Moving hospitals to electronic systems isn’t always easy – but it’s always worth the transition, says SAP Healthcare Solution Owner, Jan Korten.
How can it be normal to use an MRI – a fantastically futuristic machine that builds an image of the patient from an oscillating magnetic field detecting the radio frequency of excited hydrogen atoms – but not normal to input the data on those results in a simple format so they can be used easily by other doctors? Yet that’s what I find every day. One of the most impressive hospitals I’ve visited recently uses the latest technology when it comes to clinical treatment but still uses a system of basic IT – printed forms, handwritten and ticked, which are scanned in.
Three transitions of medical records
I started working as a doctor before moving to IT and I’ve witnessed several transitions of recordkeeping competence. The first
transition, years before my time, was the simple move from handwritten doctors’ notes to typed – given the proverbially terrible handwriting of doctors, being actually able to read the notes gave a surprising boost to efficiency. Yet paper records can still only be in one place, which is very often not where you, as a clinician, needs it.
The second was transitioning to the stage that the hospital I mentioned is at; clinical delivery supported by an IT system that merely replicates the physical records in a unitary digital form, typically consisting of scanned-in documents. This ‘enter once, use repeatedly’ method allows clinical data to be reused, in orders or in patient histories – but first, that scanned form has to be found and opened by a human.
The third is the current state-of-the-art electronic data capture, using intelligent mechanisms that can combine different topics –
like the documentation of procedures carried out on a given patient – with billing and inventory control for those services. Here, data entered by clinicians is structured, so that it can be automatically shared with other services as a recognised data point. The system handles communication, documentation, scheduling, billing, and is the hospital’s primary work environment when it comes to IT.
Of course, the needs and incentives of doctors, nurses and therapists are different from those of the hospital administrators who need data for financial and administrative management. Clinicians want to spend their time delivering patient care, not boring form-filling where they’re endlessly looking up codes in a catalogue. Yet their co-operation is necessary as they are the primary source of all clinical information. This is the challenge.
You have to convince the clinicians that data management is not a threat or timesink and that it may influence their way of working in a positive way, more than just supporting the bureaucracy of the hospital. Thankfully, the arguments for the clinical benefits are already in place – such as clinical checking and decision support – and we have established change management programs to help these transitions.
A more understandable source of reticence on their part may also be that better data could be used to track their own performance. Current data systems don’t often support this, but it’s likely that the tracking of clinicians will be something patients come to demand – it is, after all, in patients’ interests and the hospital’s interest to know who the best and worst doctors are. Some doctors struggle with this. However, we’re finding that in some countries, the incentives for clinicians and nurses are based on
what they document. Where pay-for-performance is the norm, modern IT makes sure it’s accurate, which is great for the staff and for the hospitals.
I don’t know what the next step of record-keeping will be – in the long term, I suspect that clinicians will benefit from patient
biometrics systems that record straight into the hospital’s databases, voice data inputs, and ubiquitous augmented reality technology – but if we’re to achieve true clinical excellence, we need to overcome the attachment of some doctors to these legacy processes. With demonstrable benefits and stressing change management, healthcare organizations can be successful.
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