The dormant potential for digitalisation in medical practices
16.09.2019 – Marco Dubacher
Expert article for the IT for Health Special of Netzwoche from 11 September 2019
Healthcare costs are rising, unchecked, for Swiss households. How can this trend be countered without compromising the quality or range of services on offer in the healthcare sector? Digitalisation is opening up a host of promising opportunities for medical practices to enhance their internal efficiency and improve treatment quality.
The electronic patient dossier (EPD), a personal health record that collates a patient’s treatment-related documents, will be available throughout Switzerland by the spring of 2020. The law requires every hospital to join a certified EPD community and, thus, participate in the EPD scheme.
This scheme, which will soon be a reality for hospitals, may also become a requirement for medical practices in the foreseeable future. There are 14,200 such practices in Switzerland and a substantial proportion of them still have a long way to go to achieve centralised digital management of patient data along the lines of EPD. So where do the challenges for practice information systems currently lie? And how will they evolve in the future?
Stumbling blocks in the day-to-day running of a practice
An array of processes take place in a medical practice; from coordinating appointments through managing patients’ histories, medication and lab results, to invoicing. The majority of practices make use of non-integrated, or standalone, solutions to manage a portion of these tasks.
Only about half of all practices in Switzerland have opted to fully digitalise and standardise all of their processes. The remaining 50% are still taking down entire patient histories with pen and paper. The advantage of the old way is that it allows information to be noted down quickly and simply but it also entails a range of disadvantages – for instance, practice staff have to draft a patient’s hospital referral from the doctors’ handwritten notes. This is inefficient, error-prone and generates unnecessary costs.
Practice information systems are, thus, being deployed to simplify and optimally support the input of information for medical histories and other uses – for example, with pre-defined blocks of text. This helps to minimise the effort needed to capture the data electronically and enables data entry to be carried out more efficiently. After all, the focus of any course of treatment should be on the patient, not on data capture.
The opportunities offered by digital transformation
However, digitalisation is about far more than simply computerising current processes. The following example of medical diagnostic procedures shows just what digital transformation can achieve.
When defining exchange formats, it became clear that there are major differences in terminology and/or classifications. A recurring requirement for more comprehensive and, in particular, inter-disciplinary terminology was identified, along with a need to codify complex medical facts in a standardised, semantically correct and technically conclusive way.
The established international SNOMED CT standard (Systematized Nomenclature of Human and Veterinary Medicine – Clinical Terms) codifies medical information in the required exchange formats, allowing diagnoses to be captured using standardised, language-independent codes, which, thereby, provide the basis for semantic interoperability between systems.
In the specific case of a patient referral, it will be possible to transfer the semantic content of a diagnosis from the practice information system to a target system, thus simplifying interpretation of a diagnosis for the attending specialists. In addition, treatment methods can be automatically suggested or potential complications flagged up in the target system via Clinical Decision Support.
Things look rather different in reality, however. Most doctors tend to write up a diagnosis in longhand as they feel a more comprehensive description is required. The upshot is that these diagnoses are stored in an unstructured form on practice software systems.
This raises the question of how the gap between longhand entries and structured input with a codified system can be bridged in today’s world. Natural Language Processing (NLP) is one option. NLP is both a technology and a methodology for computer-based processing of natural speech. With the aid of rules and algorithms, the diagnoses recorded in longhand can be automatically represented in codified systems such as SNOMED CT. These systems are already being used in some hospitals and they will sooner or later find their way into practice information systems as well.
Self-empowerment through collaboration
But how can information make its way into a practice software system with no manual input at all? The buzz term that invariably crops up in conjunction with eHealth is “self-empowerment”. This is all about fostering individual health literacy; raising awareness about the importance of taking more personal responsibility for one’s health and, thus, motivating people to pursue a healthier lifestyle. Digital and mobile solutions like fitness trackers and health apps are already providing support here.
It’s not just digital natives but also, increasingly, the older generation who are collecting a wealth of data in health apps. Independently, they are logging health-relevant data such as blood pressure in order to visualise and analyse data flows or trigger healthy choices – a phenomenon that is often referred to as the “quantified self”. Working from physical readings, emotional condition and lifestyle; such as sport, diet, stress and sleep, the individual’s state of health can be tracked in real time and expressed as a “health score”.
To evaluate this data within a wider context, it may make sense to transfer it to a practice information system where it can be analysed by specialists in a system-supported format so that steps can be taken where necessary.
In Fast Healthcare Interoperable Resources (FIHR), a standard is currently being established that enables data collected by apps to be exchanged with practice information systems, with no manual input. Such data transfer could open the door to a range of new services. A practice information system can “automatically” monitor a patient and alert specialists in an emergency, for example. Anomalies can also be spotted during general observation and the patient may be invited to attend a doctor’s appointment, for instance, or a prescription for medication may be issued automatically. People requiring care can live at home and yet receive optimised healthcare, even as costs are being saved thanks to more efficient work processes.
Enhancing quality through new design
Digitalisation of processes and systems in medical practices is currently still in its infancy. In a huge number of cases, only a small proportion of processes are digitalised and yet a multitude of technological possibilities and standards are now available offering the potential not only to optimise existing processes but also to redesign them from the ground up. By ensuring more efficient interoperability between systems and greater integration of patients into processes, digitalisation may offer an escape route from spiralling costs, while expanding the palette of services on offer. This will benefit not only patients but also doctors, who will be able to spare their charges more of their time and improve the quality of the treatment they provide.
This article was written by Marco Dubacher, Project Manager E-Health at Ergon Informatik AG.