The real “digital hospital” or “digital healthcare service” is that which manages to guarantee meaning, integrity, confidentiality and availability of the information, allowing continuous electronic care in cooperation with other agents inside and outside the service.
There are two phrases that are endlessly repeated in articles, at scientific conferences, software supplier conferences, blogs, journals and other outlets that I find meaningless: “Paperless Hospitals” or more accurately “Hospitals with less paper” (following the HIMSS modification made upon realizing during its latest stage of development, Level 7, that truly paperless hospitals don’t exist).
These ideas have created a misleading belief about computerization processes in healthcare and created confusion, given that the elimination of paper is not the actual objective. The physical medium; paper, is not the real problem. Our problem is the pencil; an object that in the hands of a healthcare professional has potentially unforeseeable consequences that might lead to all manner of mistakes. Prescriptions which the chemical pharmacist doesn’t know how to fill, instructions for administering a drug that the nurse doesn’t understand, a handwritten file on which other colleagues can’t find the information they need to continue treatment, etc.
Paper is a physical medium that probably won’t be discarded by the healthcare system for several decades, but it doesn’t have to be our enemy. A digitally entered prescription, informed consent granted via an electronic health record, a GES (Explicit Healthcare Guarantee) pathology or ENO (Obligatory Disease Notification) printed out by a patient from an electronic health record and delivered so that the information can be processed, are, and will continue to be necessities.
Holographic record methods do not make it possible to “use data” intelligently; the useful life of these records is limited from the moment the pencil touches the paper, they do not provide all the possibilities offered by today’s technology with regard to automatic processing or data confirmation and neither can they be converted into information that improves our overall knowledge of the organization (finding out the average number of surgeries performed, eliminating a drug administered to a patient from the inventory… Essentially: the use of the data for primary or secondary analysis of the information contained within).
If the data is entered digitally it can be confirmed, processed and made available to the entire healthcare team whilst the physical medium (paper) becomes a means of transport to its next destination.
But the task does not end with the simple digitalization of the data. Today we have, in both the public and private spheres, a large number of computerized healthcare systems in which healthcare professionals record information in electronic health records, but experience the paradox of having a lot of digital data and not much information. Digital data in free text often meets the same fate as holographic data; it is not easily processed and we can’t use it for other necessary purposes (such as statistics, warnings and billing). So it is worth asking: How can we instill this data with meaning so that it becomes information? Managing electronic data requires proper codification that allows it to be aggregated and used categorically. This need for codification is one of the main reasons for the existence of discipline known as healthcare information technology or medical IT.
As part of the SIDRA (the Healthcare Network Information System) strategy at the Central Office for IT Projects in the Ministry of Health, we have presented a sustainable solution to facilitate the codification of clinical data in order to provide SIDRA accredited healthcare software suppliers with clinical codification services containing advanced search algorithms also known as Terminological Services. This proposal seeks to standardize and centralize clinical and administrative vocabulary in order to repair the gaps in the coding we are currently experiencing, ensuring that care professionals will speak the same language (the system evolves daily with the support of professionals). This terminology service is based on decades of study of coding models for clinical information and a detailed analysis of the country’s record culture. It uses the most extensive controlled clinical terminology that exists; SNOMED-CT, which is used by over 50 countries but with a formal outlook that allows the use of locally accepted jargon and formulations.
Solving the problem of information coding to ensure that its meaning will remain constant from the source throughout its transit throughout the systems is the main pillar of interoperability (understood as two agents’ ability to communicate and understand each other). The second pillar, which is a substantial part of the SIDRA agreement framework, is related to how the message is passed on. After reaching this level of development (data coding and its efficient transport), we can reduce our dependence on paper and take better advantage of digital information because coded electronic information can travel and be understood by the different agents involved without the need for a physical support medium.
The concept of a digital healthcare or hospital system should not be confused with the physical medium by which the information is passed on, but should focus on the method and quality of the information entered. The real “digital hospital” or “digital healthcare service” is that which manages to guarantee meaning, integrity, confidentiality and availability of the information, allowing continuous electronic care in cooperation with other agents inside and outside the service.
