Being born in the former Soviet Union I was not fortunate to have the quality of a public healthcare system. However, after the collapse of the Soviet Union, countries that formed the CIS block and neighbouring European countries started the modernization of social services.
While I was only able to observe the changes happening from 1990-2000 in Russia, I was able to gain a more global view once I began my career in health IT in the early 2000s. With that said, I will be writing a series of blog posts where I will share my views and experiences on the differences and commonalities in national healthcare systems across different emerging markets and the so called “green field” countries, where real modernization barely started a few years ago.
And so right to the first thought.
As most everyone knows, starting from scratch isn’t easy. However, in health IT you hardly find any country or even a region within a country that has a similar healthcare system legacy. Everyone is essentially starting from scratch because no two regions have the exact same circumstances.
For example some countries, like Georgia, passed through a centrally driven privatisation, which made it challenging for national initiatives to impact on a local level. Poland has a mixture of private and public medical institutions, so private institutions can participate in the public healthcare system. Ukraine has no current working insurance system and still relies on direct funding. Countries, like Russia have created their own standards in health IT, but this is less common.
These differences are amplified with scattered investments and a need for a visionary approach. Even though the attempt to replicate development models from mature countries can be quite challenging, countries continue to look to one another for best practices.
We recently saw a Russian delegation visit Singapore to get an idea of how quickly a national EMR can be built and an Armenian delegation did the same in South Korea. The profiles of the visited countries are so different for those who attended, however any successful implementation is worthy of being explored. There are still many projects in the health IT space that have not yet reached national scale.
In later posts I hope to deep-dive into a working system, but for starters I’d like to share a few factors that I have observed in many underfinanced healthcare systems:
1. Government needs a quick win with citizens and medical personnel
Depending on the country or region size, both in terms of population and scale, a cloud approach is the simplest way to go. Most likely the underlying healthcare provider isn’t very well automated and reliable in terms of sharing data. A light-weight centralized EMR along with the remaining paper based process can be quickly provisioned from the Government Cloud to the underlying medical institutions. Citizens and medical doctors will benefit from an integrated and unified medical record even with limited but centralized content.
It is important to create a future proof architecture in the very beginning so it will be possible to scale and develop systems further. Obviously the most secure way is to base it on emerging interoperability standards like those recommended by IHE.
2. Healthcare Ministry Approaches
The lack of funding for some public social services has prevented various ministries from driving complex modernization projects, and IT projects are no exception. Nations that scale health IT based on the variety of different stakeholders, legacy of systems and influences, require strong project management skills. It is especially important when MoH isn’t empowered with the budget directly and there is an IT related Ministry or Ministry of Finance paying and implementing systems.
Closer collaboration of ministries is recommended. Various goals and objectives should be allowed and a balance between operational efficiency and quality of care should be found to achieve those goals. In such circumstances, the national data sharing platform or information exchange hub can satisfy many participants and can be chosen as a first step. During the following phases the project could be parted to financial, medical, infrastructure and others under one national program.
3. Healthcare Standards Maturity
Lack of modernised legislation holds back any transformational project and especially those in the health IT realm. Standards are the foundation of the any healthcare system, therefore nothing can be changed before the legislation base is in place.
Some changes in legislation take months and even years, however in some cases I have seen IT project preparations trigger quicker introductions of supporting laws like electronic signatures, medical record retention policies transformation and/or decisions for ICD9 or 10 and LOINC implementations in the country. By nature those projects shouldn’t be united. They are not dependent on each other but obviously influence each other and support transformation for the sake of a global modernization program.
These considerations are not the recipe for success but important elements to be considered for success. When implementing a big scale healthcare IT system it is crucial to work with the guidance of a team of trusted companies who can work together and can bring solutions to the table that are unified.
In my next post I will share an example of one of the working consortiums in one of the countries of Former Soviet Union territories which is successfully building a national electronic medical record system.