E Health. In Polish Local Hospitals: Present State, Requirements And Possibilities. M. Karlinska,, R. Rudowski. Poland

Transcription

1 E Health In Polish Local Hospitals: Present State, Requirements And Possibilities M. Karlinska,, R. Rudowski Medical University of Warsaw Department of Medical Informatics and Telemedicine Poland

2 Local hospitals and telemedicine Local hospitals play a major role in granting access to health services for the inhabitants of small towns and villages. THESIS: Application of e-health, which ensures effective communication among health care units with different diagnostic equipment and referential level, enables a significant improvement in the quality of medical service.

3 Local hospitals and other entities

4 Poland the administrative division 16 provinces Second Level Local Government: 314 counties 65 city counties

5 Survey organization A pilot study involving local hospitals of Mazovia District in cooperation with Marshal Voivodship Office (97.0% response rate) On-line questionnaire on the Medical University of Warsaw website Forwarding information on the projectto to all local hospitals in cooperation with the Association of Polish Counties Circularizing information via ZOZMAIL (healthcare institutions mailing system of National Centre for Health Information System)

6 RESPONSE 346 local hospitals were invited to take part in the main study Detailed data from 96 (27.7%) local hospitals were obtained and subsequently analyzed

7 RESPONSE MAP (categorized by counties) Odpow iedzi szpitali pow iatow ych Returned questionnaire: 1 YES NO 0

8 Number of responses ( by voivodship) liczba odpowiedzi w podziale na województwa Dolnośląskie Kujawsko- Pomorskie Lubelskie Lubuskie Łódzkie Małopolskie Mazowieckie Opolskie Podkarpackie Podlaskie Pomorskie Śląskie Świętokrzyskie Warmińsko- Mazurskie Wielkopolskie Zachodniopom.

9 RESPONSE RATE MAP (BY VOIVODSHIP) Polska województwa Maximal 12 Mininmal 1

10 QUESTIONNAIRE (1) : Hospital s information resources and equipment Diagnostic equipment with digital output Laboratories Emergency ambulances capable of data transfer Access to the Internet (bandwidth) Computer network Computer terminals Hospital s website (and its functionality)

11 QUESTIONNAIRE(2): Consultations with other units Subsequent relations were evaluated: Local hospital Specialist unit / hospital Patient s qualification for surgical procedures Interpretation of radiographic/pathomorphological findings Other specialist consultations Emergency ambulance Local hospital Emergency ambulance Specialist unit / hospital Doctor Medical data base

12 QUESTIONNAIRE(3): Plans for the development of the hospital information system and telemedicine Expanding/purchasing DICOM compatible diagnostic equipment Involving diagnostic laboratories in hospital computer network Bandwidth broadening Hospital s website construction/ enabling on-line services Introduction/enhacement of teleconsultations

13 QUESTIONNAIRE(4): Opinions and comments Opinions and comments: Doctor s limited access to the Internet at the hospital Identifying the reasons for insufficient development of telemedicine in particular areas Types of relations with other units that might become more effective by application of telemedicine

14 PRIMARY OBJECTIVE DIAGNOSIS: AIM OF THE STUDY present state and plans regarding telemedicine needs and potential possibilities level of ZOZ management awareness SECONDARY OBJECTIVE DEMONSTRATING THE POTENTIAL OF TELEMEDICINE TO: the ZOZ / hospital managers the hospital founding bodies the institutions that contract medical services

15 RESULTS

16 Hospital s information resources (1) number of hospitals Diagnostic equipment CT x-ray USG Electr. Endoscop. Histopat. DICOM no DICOM but expandable no DICOM no diagnostic equipment

17 Hospital s information resources (2) Emergency service resources Accident and Emergency Departments 55 Hospitals with emergency ambulances capable of data transfer 16 Number of emergency ambulances capable of data transfer 22

18 Hospital s information resources (3) Max bandwidth > 1MB /s 39% < 512 KB /s 8% 512 KB /s 20% 1 MB /s 33%

19 Hospital s information resources (4) Computer network involving: Diagnostics Accident and Emergency Department Wards Administration Number of hospitals

20 Hospital s information resources (5) Hospital Information System number of hospitals % 50.0% admission/discharge patient record ordered diagnostic procedures 37.5% 38.5% ordered medications

21 Hospital s information resources (6) Computer terminals in hospitals number of terminals overall in hospital for the medical staff in total with Internet access

22 Hospital s information resources (7) Other data about hospital resources firewall anti-virus protection on the hospital website available on website online services detailed informatins at hospital's services general inf. at hospital's services general information number of hospitals

23 Consultations with other units (1) Consultations with other health care units number of hospitals qualification for surgical procedures diagnostic results interpretation specialist consultations phone or mail personal contact data transmission the need for improvement

24 Consultations with other units (2) Frequency of contacts with units of higher referential level number of hospitals > 2/week 1-2 a/week < 1/week < 1/month or none qualification for sugery specialist diagnostic results interpretation

25 Consultations with other units (3) Consultations while transporting patient no data transfer 89% 11% data transfer (e.g. ECG) to the specialist cardiology unit

26 Consultations with other units (4) Medical database in everyday practice number of hospitals access to medical database e-learning

27 Plans for development Plans for development of hospital's information system 0% 20% 40% 60% 80% 100% extension of hospital information system extension of hospital network website construction/enhancement purchasing of DICOM compatible equipment broadening bandwidth introduction of teleconsultations extension of teleconsultations planned not planned doesn't concern

28 Opinions and comments (1) Limitations on doctor's Internet access access not need 21 economic reasons 60 technical reasons 42 work discipline 21 number of hospitals

29 Opinions and comments (2) Obstacles to the development of telemedicine in local hospitals 80 number of responses lack of recognition doubts about effectiveness hospital resources Internet access economic reasons security regulations

30 Survey summary (1) Hospital s information resources : Access to the Internet is available in all questioned hospitals Almost everywhere information system is secured by adequate software

31 Survey summary (2) Hospital s information resources : Few hospitals own diagnostic equipment with digital output Few emergency ambulances are capable of data transfer Patients medical records are stored in digital form in 1/2 of questioned hospitals 3/4 of Accident and Emergency Departments are involved in hospital computer network Many computer terminals for medical staff are without Internet access Great majority owns an Internet website, however on-line services are provided only by 2 hospitals

32 Survey summary (3) Plans for the development of the hospital information system: 32 hospitals (33.3%) intend to introduce teleconsultations in the nearest future 14 hospitals (14.6%) intend to expand teleconsultations in the nearest future Over half of questioned hospitals (58.3%) intend to create/enhance an Internet website

33 Survey summary (4) Plans for the development of the hospital information system: Great majority of hospitals is planning to extend hospital information system and hospital computer network Over 50% intends to purchase diagnostic equipment with digital output 43 hospitals (44.8%) intend to introduce broad bandwidth Internet access ( > 1MB/s)

34 CONCLUSIONS The need for application of telemedical solutions, epecially in the field of teleconsultation, is well realized by the local hospitals. However, prior enhancements in the following fields are necessary: availability of diagnostic equipment with digital output telecommunications infrastructure making telemedical services refundable

35 THANK YOU FOR YOUR ATTENTION Further analysis extended with statistical data from the State Statistical System needs to be performed in order to finally evaluate actual demand for e-health services in Poland.