IT development in the health care sector at a standstill

It is often said that nowadays doctors look more at the computer screen than their patient during a consultation. It is estimated that information management takes up about three-fifths of the working time in specialised health care.

The Parliament’s Audit Committee has noted that health care resources are being wasted on completely unnecessary and overlapping work. According to the Committee, mistakes and risks multiply when the same information is entered and copied manually or maintained in various information systems.

The fault surely lies in part in the development of health care information systems, but it is also a question of conscious choices. The development of systems has withered in a lack of competition.

Physicians usually use several different systems in their work, each of which requires signing in. For example, a physician in the Hospital District of Helsinki and Uusimaa (HUS) signs in to 6 to 8 different systems during a regular patient visit.

However, these systems could be connected under one user interface, allowing simultaneous signing in to all of them. Also entering the information could be made considerably smoother.

The skewed market situation is the major cause of the fact that health care information systems lack innovation and are hard to use.

The current market in the sector is only open to small companies that offer new systems to support certain, usually new, treatments. The threshold is high because programme development requires strong and specific medical expertise.

On the other hand, the development of information systems to support processes, usability and affect the smooth running of work is in the hands of two companies. Even though they employ thousands of health care experts, only a small minority are actual systems developers. One cannot expect innovations with the current resources.

The central reason for the current market situation is that the actors in the sector are unwilling to share information on how systems are matched to function together. The lack of information effectively blocks the entry of new actors to the market.

The unwillingness to share the information in question is partly explained by the unwillingness of actors in the sector to give up their mutual competitive edge and market position. In public, this is explained away as a matter of security.

However, security is a weak defence for holding onto information about connections between various systems.

Information can be distributed among the actors in the sector if clear mutual rules on its use are defined at the same time. Common sense dictates that it is possible to drive in two directions on the road if both parties stay in their lanes.

Sharing information among the actors in the sector would open the markets to genuine competition and would, in practice, improve patient safety. When new actors enter programme development, malpractice cases decrease and health care is made more effective.

How then should the markets be opened to genuine competition? It is really quite simple: by the decision from the customer. It is a well-known fact that customers, or health care units, listen to the Ministry and legislators. If there is a will, there is a way.

At the current pace, the winners are not the two companies sharing the markets. In the lack of competition and innovations they are hardly able to develop world-class information systems or even keep up with the global competition in the sector.

The development of health care information systems also has a wider national significance. The Finnish systems have been developed on the terms of emergency patients and one-off visits. It is, for example, difficult to monitor national health problems. Neither do the systems provide help in screening of high-risk patients and inviting them for treatment.

If we look at the costs and human suffering caused by the deficiencies in the information systems, even by carefully estimating, we can conclude that Finland cannot afford to continue in this way.

Juha Lamminkari

The article by Juha Lammenkari was published in the Helsingin Sanomat newspaper’s guest writer section on 23 March 2009.