The future of hospital IT

What is the impact of the internet and related technology developments on hospitals? 

It is certainly changing the way we communicate.  The days when hospitals simply handed out brochures as their primary means of communication are clearly numbered.  The emergence of the web and social media are changing communication practices pretty fundamentally.  Some leading hospitals are discovering the merits of social media.  For example, the reputed Mayo Clinic in the U.S. has over 120,000 Twitter followers; they’re really cultivating this type of communication.  We haven’t started using such social media platforms yet, but we are making progress developing and testing a new web-based communication interface for our patients.  MyUZ, as we call it, will enable a totally different way of communicating with patients.  At this stage we have several hundred patients on the system while we fine-tune it for official launch in 2011. Basically it is a communication platform that will deliver very personalized information to patients about what they can expect before, during and after their hospital stay.  It doesn’t compete with the general information out there on the web; the objective of this system is to give people very specific information that is linked directly to their medical record and treatment plant.  We expect this to become a very important service.

What do you make of patient empowerment and the emergence of personal health record platforms?

Patient empowerment is a pretty hyped concept at present but it is important.  Essentially it is about involving patients more in the decisions that are made regarding his or her treatment and in the monitoring of their condition. In that sense it is also about responsibility.  As health care providers we can offer patients more resources to make decisions and help manage their condition, but it does require patients to accept that responsibility.

In principle it should be possible to link hospital information platforms like ours to personal health record systems.  For example, in our platform you can enter your blood pressure and it will create curves and alerts, but it tends to be focused on the patient’s specific illness and treatment.  Personal Health Records such as Google Health and Microsoft Health are focused more on general health indicators.  In that sense you could say that we have complimentary platforms.

It is important to emphasize that MyUZ is not a replacement of the information that patients receive during the consultation with the physician; on the contrary, it is an alternative source of information.  The problem with the consultation is that patients typically have difficulty processing all the information received during that short time.  With MyUZ you get drip-fed the information which makes it much easier to process.  

How is the country’s e-Health strategy progressing?

The e-health platform in Belgium is on track.  A number of basic services are currently live and there are several projects on the go to create additional authentic sources of medical data.  These projects are implemented by several large provider networks organized around key hubs, such as the University Hospitals of Gent, Charleroi and Leuven. One of the important technical developments is the time stamping model that we developed for the eHealth Platform and was handed over to them. This was accepted as an alternative to solve the key challenges related to the use of digital signatures in a hospital setting.  As it stands now, creating a digital signature is only possible via use of the electronic identity card and the entry of a PIN code.  But that is almost impossible to implement in a hospital setting.  You cannot ask a physician to use his eID and type in secret codes a hundred times a day.  Also, the ID cards wouldn’t be able to cope with such intense use—they were designed to handle about 5000 signatures per year.  The solution to this problem is a trusted time stamping model.  It basically allows the hospital to timestamp an entry in a medical record in such a way that the entry cannot be changed afterwards without breaking the trusted timestamp. All this can be done without sending the medical data to a third party. This is a great improvement on the previous model and is currently used by 30 hospitals.

Do you see opportunities for the remote monitoring of patients?

The remote monitoring of patients’ health should become increasingly important but I suspect that only ‘slow’ monitoring—where patients take responsibility for their own monitoring via self-report or diary methods—will gain traction in the near future.  At present, the problem with automated telemonitoring—for example where a device monitors a diabetes patient’s blood sugar level and automatically relays this data to the health care provider—isn’t technical but legal.  Who is responsible if something goes wrong: the health care provider, the patient, or the technology vendor? As of yet there is no legal framework that will encourage the use of such technology.  It will take time.  But I believe that self-report approaches using online tools will take off in the coming years.  Ultimately this is about empowering patients; encouraging them to take responsibility for the management of their illness.  Automated telemonitoring could lead to the opposite; it could give patients a false sense of security.

Could technology have a disruptive impact on the way health care is organized?

I don’t know if there is anything really disruptive about eHealth.  It is certainly going to improve the way we work but I don’t know if it will fundamentally change things.  For example, our clinical workstation is being rolled out at five other hospitals.  That will make it easier to collaborate across sites via the sharing of a single medical record.  The treatment process across different hospitals will be easier to coordinate. It’ll be more efficient in the sense that we’ll be able to allocate our resources—people and infrastructure—more effectively.  And we’ll be able to collect a huge amount of data, which is great for research and quality improvement.

Some people argue that the emergence of medical data platforms like eHealth or the patients networks like PatientsLikeMe where patients share medical data will lead to fundamental changes in the way research is done.  I don’t know.  Legally, we can’t simply start doing research using data from other hospitals.  What we can do is recruit patients for clinical trials from several hospitals.  That way we create scale too.  But that’s still within the confines of clinical trials and stringent scientific method. You have to be aware how stringent the criteria are for publishing medical research.  Where the information platforms do help is in the logistics of such research, in the way that we can refer and recruit patients for trials.  

Ultimately, I think the most important change in healthcare will be the closer collaboration within the healthcare system.  Technology enables such collaboration but it is really about people and organizations.  The technology itself isn’t that disruptive.

What about the impact on quality and the measurement of health outcomes?

IT will enable the easier collection of health care outcomes data but the defining of such parameters will remain a difficult challenge.  The validity of such data is obviously important—you need to account for patient risk profiles—but the logistics of data collection is also difficult since health care workers are already spending too much time on reporting.  Nevertheless, it is an inevitable evolution.

How do you see the hospital IT sector evolving?

The hospital IT sector is very chaotic and fragmented.  There are still too many different players about. It is nothing like the ERP market for example, which has consolidated to about four or five dominant players globally.  But the comparison is anyway difficult to make because ERP addresses business processes that are pretty universal and standardized across the world. Healthcare isn’t like that; it is a great deal more complex.  It is constantly changing—partly due to advances in medicine and partly due to regulatory changes—and the system varies from country to country, especially with regard to the financing of healthcare.  Even the medical culture can differ remarkably from country to country.  As a result of this complexity, hospital information systems will differ fundamentally from country to country.  That is why we have developed our own systems thus far.  We did assess the merits of this approach back in 1993 but it is indicative that most of the players we looked at back then don’t exist anymore today.  

People have been telling us for years that our approach isn’t sustainable.  We disagree.  As I see it, the larger IT players are losing interest in the health care sector.  Also, IT capabilities are a differentiator toward other hospitals.  For example, we recently completed the JCI accreditation for patient safety and quality of care.  This is an arduous audit that requires assessment of 1,300 measurable elements of care and the setting up of a system for ongoing monitoring of a range of indicators.  To comply with the JCT standards we adapted our IT system.  We could do so, since it was up to us.  If we relied on an off-the-shelf solution we would have had to ask the vendor to make those changes—would they have agreed?

Hypothetically speaking, would you imagine starting a business in the hospital IT market?

The hospital IT market is complex, expectations are high, and budgets are low.  So no, I probably wouldn’t start an IT company in the sector.  I understand why people are interested in the sector.  Healthcare is taking an increasingly large share of GDP, but that doesn’t mean it is such an attractive market for IT vendors.