CHALLENGES IN HEALTHCARE MANAGEMENT DIGITALISATION [PART 1]

Healthcare digitalisation has commenced for 20 years ago in public healthcare settings. It started with Hospital Selayang, where it is the first hospital in Malaysia utilising complete solution of digital healthcare management, called as T-HIS (Total Hospital Information System). The enrolment of T-HIS later slowed down due to multiple factors such as cost, political interference and user readiness. This changes with Covid-19 pandemic, where swift healthcare management and rapid information delivery is vital in fighting the pandemic.

Since pandemic struck our nation, more healthcare facilities begun deploying digital solutions for healthcare management. This solution comprises both on the clinical module and also non-clinical module. Healthcare software also becoming more and more matured, providing seamless integration between various hospital settings and departments. Ministry of Health also started their pilot project on healthcare management software, call HIS@KKM (Hospital Information System KKM), in order to speed up implementation of digital healthcare towards all of its facilities. The goals of this transformation are to provide better healthcare services to the public. This grand project seems great on paper, inevitably challenges also come along the way, be it internally or externally. My article for this publication is to shared my own observation, the internal challenges that occurs during deployment of HIS@KKM, based on my experiences of this pilot project for both tertiary care and secondary care public hospitals in Malaysia.

Internal challenges for healthcare digitalisation are coming from three camps, the clinician camp, the non-clinician camp and also the management team, both at the hospital level and also ministerial level. The strongest voice will be the clinician camp, as they are the primary user of digital healthcare solutions, facing split seconds life decision and the biggest influence whether the deployment is a success or not.

The arrival of new sets of computers, laptop, tablets and all the electronic devices has proved to raise some of the eye-brows of our frontliners. The question that being a nightmare for them is, does this “thing” really help to make their life easier in providing services to the patient? Does the entire workflow changes? Can they adapt to it? And a lot more questions, that keep being passed along from mouth to mouth in the hospital. Medical doctors and nurses are having a hard time documenting their clinical findings to the system, and also presenting it later to their specialist. Specialist, on the other hand, mostly are seniors and veterans, whom, a very big challenge for them to see through the small, and sometimes blurry screen. The feeling of gliding through pages of papers are gone, replaced with the serial click of the mouse and touchpads. Some clinician finds it easier to just click the mouse and keyboard, while, most of the clinician think it is more time consuming and confusing to navigate through the whole webpage of the system. The availability of the system also contributes to the biggest risk during medical intervention, as system down or energy blackout renders medical information inaccessible to clinicians. The numbers of devices provided also mostly inadequate in every ward or clinic, because of more resources is being use to mitigate the time-consuming process of digital documentation. For example, one specialist round may utilise up to 3 laptops, one laptop is used for entering the clinical notes, another laptop for tracing blood and investigations result, and the other one for the nurses to record vital signs and patient care information. Together with some of the devices are decommissioned due to failure beyond repair, this led to scarcity of facility to help clinician enjoying the digital transformation of healthcare.

The internal challenges don’t stop only to clinician, they are also affecting the non-clinician team. Medical record office finds it more troublesome to process and securing the electronic medical record (EMR), due to its complexity, compare to manual bed-head ticket (BHT). Some of the software are too complicated, flooded with bugs, that increase the processing time for each medical record, be it for storing, or retrieving. Data safety also become the major concern in the EMR technology, as confidential patient information now stored in the form of binaries, that can be accessible by other people, with or without permission from the medical record office. The billing department also reported challenges of correcting payment processes compared to pre-digital era, as more steps need to be taken, if the issues raised by them is not about the application glitch.

Finally, the decision maker at both hospital and ministerial level also having a hard time in paving the pathway for healthcare digitalisation. The main concern is always about the cost. Cost of electronic healthcare applications are very expensive even though with the development and deployment from the local companies. Local solution of digital healthcare solutions is too young compared to the foreign solutions, as local talent needs to be groomed further to be able to compete with multinational workforce. For the ministry to subscribe for foreign providers, the current economic situation is not favouring for that pathway. Furthermore, Ministry of Health is becoming more and more vigilant regarding the data safety of our citizen, and also the ownership of government intellectual properties. Developing our own software with local companies, need more support and expert talents, to ensure the software is ready for nationwide enrolment.

As for now, I am highlighting the issues here so action can be plan and executed, in order digitalisation of healthcare management will be fruitful in landscaping better future for our national healthcare. The deployment of digital healthcare has been proven to be a big challenge in healthcare management, and new strategy must be employed, in this fast-changing era.

Dr. Muhammad Azrul Azizi bin Dato’ Amir Hamdan
Project Manager (RayaTech Sdn Bhd)
HIS@KKM Hospital Raja Permaisuri Bainun Ipoh.
MBA Healthcare Management, KPJUC.