Abstract
The purpose of this work is to analyze the digital transformation challenges related to the implementation of quality electronic medical record systems in Greece, within the wider frame of the European digital single market. The authors explore characteristics of quality, interoperable and secure electronic medical records, and provide an overview of the challenges and factors affecting their adoption, implementation, and operation. Key challenges relate to linking electronic medical records with the workflow, building trust and acceptance by making the best use of champions and key stakeholders, and financing the digital transformation transition and sustainability. The foreseen benefits include better support of medical decisions across all stages of the patient pathway, patients empowered to carry with them clinically significant information, fostering research, and unlocking the full potential of vendors to implement innovative tools to support continuity of care.
TopIntroduction
Healthcare systems worldwide face significant challenges that relate to increasing costs, increasing demand for the provision of quality services in an aging society and improvement of outcomes (Herrmann et al., 2018). It has been shown that despite the fact that medicine becomes increasingly high-tech, the standards of care often remain low compared to cost (Porter et al., 2006). Digital transformation in healthcare can modify operations, reduce costs and improve the quality of patient services and care.
Data is a key enabler to achieve digital transformation and drive health systems towards seamless information flows. Currently, health data is not available in the same formats nor managed in the same way across European Union (EU) member states or even within national health systems. Citizens, public authorities, medical professionals and researchers do not usually have access to all the data that would help them manage their health, deliver better diagnosis, treatment or personalized care. When health data exist in digital form, they often depend on technologies that are not interoperable, thus hindering wider use.
Lack of key information results in limited health systems optimization and difficulty to implement digital health and care solutions to support cross-border use of health services in the EU. In addition, the uptake of digital solutions for health and care remains slow and varies greatly across EU member states. The Digital Single Market in this area cannot achieve the envisioned results for citizens and health professionals. Market fragmentation and lack of interoperability across health systems hinder an integrated approach to disease prevention, care and cure. Appropriate regulatory frameworks and high quality data are necessary to realize and safeguard the rights of individuals and society. Secure access to a comprehensive electronic health record (EHR) anywhere in the EU will enable citizens to share their health data for medical treatment, preventive services, and research, irrespective of where the data is located and in line with data protection legislation (Katehakis et al., 2017b).
The national health system (NHS) is responsible for the provision of healthcare services in Greece. The execution of the operational program for implementing the information society strategy for Greece (2000-2010) resulted in the introduction of modern information technology (IT) systems for the vast majority of hospitals in the country (Katehakis et al., 2011). Foreseen benefits included an upgraded quality of services to citizens through business process re-engineering and reduction of medical errors, secure exchange of medical information, and efficient access to the EHR.
Following the introduction of integrated IT systems at the hospitals, a multitude of eHealth services has been introduced, in line with EU priorities, to control costs and improve services in a secure manner. These include: ePrescription; electronic dispensation (eDispensation) and electronic referral (eReferral) for primary care (http://portal.bi.moh.gov.gr/) that automates online retrieval of operational data for the Hellenic Ministry of Health (MoH).
Key Terms in this Chapter
Electronic Health (eHealth): The use of information and communication technologies for health.
Mobile Health (mHealth): The use of mobile and wireless devices to improve health outcomes, healthcare services and health research.
Interoperability: The ability of organizations to interact towards mutually beneficial goals, involving the sharing of information and knowledge between these organizations, through the business processes they support, by means of the exchange of data between their ICT systems.
Health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Digital Transformation: The process of using digital technologies to create new—or modify existing—business processes, culture, and customer experiences to meet changing business and market requirements.
Electronic Medical Record (EMR): An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization.
Electronic Health Record (EHR): The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting.
Personal Health Record (PHR): An electronic, lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in the PHR, which comes from healthcare providers and the individual. The PHR is maintained in a secure and private environment, with the individual determining rights of access. The PHR does not replace the legal record of any provider.