Informatization gaps still show up in X-ray of health system

The informatization of the Romanian medical system is like a patient on the mend: emerging from a long and scarring disease into a strenuous convalescence. While the European Union is injecting doses of funds to push the development forward, Romania is still limping through deadlines and implementation hiccups on a road where going forward is the only remedy.

Otilia Haraga

“The informatization of the Romanian health system in general, as well as, more specifically, clinics – both private and state owned – is an absolute must without which it cannot develop efficiently or yield results,” Mihai Ciochinaru, medical director of Medlife, tells BR.

From a chronological perspective, “the informatization of health units in the public system began in an extremely shy manner, especially via local initiatives in departments, then hospital units or individual medical practices, through the efforts or personal enthusiasm of doctors, hospital managers, family doctors or specialists with individual practices,” says Ciochinaru.

But what does the data look like? Unfortunately, not very flattering for Romania. “Romania is lagging about ten years behind the Western European average as far as the informatization of hospitals in the state sector is concerned,” Radu Bengulescu, IT director of Regina Maria private health network, tells BR.

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Significantly, Romania is also at the lowest end of the European Union ranking for fixed broadband internet access. The most recent EC report described Romania as being one of the last in the race, with a 13 percent penetration rate of fixed broadband internet.

The survey shows that approximately 92 percent of European hospitals have broadband internet access, while 80 percent of them have already implemented electronic patient files.

The data found that 71 percent of European hospitals use eReservation systems for making patient appointments, 65 percent have a common system for registering patients, while 61 percent have a common archive system for patients’ files. Only 39 percent of hospitals use video-conferencing for consultations while 54 percent have Wi-Fi internet access.

The system of electronic prescriptions (ePrescription) has already been implemented in countries such as Sweden (100 percent of units), Estonia (80 percent) and Spain (40 percent) and even in Bulgaria, though on a lower scale.

The implementation of ePrescription by 2015 is one of the targets set out by the European Union, which also requires that patients have online access to their medical files.

However, a report by the European Commission shows that only 30 percent of European hospitals use the ePrescription system and only 4 percent offer patients online access to their electronic medical records.

In the first half of last year, the Romanian authorities signed off two major projects for the health system – electronic patient files and ePrescription, for which EUR 40 million in non-reimbursable EU funds are available. The implementation of the two projects should have been kick-started beginning with last year but the process tarried.

The electronic patient file project has a total value of EUR 46 million (VAT included), and an implementation period of 24 months. It will outline the entire disease and treatment history of the patient.

In Romania, ePrescription should have been on the cards since 2011 but the company that will implement the system was elected only this year: HP Romania will supply the IT solution to the National Health Insurance House, under an approximately EUR 10 million contract (VAT included). The EU-funded project should be finished within six months. The ePrescription system will allow the real-time monitoring of drug consumption in Romania, and eradicate medication errors and fraud from the system. The beneficiaries of the project will be insurance companies, doctors, pharmacies and insured patients.

Also this year it was announced that HP and Novensys form the consortium that will supply the CNAS with an IT solution for the introduction of the electronic health insurance card (which should also have been introduced in 2011), under a contract worth in excess of EUR 25 million (VAT included). The contract must be implemented in nine months since signing and will be financed from CNAS funds.

The cost of a card is EUR 2.25 (without VAT) and they will be distributed to all the insured patients by post.

The health card, ePrescription and the electronic patient files are part of an informatization process for the health system, the first seeds of which were sown ten years ago.

The first stage of the informatization system – the unique integrated informatics system (SIUI), developed by HP Romania, Siveco Romania and the Romanian Service of Special Telecommunications (STS), which connects doctors with the CNAS database – has been completed following investments of approximately EUR 45 million; however, teething problems appeared.

“The quality of the supplied (imposed) software by the CNAS such as SIUI and the system for reporting oncological cases to the National Cancer Registry is sometimes cumbersome and has elements that could be perfected, but most medical professionals realize the need for an IT system that keeps track of medical activity,” says Ciochinaru.

Public and private needs

When talking about the informatization of the public health system, “special attention is given to ERP (enterprise resource planning) systems that ensure a transparent control of resources and costs,” Daniel Prisacariu, sales manager for key projects at TotalSoft, tells BR.

Ciochinaru’s view is that “many health units have still not entirely solved the informatization issues concerning the inter-connection of the various departments, pharmacies, imaging and laboratories, because everything involves budget expenses for which the current resources allocated by the authorities are insufficient.”

“Informatization needs in the state sector are approximately 75 percent the same as those in the private sector in order to ensure quality medical services, that are economically efficient and allow at some point the creation of the patient’s national unique medical file,” Bengulescu tells BR.

In the private sector, the target of clinics is to unify the entire critical information into one single IT system. “Private units wish to have a unitary administration of health contracts, subscriptions, labor medicine activities, lab analysis, compulsory reports to the state, the electronic patient files – everything integrated and reflected in the financial-accounting activity,” says Prisacariu of TotalSoft.

Thus, informatization needs in private health networks stretch across all verticals, according to the Regina Maria official. He gives a detailed X-ray of the situation – in the operational department (for inputting patients and doctors into the system, allocating resources, making appointments, introducing requests for services), in the medical department (storing data on the patient’s electronic chart), in the financial-accounting department (managing costs and revenues), in the management department (control and forecasting, optimization processes, business intelligence, statistics) and in lab services (receiving requests and distributing results in electronic format).

There are also needs in the commercial and client service department (for managing client accounts, subscription and insurance plans, customer relationship management, profitability analysis, the interface for reporting to the state regarding health insurance), in the marketing department (interacting via electronic means with individual patients and corporate clients) and in the acquisitions department (managing stocks), according to Bengulescu.

“New medical services and compartments that bring with them new IT needs that we must face keep on appearing. Though we are better and better off, I think we are still some way behind systems abroad,” says Ciochinaru. “We will most certainly be able to ‘burn stages’, but only following solid and efficient investments in this field will we achieve performance.”

otilia.haraga@business-review.ro