Technological poverty in the care sector produces wealth

Nowadays you do your banking affairs, tax return and even your shopping via Internet. Isn't it strange then that staff and visitors in the care sector still use techniques from the previous century for their mutual communication? The availability of patient data should be no problem in the current information age, writes Peter van der Voort, Academic Director of the TIAS Executive Master of Health Administration, in this column.

A strange sensation indeed in 2016: patients who are transferred to another center of expertise, are given a printed letter which then needs to be scanned in order to be included in the local file. Family members who want to know how their loved one fared at night in hospital, have to phone the ward, with all the associated waiting times and transferred calls. Laborious, inefficient and incomplete.

For the provision of good health care, access to information is essential. Surely that should be no problem in the current information age? Background knowledge is readily accessible to the medical sector, certainly with the increasing number of open access journals. My children can no longer imagine a world without computers, Internet and Wikipedia. And yet the accessibility of patient data is still not standard practice.

In well-known hospitals, use is now made of reasonably complete medical files. But a link with the general practitioner's notes is not so common and certainly not a link with other hospitals! 

Emergency room

This is particularly problematical at the emergency room (ER). Due to the concentration of complex acute care, such as aneurysm surgery and intensive care, patients are referred to another ER than that of their own hospital. But basic background information about the patient is not available there, neither for the ambulance personnel nor for specialists such as ER doctors, surgeons and intensivists.

So doctors seeing patients at the emergency room (ER) who are not known at that hospital, have a crucial knowledge gap. This results in, for instance, reanimating patients who have a non-reanimation wish. Another example: ambiguities about "old deviations" on thorax photos which prevent a correct diagnosis.

Whatsapp

But eureka! These academics send each other a photo of a roentgen photo, an ECG or of a wound via Whatsapp to verify whether there is a correlation with an earlier observation and to consult with colleagues. A paltry solution for a much larger problem: namely the absence of knowledge sharing between health care institutions. Safety, privacy and competition are key concepts in the explanation for this.

Even if patients wanted to, they have no access to their own file. So they cannot grant access to necessary knowledge to doctors who are new to them. If a doctor asks another hospital for an old photo or earlier ECG, then that must first be arranged along secured channels. A patient requiring immediate medical attention cannot wait for that. So then better send a Whatsapp to an often known colleague.

We could forbid doctors from doing this, but that would not get us any nearer to a solution. A watertight system of information exchange would be better, preferably with the patient in control and with a built-in emergency provision for emergency situations.

Recent progress

Fortunately some progress has been made. Experiments are being made with online access to up to date information about hospital patients for next of kin and family members. And with information about (home) medication, it is now reasonably organized between the pharmacy and the hospital. And doctors? They try out their home techniques at work too because the health care (organization) doesn't innovate fast enough. That is on the one hand poverty and on the other hand a wealth to be valued.

Executive Master of Health Administration

Peter van der Voort is Academic Director of the TIAS Executive Master of Health Administration. This part-time program handles current themes in health care and provides participants with the right knowledge and skills to respond in a strategic way. With twelve months of lectures you will develop into a modern health care manager and strategist.

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