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
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.
Local hospitals and other entities
Poland the administrative division 16 provinces Second Level Local Government: 314 counties 65 city counties
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)
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
RESPONSE MAP (categorized by counties) Odpow iedzi szpitali pow iatow ych Returned questionnaire: 1 YES NO 0
14 12 10 8 6 4 2 0 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.
RESPONSE RATE MAP (BY VOIVODSHIP) Polska województwa Maximal 12 Mininmal 1
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)
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
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
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
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
RESULTS
Hospital s information resources (1) number of hospitals 90 80 70 60 50 40 30 20 10 0 Diagnostic equipment 31 31 28 26 30 17 20 10 14 13 2 3 CT x-ray USG Electr. Endoscop. Histopat. DICOM no DICOM but expandable no DICOM no diagnostic equipment
Hospital s information resources (2) Emergency service resources 0 10 20 30 40 50 60 Accident and Emergency Departments 55 Hospitals with emergency ambulances capable of data transfer 16 Number of emergency ambulances capable of data transfer 22
Hospital s information resources (3) Max bandwidth > 1MB /s 39% < 512 KB /s 8% 512 KB /s 20% 1 MB /s 33%
Hospital s information resources (4) Computer network involving: Diagnostics Accident and Emergency Department Wards Administration 0 20 40 60 80 100 Number of hospitals
Hospital s information resources (5) Hospital Information System number of hospitals 80 70 60 50 40 30 20 10 0 75.0% 50.0% admission/discharge patient record ordered diagnostic procedures 37.5% 38.5% ordered medications
Hospital s information resources (6) Computer terminals in hospitals number of terminals 8000 7000 6000 5000 4000 3000 2000 1000 0 overall in hospital for the medical staff in total with Internet access
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 0 10 20 30 40 50 60 70 80 90 number of hospitals
Consultations with other units (1) Consultations with other health care units 100 90 80 number of hospitals 70 60 50 40 30 20 10 0 qualification for surgical procedures diagnostic results interpretation specialist consultations phone or mail personal contact data transmission the need for improvement
Consultations with other units (2) Frequency of contacts with units of higher referential level number of hospitals 40 35 30 25 20 15 10 5 0 > 2/week 1-2 a/week < 1/week < 1/month or none qualification for sugery specialist diagnostic results interpretation
Consultations with other units (3) Consultations while transporting patient no data transfer 89% 11% data transfer (e.g. ECG) to the specialist cardiology unit
Consultations with other units (4) Medical database in everyday practice 40 35 34 number of hospitals 30 25 20 15 10 5 16 0 access to medical database e-learning
Plans for development Plans for development of hospital's information system 0% 20% 40% 60% 80% 100% extension of hospital information system 81 15 3 extension of hospital network 71 16 10 website construction/enhancement 56 10 30 purchasing of DICOM compatible equipment 53 35 6 broadening bandwidth 43 22 30 introduction of teleconsultations 32 53 11 extension of teleconsultations 14 41 23 planned not planned doesn't concern
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
Opinions and comments (2) Obstacles to the development of telemedicine in local hospitals 80 number of responses 60 40 20 0 lack of recognition doubts about effectiveness hospital resources Internet access economic reasons security regulations
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
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
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
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)
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
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.