Sri Lanka is on the brink of a revolution in health care. The Health Minister’s recent announcement of creating 300 digitalized hospitals has been welcomed as filling a need for faster analysis, diagnosis and management of patients.
The digital infrastructure has already been set up as far back as 2009, with the adoption of Electronic Medical Records (EMR). Besides automating manual tasks that impede patient safety and care, digital health care paves the way for delivering the highest quality care to most persons at the lowest cost.
The Sunday Observer spoke to Coordinator, Directorate of Health Care Quality & Safety of Health Ministry, and General Physician, Dr Ramya L. Premaratne for more insights into this new approach to health care.
Excerpts…
Q. The Health Minister has recently said that he proposed digitalizing 300 state hospitals by 2019. Do you think that bringing IT into our health care system is a long overdue need?
A. This is the opportune time for it.
Q. Do you honestly believe we are ready to take on those challenges?
A. Yes. We have a high level of computer literacy and technical knowhow among health care professionals and with the recent developments in IT infrastructure these challenges can be overcome.
Q. What is the link between digital technology and health care? Firstly, tell us what digital technology is as it is a relatively new concept. How did it develop and what was the reason?
A. Connected health, also known as Technology-Enabled Care (TEC), involves the convergence of health technology, digital media and mobile devices. It enables patients, health care workers and Health Care professionals (HCPs) to access data and information more easily and improve the quality and outcomes of both, health and social care.
Digital health is the convergence of digital and genomic technologies with health, health care, living, and society to enhance the efficiency of health care delivery and make medicines more personalized and precise.
Q. Do you foresee a future where health care will increasingly rely on IT to improve efficiency and quality care in the near future in Sri Lanka?
A. Yes, especially, with e health initiatives efficiency in the health care sector will improve by leaps and bounds in the medium term.
Q. What kind of benefits will a digitalized health care environment bring to our health system?
A. Digital health care environment can improve the efficiency and quality of care in 8 ways
1. Better Storage Capabilities: An improved health care IT plan can greatly increase an organization’s storage capacity. Medical records become less of a nuisance to store for longer periods of time, and through various available computing systems become easier and faster to retrieve as needed. This also means less paperwork and saved time for health care professionals.
2. Better communication among staff: IT solutions implemented in-house can provide professionals better ways to communicate in real-time.
3. Security & Privacy: With health information, there is always a great concern for privacy, especially, in this volatile digital age, where identity thieves and other information crooks are constantly developing new ways to compromise the computer systems you already use. The answer is beefed up security to prevent errors and protect patients from mistakes: Structured Health care IT can help prevent errors, promote accuracy, and sustain procedural correctness at every level of the organization.
4. Increased Efficiency: Computer systems streamline the many different medical care processes, allowing for a more productive treatment experience. Learn how IT can reduce the instance of unnecessarily repeated tests and automate processes that used to be manual.
5. Patient Access to Information: Along with allowing health care pros do their jobs better, IT solutions also open up doors for providing better information to patients about their condition or the procedures they undergo. Patients can get more access to their own medical records, personalized health care information, and opportunities to take a more hands-on role in their own care.
6. Reach Out Through the Web: Through social media and the worldwide web, health care providers can communicate with patients and possible future patients to promote healthier habits and lifestyle choices. There is a great need for this, as more and more citizens are seeking their health information online, often from unreliable sources. Qualified health care professionals can tap into this demand by providing better information and simultaneously grow their practices through internet traffic.
7. Reduce the Costs: Increased efficiency at any level often results in reduced costs, and these costs can help lower the bills for patients who need quality health care on a budget.
Q. With a rapidly growing population and so many health care outlets scattered around the country, will digitalized health care help to improve the efficiency of delivery of services? How?
A. Yes. Sri Lanka has a fast aging population. Our demographic pyramid is already middle heavy, and in another 10 to 20 years we will be burdened with an aged population that is afflicted with chronic disorders such as, diabetes, hypertension, ischaemic heart disease, stroke, cancer and chronic kidney disease, to name a few.
Various domains
Assistive technologies and rehabilitation robotics This means the use of rehabilitative systems and devices, for patients with disabilities to aid in their independence to perform daily tasks.
Clinical decision support
The use of decision support systems to aid clinicians at the point of care. This includes diagnosis, analysis and interpretation of patient-related data.
Computational simulations, modeling and machine learning approaches The use of computational and mathematical equations and algorithms to model health-related outcomes.
E-health
The combined use of electronic means to deliver health information and services so that data can be transmitted, stored and retrieved for clinical, educational and administrative purposes.
Assessment and monitoring
The use of any technological intervention to prevent, diagnose or treat diseases, monitoring of patients, or for rehabilitation or long-term care.
Such technologies include assistive and rehabilitation technologies, unobtrusive monitoring sensors and wearable devices.
Health systems engineering
The use of engineering applications in health care systems, such as, knowledge discovery, decision making, optimization, human factors engineering, quality engineering, and information technology and communication.
Human-computer-environment interactions
The study of interactions between people, computers and their environment. Human-computer interaction principles tend to be based around, user-centered, experience-centered or activity-centered designs.
Information management and policy
The continual process of systematically reviewing and providing concise data summaries of high quality evidence on digital health care technologies based on principles of information design so as to inform decision and policy making regarding patient care.
Virtual reality, video gaming rehabilitation, and serious games
The use of 3D virtual worlds and gaming technologies to provide a social and interactive experience for health care student and patient education. The popular “Second Life” virtual world is an example.
Speech and hearing systems
The use of natural language processing, speech recognition techniques, and medical devices to aid in speech and hearing (e.g. cochlear implants).
Telehealth, telemedicine, telecare, telecoaching and telerehabilitation
The use of telecommunication and information technologies to provide various forms of patient care remotely at a distance.
Q. Tell us about the designing of the digital solution
A. The prototype solution is designed and developed with the aid of various stakeholders according to principles of human-computer interaction, and/or activity-centered designs.
Q. How is it evaluated to ensure effectiveness and safety?
A. The technological solution is pilot-tested in patient and user groups to ensure its effectiveness, safety and affordability. Impact evaluations are then carried out in large-scale clinical studies and/or trials, and the evidence is synthesized through published literature. This may also include clinical studies that evaluate the economic impact.
Q. There is now a communication gap between science and the public who often remain in the dark about their conditions and procedures. If they can use e-technology to access their medical records and personal files it has been argued that it will help patients to have a more hands-on role in their own care. Your opinion?
A. Yes. It will give the much-needed connectivity to the people living in the most remote parts of the country. To go with it, we should implement a cloud-based Central Personal Health Record System for our entire population, managed by the government. In this system, the personal health record of every individual should be owned and controlled by that individual via mobile Internet access using smart phones. The individual could give access to any health care.
There is an app that allows a person to take his or her own glucose readings every five minutes by wearing a tiny sensor on the body.
It transmits data to a watch or smartphone for pennies a day and makes patients’ glucose levels much easier to monitor. In future, patients will have virtual health coaches if desired, and receive alerts when their data shows a concern, such as, a rise in blood pressure or glucose levels. The virtual coach will even be able to issue a warning when the data signals a possible asthma attack, seizure or other preventable episode.
Q. Cost benefits ?
A. With the right technology insight, medical device developers can provide the health care system with cheaper, faster, and more effective treatments.
Q. Will electronic technology help in better distribution of medical drugs etc.?
A. Yes.
Q. What is the Health Ministry doing to raise awareness on this new approach to health delivery to the common man?
A. It will be a gradual process carried out by medical professionals at clinics, workshops and through print and electronic media.
Q. The future plans of the Ministry? Will all hospitals in the country be digitalized in the near future? If so when?
A. It is planning to digitalize 300 state hospitals by 2019. The transition is already taking place in the West, and we cannot be left behind. The CKDu epidemic in the North Central part of the country should be an eye opener for everyone that we need to wake up and face new challenges.
Q. What is the goal of a digital hospital?
A. The goal of a digital hospital is to automate as many of these tasks as possible to improve staff efficiency, information accuracy and overall cost savings. Once processes are well understood, technology solutions can be streamlined and integrated. Essential to this integration is implementation of Information and Communications Technology (ICT) that interconnects all aspects of care delivery and hospital administration. If properly integrated and automated, these processes have the potential to unite patients, doctors, staff, assets and information throughout the hospital.
Q. What is needed to achieve this goal?
A. For transformation to succeed, hospitals will need to adopt both technology and process improvement strategies to enable secure access, exchange and analysis of patient information and to create greater efficiencies in clinical processes.
These strategies will give rise to a more patient-centric care model through better monitoring and management of wellness and chronic disease and enable cost containment while improving overall health care delivery system.