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Innovative technologies, electronic documentation and cost reduction: On development of digitalization in healthcare

Friday, 20 November 2020, 18:01:14

In his speech, the Head of State noted the importance of digitalization of the healthcare system, which includes the integration of databases, the creation of a monitoring system for patients undergoing treatment at home, and other issues. Already in 2013, taking into account the provisions of the state program Information Kazakhstan-2020, the Concept for the Development of E-Healthcare in the Republic of Kazakhstan for 2013-2020 was developed and approved. Read the review about the development of digital medicine in Kazakhstan.

The implementation of the Concept was supported in the Densaulyq State Healthcare Development Program for 2016-2019 and was continued in the state health development program for 2020-2025.

This year, the Ministry of Healthcare is assessing the results of the implementation of the Concept and is preparing a draft of a new strategy for the development of digitalization of healthcare.

Within 7 years of the Concept implementation, the introduction of information systems in all state medical organizations was ensured. Taking this into account, the ministry canceled the obligation to maintain certain types (forms) of medical records on paper.

Citizens of the republic are actively using mobile applications that allow making an appointment, calling a doctor at home, accessing test results and other medical information.

At the republican level, a number of national registers have been created and are actively used for management and financing purposes for individual nosologies, types of care and categories of citizens (patients). Key standards have been developed and approved to ensure the integration of health information systems.

In addition, the new version of the Code "On People's Health and the Healthcare System" provides provisions to ensure further digitalization of health care, taking into account the protection of confidential medical data.

One of the key achievements necessary for the successful implementation of the vision of digital health according to the Concept for the development of e-health for 2013-2020. is to ensure the continuity of medical care through the standardization of medical information.

Medical data standardization is a requirement that defines the formats of medical information, as well as the methods of its registration, storage and exchange in the health care system.

Experience of which countries taken into account in developing Kazakhstani project?

In the development of the Concept, the experience of countries that are leaders in e-healthcare was taken into account: Canada, Australia, Great Britain, Estonia, etc. In addition, the results of reviews and studies conducted by the World Health Organization, the Organization for Economic Cooperation and Development, WHO guidelines and the International Telecommunication Union (ITU), such as the National eHealth Strategy Development Toolkit.

Taking into account the experience of developed countries, the strategy for the development of e-health was reoriented towards the formation of an open market for solutions in the field of health informatization, based on the principles of demonopolization and decentralization.

The primary task is to create a stimulating and regulatory environment for the development and implementation of competing medical information systems. This approach involves the involvement of all stakeholders, including both health organizations as end users, and the private sector, represented by developers of medical information systems. This strategy has fully justified itself, providing competition and full coverage of the healthcare sector with medical information systems without the need to invest funds from the republican budget in the development, implementation and support of software for each medical organization in the country.

These institutional changes also meant a shift in focus from the collection of statistical data for government agencies to the collection and daily use of medical data by both the doctor and the patient. The objectives of the MIS are to automate the internal business processes of a medical organization, support the adoption of clinical and managerial decisions, a gradual transition to paperless management of medical information, assistance in improving the quality, safety and efficiency of medical services, and reducing the number of medical errors.

Currently, in order to implement the Code, the Ministry is developing regulations governing the field of tv healthcare, the provision of remote medical services, telemedicine and mobile technologies. The goal of these efforts is to legislate norms for the development of digital health.

How long will preparation take?

The complete digitalization of the healthcare system is a long-term goal that has not yet been achieved by any country in the world. According to analysts' forecasts, within the framework of digital transformation, not only new professions will appear, but also the requirements for representatives of classical specialties will change.

The IT sector is currently the fastest growing and what is innovation today will become obsolete tomorrow. Taking all this into account, it is difficult to predict the achievement of some final stage when it will be possible to conclude that the system is completely digitalized.

The criteria of healthcare digitalization used in international practice are constantly changing towards complication and the task is not so much to achieve a conditional maximum as to constant development.

At the moment, in Kazakhstan, individual medical documents are already being maintained only in electronic form, certain types of services are provided in electronic form, but there are whole sections ahead that are not covered by digitalization, such as work with the genome and personalized medicine.

The ministry nevertheless has certain plans until 2025, within the framework of the current Digital Kazakhstan and State Program for the Development of Healthcare.

During this period, it is necessary to implement verification and advanced data analysis tools on the basis of existing digital data collection tools. This will provide an impetus for the intensive development of the health care system at the expense of available internal resources, and not through attempts to constantly increase the number of hospitals, clinics, doctors and medical equipment.

What difficulties in country's health system do not allow transition to digital format?

Over the past 7 years, digitalization efforts have focused primarily on healthcare delivery. Kazakhstan was able to quickly implement a number of technologies, including medical information systems and mobile applications for patients. This was achieved by transferring this direction to a competitive environment and active collaboration with government medical organizations and private providers of information technology.

At the same time, the project to create a single platform at the national level that would integrate medical information received from various sources around a particular patient has not been completed. Such a platform is needed both for the patient himself and for the doctors who provide him with medical care, as well as for governing bodies and funding.

The public health sector is poorly covered by digitalization activities, which was especially acute against the backdrop of the pandemic caused by COVID-19. Insufficient attention has been paid to the collection of depersonalized data for scientific and applied research.

Many initiatives related to digitalization of healthcare stop at the pilot stage, as was the case with projects to implement artificial intelligence for oncology and augmented reality for medical education. This is due to the fact that it is difficult to monetize private investments or guarantee their return, since the health care system in the country remains socially oriented. In turn, the allocation of funds from the republican budget for activities on digitalization of healthcare was suspended taking into account the general policy on the transition to PPP projects.

There are infrastructural problems, including the availability, cost and quality of the Internet in remote rural areas, and the availability of good computer technology. Despite the work done to equip the work places of the medical staff with computers, many organizations continue to use morally and physically outdated computer models.

Not all healthcare managers and healthcare professionals are fully comfortable with the digital tools offered and the new opportunities that are emerging. For many older physicians, the transition to electronic health records is a challenge.

There are a lot of outdated medical equipment in the village, which does not transmit research results in digital format, or uses outdated data exchange technologies that cannot be used with modern computer equipment.

How and to what extent will healthcare digitalization simplify work of medical staff?

When properly implemented, digital tools can provide support for daily clinical practice at every stage and level of healthcare delivery:

  • facilitating the planning of preventive and planned health services;
  • acceleration and facilitation of diagnosis based on digital medical images (X-ray, ultrasound, CT, MRI) using artificial intelligence;
  • checking the correctness of the prescribed drug and its dosage, including checking for allergies and drug compatibility;
  • access to a complete history of diseases and seeking medical care, including access to vital information (allergies, intolerances, contraindications) in case of emergency and urgent situations;
  • notifications and reminders about cases or patients who need the provision of planned or unscheduled medical services;
  • quick access to information on the availability of free resources (drugs, medical devices, equipment, services, beds) for patient referral;
  • access to reliable depersonalized information for medical research, development of treatment standards and protocols, etc.

In general, how will digital medicine affect public services?

As a rule, the introduction of digital tools at the level of the healthcare system has a positive multiplier effect, expressed in an overall increase in the availability, efficiency and quality of medical care.

Case studies, implemented by the Organization for Economic Co-operation and Development show that ICTs in healthcare can:

1) improve the safety of health care;

2) improve work processes by facilitating administrative and clinical tasks such as prescribing drug therapy and supporting clinical decision-making at the point of care;

3) reduce operating costs for medical services;

4) reduce administrative costs;

5) achieve a “transformation” of care by providing the means to make changes that are otherwise impossible: by improving access to health care (telemedicine), by improving care for chronic diseases, coordinating care, and by improving feedback on the quality of health care. help.

The World Health Organization, summarizing the results of the pan-European study of digital technologies in health care, notes that digitalization of health care allows to expand the range of health services in conditions of limited resources, increase the level of transparency and accessibility of medical care and medical information, stimulate innovation and increase efficiency.

How much of republican budget will digitalization save in terms of financing medical industry?

Targeted allocation of funds for investment costs for digitalization of healthcare is not envisaged, and therefore it is not possible to calculate the amount of funds. However, digitalization of healthcare will apply private sector incentives for IT companies to independently invest in digitalization of healthcare, including through public private partnerships.

Planned effects of digitalization by the end of 2020:

- savings of about 187 million tenge on the purchase of paper on medical paper documentation;

- reduction in the number of purchased consumables for medical images (fluorography, X-ray, mammography, etc.) for 2 billion 165.6 million tenge;

- reduction of the time for registration of blood sampling by 2.5 times (by 60%) due to electronic services;

- reduction of the time for obtaining laboratory test results due to electronic services by 5 times (by 80%);

- reduction of time when assigning directions for laboratory and diagnostic studies due to electronic services by 4 times (by 75%);

- reduction of the processing time for house calls (by 80%) by 5 times;

- reduction of time when making an appointment with a district doctor (by 80%) by 4 times, when making an appointment with narrow specialists by 86.6% (by 7 times) using to e-services.

What problems in healthcare will digitalization solve?

Digitalization of healthcare is the use of digital technologies to transform traditional business processes in healthcare.

Similar to other sectors of the economy, such as banking or sales, where digital technologies make services faster, cheaper and more efficient for customers and service providers, there are many examples in healthcare of how digitalization can reduce costs, improve the quality and efficiency of medical services.

The simplest example of how digitalization affects the process of medical care is the use of mobile applications, thanks to which patients do not need to come back to a medical organization to obtain laboratory results, as they become available on a smartphone. This means not only saving the patient's time, but also reducing queues and employment of medical personnel.

A similar effect can be achieved with the use of telemedicine and telehealth systems, both for the purpose of providing remote counseling assistance and for monitoring chronic conditions.

Expert systems and artificial intelligence that assist medical personnel in diagnosing and prescribing treatment can improve the quality and safety of care.

Full access to the entire medical history of a patient, which can be provided provided the integration of disparate medical information systems through uniform standards at the national level, also contributes to the formation of a more complete clinical picture for the doctor and, accordingly, to making the right decisions during diagnosis and treatment.

Drug tracking and patient feedback systems can facilitate more rational use of drugs, especially high-cost drugs.

Business intelligence systems can help solve public health problems, including improving the surveillance of communicable and noncommunicable diseases, and predicting morbidity and mortality.

Augmented and virtual reality systems are used for medical education at the pre-pre-and post-graduate levels, thereby increasing the quality of education and the level of knowledge of students and practicing doctors.

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