No, this is not a quote from an article in Pulse, nor from a English doctor in a hospital near you, unless you live in Sweden and read this. This is a quote from an article in the latest issue of Sjukhuslakaren (the hospital doctor) featuring the state of eHealth in Sweden (more of this further down).
I spent most part of this week in beautiful Copenhagen, Denmark where European leaders, vendors and health professionals gathered for the eHealth week to share experience and views on where eHealth is going in Europe. Denmark put on a good show, boasting its success over the Patient Index, joined up systems etc. But behind the scenes another view of reality was talked about:
- Frustration over lack of interoperability
- Procurement that takes so long that the solution is out of date when it’s finally being implemented
- Lack of standardisation
- Inadequate upfront ownership by executives and clinical leads
- Out-of-date systems based on requirements developed 10 years ago
It seems that even countries we thought were a bit more advanced than ourselves face the same problems we do here in England. In fact, the leaders from Europe praised the successes here in England – from our infrastructure to NHS Choices. Just like here there are programmes in place across Europe to address the issues above, but progress is painfully slow.
And for us in England all work we’re doing takes place within the current framework of how healthcare is organised and delivered, how eHealth and IT is viewed and procured, i.e. we are trying to make improvements on the ‘as is’ situation. Rarely do we stop and think, why aren’t we a bit more radical. We know we can’t be sustainable in the long term in the current framework.
Why can’t we in industry take on the leadership mantle and say this is actually how it should be. This is how systems should look like; how joined up care enabled by ICT is delivered; this is how we can enable patients and service users to take ownership of their care, their records, and their information.
I know there are leaders in industry who are thinking this way and want to be a bit more radical. But it’s difficult when we have to operate in the current world as well to survive. I have some hope that the forthcoming Information Strategy for Health and Care will help spur us from debate to action. But as industry start thinking in new ways, designing all-in-one systems with under 10s logon process, digital identities, accessible online, over smart phones and tablets, where the data is hosted and shared in a uniformly coded language we must not forget the needs of the professional user and ultimately the patient.
At a UK Trade and Investment breakfast event at the UK Embassy in Copenhagen we were shown a picture of a patient in Denmark who had been given a home monitor device and used it as a coaster for a vase with flowers because it did not fit that person’s aesthetic and social views. Needless to say there was no data collected nor did the device help that patient feel better. I heard from a doctor who complained about the design of systems not being up-to-date to how care is delivered, but admitted doctors are not good at clearly telling vendors what they want and how it should look, and did not know how that could be improved.
So the message is: industry should lead more, but to never forget the professional users of the systems or the patients and services users – know your customer I guess it means. I do believe this will be the key challenge to overcome for us to successfully deliver on the forthcoming Information Strategy here in England as well.
How can we succeed in this? What do we need to do to let loose the imagination and ingenuity of the industry but at the same time ensure development is with the users and ultimate end user in mind? I’m open to ideas.
Now to something different: a market update on the Swedish eHealth market
The same journal, Sjukhuslakaren, which provided the opening quote, ran a survey (in Swedish, let me know if you need translation help) of the Swedish counties responsible for delivering health and buying IT solutions. In the survey they outlined the current EHR systems in use and the plans for buying new systems or keeping existing ones.
For vendors eyeing the Swedish EHR/PAS market, be ready for disappointment. Most counties are planning to keep their systems for at least another five years.
But that does not mean the counties or hospitals are pleased with the systems. There is great frustration about lack of integration (even where hospitals in a region use the same system), out-of-date systems with limited functionality, and disconnection from what’s being delivered nationally by the National Board of Health and Welfare via CeHis (centre for eHealth) and their annual 300m SEK budget. The doctors interviews all said they ideally would want systems that provides all-in-one functionality for the surgeon, the nurse, the pathology to the patient herself having online access and communication channels to her carers.
The journal also goes into an interesting review of Epic by a team of Swedish doctors, but not for me to comment on.