuity. For example, nursing used to have its own departmental system, ICU had its own system and different areas of the hospital worked with different systems. In this process involving improving usability we’ve integrated the healthcare process into a single system, leaving out tools where an event or information is generated which leaves the system and returns; such as laboratory tests or diagnostic tests. Issues such as the nephrology system aren’t dealt with as departmental [processes] since they are already part of the patient’s history and activity.
This is our vision of how things ought to be, and, without getting into a debate over the specific volume of the systems in existence, I believe that the systems can improve in this respect.

• Do they meet the organisations’ current needs?
  

If we think of organisations on an individual basis, yes, and moreover we’ve all started down this path of improvement. Thinking about whether the needs are met beyond the walls of each centre, is questionable; Although we have fully operational platforms, such as HC3 and iS3 which allow us to share information and part of the process, they often prove to be inadequate. Right now we are in processes with Barcelona Esquerra [1] and C-17 [2], and since we’re a major hospital we have a lot of connections, and these tools don’t provide us with enough capacity to share information concerning the patient’s process, since ultimately this is the centre and that’s what’s most important, to the level we really need [3]. So what we need to do is to keep making incremental improvements and this is where IT systems reveal their shortcomings in terms of the organisations’ needs when dealing with outside institutions.

• Do you think that an integrated IT system for the whole of Catalonia would provide a solution to meet our current needs?
  

My personal opinion is clearly in the affirmative, that it would help us meet these specific needs. Firstly, in terms of sharing information. If we have a single integrated system and a single database, since a database is virtual and non-physical, everyone would have access to the same data, to all the information. This is one of the most frequent requests from Primary Care professionals, for example, who need information on a patient’s treatment and need to access all their files. These developments are already underway, but it’s a slow process and an integrated system implies not having to send specific information but instead having access to a unique, shared system.
Such a system has certain disadvantages such as a loss of autonomy and the organisation’s IT system’s role as a strategic asset. Meanwhile, sharing information saves time and effort and optimizes the use of resources.

• What degree of autonomy should organisations have?
  

I believe it’s about establishing good governance that establishes working practices based on common needs for all organisations. So we don’t end up creating different solutions to a common problem. Therefore, talking about a governance model implies being able to agree on and create a way of providing feedback whereby everyone can express themselves freely in order to create solutions that help everybody.

• Should we be moving towards a unique, integrated model at the European level?
  

At the moment we are part of Spain and with the way the health system is constructed at the state level, I don’t see it happening. From the experience I’ve gained from participating in European projects and others in which we’re currently participating, I think we need to have a repository or clinical history which is the patient’s property which is of a transnational nature. It ought to be accessible from anywhere in Europe and the various integrated IT systems ought to have the ability to interact with this patient repository. Furthermore, with the patient’s permission, a healthcare professional belonging to the European healthcare network can freely access this information. These ideas are currently being considered.

• What new technologies are being introduced? Is your organisation developing any?

We ought to apply everything to do with Machine Learning, processing natural language and so on, the whole set which I usually lump together in under the umbrella term Artificial Intelligence. We’re conducting voice recognition experiments and tests to create user-friendly home-machine interfaces focused on healthcare professionals who often have their hands full and who are unable to interact with a machine. Another example involving the processing of natural language would be the development of a tool that lets us automate the assignment of diagnosis codes to improve our ability to generate CMBD more quickly. We’re making use of it the ER, with inpatients, for specialized care and we’re constantly making improvements.
One of the key elements is the diagnosis. We need to extract a diagnosis from every patient’s visit to the ER department; We have tools that extract this information, using ICD-10 codes, which are used to conduct a statistical evaluation of the healthcare activity.
Apart from this Artificial Intelligence package, I would also include data analysis to create predictive models based on neural networks that have high rates of effectiveness. This includes Big Data, large volumes of data used to generate predictive models, and blockchain. The idea is to guarantee the privacy, security and integrity of data by using technologies which are inherently secure.

• How do you think the current model of out-patient care ought to function?

Going back to my earlier answer, and considering that every organisation does whatever it likes and whatever it can according to its budgetary limitations, we are at different levels. My hospital, for example, is currently in the implementation phase of a new model of functional applicability. In response to this specific case, I can say that you get an idea of ​​what direction we ought to be headed in. From my point of view, we ought to move towards the development of tools which are integrated into the doctor’s workstation; and in terms of the patient, towards the development of tools which are integrated into the models of interaction with the health system.

• How can ICT empower patients within the healthcare process?

At present we are raising the public’s awareness. We can empower them by creating a system where society owns the data it generates. In other words, by obtaining full control and ownership over this data, for the patient, in accordance with the stipulations and legal framework in force.

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[1] The Hospital Clínic’s catchment area in relation to the city of Barcelona. Providing healthcare to 540,000 people via 19 Primary Care Centres.

[2] The Hospital Clínic’s catchment area in relation to the metropolitan area and based on the management of demand from third parties.

[3] IT systems don’t share a patient’s entire healthcare information when they receive care in different specialized care centres  such as a local, referral or tertiary hospital. The development of a fully integrated exchange of information is currently in the process of being developed.