From slowness to lack of interoperability: what are the problems with IT systems in Healthcare? And what is being done to improve?

From slowness to lack of interoperability: what are the problems with IT systems in Healthcare?  And what is being done to improve?

In the medical office, the healthcare professional’s gaze often has to focus too much time on the computer, instead of on the person in front of them: there is information to fill in and search for and, often, failures in computer systems do not help. .

The most common problems, with high impact, have to do with the slowness of the systems”, says doctor João Sousa, from USF da Baixa and member of the board of directors of the National Association of Family Health Units (USF-AN), to Expresso. In consultations that normally last between 15 and 20 minutes, if there are “three, four, five minutes just waiting for the information to be loaded by the software”, the impact is easy to understand.

The annual study carried out by association, released in October last year and for which the coordinators of the 615 units that existed at the time in the country were questioned, shows that the computer failures “still occurred more often than the previous year.” All USFs had at least one failure in the previous 12 months: in 71% the problems occurred more than 11 times and, within this value, in 26.3% they were “more than 50”. Asked whether the lack of access to computer applications disrupted the quality of care provided, 96.5% of coordinators confirmed the negative impact.


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In addition to wasted time, other consequences are dissatisfaction and stress, which can lead to burnout situations, says doctor João Magalhães. Among the problems of the systems used are “information redundancy” and “lack of interoperability”. “This means that doctors have to use and repeat information in different systems”, explains the co-founder of Knok, a technology company that provides tools such as video consultations, to Expresso.

Interoperability between health information systems is precisely “one of the most critical points” and “it will be more and more”, highlights João Fonseca, doctor and professor at the Faculty of Medicine of the University of Porto (FMUP). This is because “there are more and more” devices, which “are connected and provide information in the area of ​​health, one clinical, the other non-clinical”.

Also the “lack of updating” of the systems in some units, which are often “completely obsolete”, is a problem that causes difficulties in everyday life and that “has to be corrected quickly”, notes Afonso Pedrosa, member of the working group to the management of health information by the Portuguese Association of Hospital Administrators (APAH).

Know the reality

The systems are often developed by people who “have no knowledge of clinical practice”, says João Fonseca. For example, although Medical Electronic Prescribing has been a “brutal success”, with a transition from paper to digital accelerated, there are glitches. In the case of renewing chronic medication, it is possible to see the previous prescription and continue treatment, but you are asked again to fill in the dosage. “Now, 99% of the time the dosage is the same. O software was not developed sufficiently know-how clinical”, he points out. “Thousands of hours are wasted for nothing. It is one example of dozens of examples that are repeated. This is a good example because it is repeated many times, every day, in many places.”

The importance of knowing reality is highlighted by João Magalhães. “Having experience or knowledge of the clinical area allows you to understand all these bureaucratic pressure points that exist in consultations and allows you to anticipate most of the problems”, he states, exemplifying with his own case. “One of the things that I do a lot and that I did in the development of our telemedicine platform was to sit next to the doctors, despite having experience, see how they use the platform, have the real experience and see the context in the hospital, because that’s what makes everything more efficient.”

It is based on the realization of the need to “new hybrid professionals” that the new degree in Digital Health and Biomedical Innovation at FMUP appears, scheduled to start in the 2024/2025 academic year. “What we have been noticing is that there is a great need for professionals who have skills in technological areas, but have experienced and know deeply about clinical practice and especially health services, that is, they know how things work and what is necessary”, explains professor João Fonseca, responsible for the new course. “And by knowing, not only having knowledge in these areas, but knowing the languages ​​and reasoning, they can make different people communicate”, he adds.

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The objective is for future professionals to be “focused on improving health services through innovation and, in this case, digital health”. “If not for digitalthrough artificial intelligence and data science, the health sector everywhere, not just in Portugal, is already failing but will stop responding to the needs of the population”, argues the professor.

Artificial intelligence should be the target of “much more pragmatic and less futuristic use”, that is, focused on “points that are more practical and more operational”, considers João Magalhães. Among the existing solutions are tools that can “interpret the doctor’s speech and then assist in writing the clinical record” and others that allow “summarizing all the clinical information that exists about a patient”, in order to “reduce the bureaucratic burden” of professionals.

European funds

Investment in the digital transition

As part of the Recovery and Resilience Plan, SPMS is implementing an investment of 300 million euros intended for the digital transition in the healthcare sector. The main objectives are to “resolve issues of obsolescence in information systems”, the “need to update the security principles of systems and their users” and “improve access to healthcare”.

The entity has already started to “renew the computer park” in primary health care: the distribution of around 16 thousand computers began at the beginning of the month, of which “more than 4600” have already been delivered, with delivery expected to be completed by April, according to information provided to Expresso.

However, sometimes exchanging just one part can be enough: in the case of the USF in Baixa, the computers date back to 2016 – when the unit was created. Meanwhile, the hard drive of the computer that doctor João Sousa uses was replaced, which “allows it to run much faster”, translating into a “brutal difference”. “I do not need this computer replaced at this time.”

The package is scheduled to be implemented by 2025 and “there are more than 120 projects underway”, says SPMS. For Afonso Pedrosa, from APAH, “the intentions are good”, but “one of the big problems” is that, over the years, there are “many projects that later do not come to fruition”, that is, that “did not bear fruit or It took a long time to implement.” “It hasn’t been clear what the strategy is.”

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The package represents “a good contribution”, in João Fonseca’s opinion, but the value of 300 million euros “is a drop in the bucket”. The FMUP professor also classifies the idea of ​​creating a “clinical information system that will do everything” as “utopia”. According to SPMS, the Single Electronic Health Record is the “most emblematic” and “transversal” of the projects being implemented.

For users, it is so that “they can have all their contacts with healthcare professionals registered in a single place” and also “all the information on these contacts”, such as medical reports or exams. And for health professionals, so that they have more information, through “access to the user’s history”. “We are developing interoperability solutions between information systems, across the public, private and social sectors, to guarantee citizens, through the Single Electronic Health Record, continuity in the provision of healthcare”, he summarizes.

“We are the biggest defenders of this new model”, declares Paulo Gonçalves, member of the governing bodies of Plataforma Saúde em Diálogo – which brings together 69 associations in defense of the interests and rights of users –, to Expresso. “If you were treated at a hospital in Lisbon and then had to change city and create a new record at the hospital in Setúbal, you would no longer have your previous history. We needed to make this change”, he argues. Something particularly important for chronically ill people, who “produce much more information and need health professionals to have access to this information”.


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