Implementation of a healthcare information system in Lithuania.

• Author: Cholewka, Patricia A.
• Position: Report

Abstract

This paper presents a general overview of the process of implementing a hospital information system in Lithuania, one of the post-Soviet transitional economies in the Baltic Region. This country was chosen in order to illustrate an example of the many issues and tasks undertaken by a new member of the European Union to reorganize its healthcare system to provide an improved level of care previously unavailable to its population under Soviet administration. This reorganization focused on the European Union eHealth action plan that defines a number of targets. The first target was for all member states to develop roadmaps for eHealth by the end of 2005 in anticipation for supporting the deployment of health information networks based on fixed and wireless broadband, mobile infrastructures, and Grid technologies by 2008. This eHealth strategy, called Baltic eHealth, would develop a transnational digital eHealth infrastructure based partly on existing data networks. This paper presents how a teleradiology application was implemented within this eHealth program into a healthcare system with limited resources but needing to improve service quality while expanding its capacity to meet increasing demand.

Introduction

The process of reorganizing and improving the Lithuanian healthcare system began in 1990 when it regained its independence from the Soviet Union and continues to this day, even after its accession into the European Union (EU) in 2004. In order to restructure their organizations to remain viable within these new constraints, healthcare system administrators are realizing the need to utilize more effective management methods. One of the priorities of this reorganization effort was the improvement of the knowledge base and consultation ability of physicians in the diagnosis and treatment of medical-surgical conditions at Kaunas Medical University Hospital, a large urban hospital in Kaunas, Lithuania where most of the nation's medical and nursing practitioners are educated. The purpose of a recent local healthcare information technology (IT) initiative, known as the Litmed Project, was to improve the quality of medical education, diagnosis, and treatment across distance, beyond the academic and/or hospital setting. Developing an IT system for storing and accessing images from telemedicine system archives connected to medical instruments for integration with a pathology laboratory system for eventual expansion to an electronic medical record (EMR) system is the ultimate goal of the national eHealth strategy for Lithuania.

Background: Country and Healthcare Sector

Lithuania is the southernmost and largest of the Baltic countries. It covers 65,000 square kilometers and has a population of about 3.7 million. After severe social and economic shocks in the initial years after independence, the economy stabilized and growth began in 1995. After independence and during economic transition, aggregate health indicators for mortality and morbidity further deteriorated in comparison to its period under Soviet occupation. Lithuania was incorporated into the European Union in 2004. However, even after accession, there is still a gap in health status compared to EU countries due to the fact that the Lithuanian health system suffers from problems similar to other countries in the post-Soviet regions that include excess hospital capacity, weak primary health care, over-reliance on hospital inpatient treatment, outmoded equipment, inefficient purchasing practices, high level of corruption, and inefficient use of facilities and economic resources (Lithuania Health Report No. PID6544. Retrieved, August 14, 2006, from http://wwwwds.worldbank.org).

Overall, healthcare reform in countries of the former Soviet Union is still slow and fragmented. Although healthcare providers are anxious to acquire technological advancement within their individual practices, they are also anxious to see improvement in the total quality of clinical practice, service provision, and overall organizational management. However, their ability to monitor and control costs, to develop and implement professional practice standards like those being used in Western countries, and to manage and develop human resources, is rudimentary. Sustainable programs for system improvements are hampered by changes in governance and policy at the MOH (national) level and the managerial ability and strength of commitment to change programs by leadership at the organization (local) level (Cholewka, 2004). However, demands by practitioners and patients for advanced technology and improved healthcare services, as well as the burgeoning use of economic accountability standards by government, investors, and regulators, are helping to drive the healthcare sector's transformation. According to the World Health Organization (WHO), post-Soviet transitional economies still have inadequate information management systems in place for financial and management accountability, monitoring, and evaluation of national and local system operations (World Health Organization, 2002).

In general, a recent paradigm shift has occurred within the healthcare sector throughout the world from an obsession with curing diseases to an interest in prevention; from problem identification toward outcome-specification; to systems designed for patients rather than physicians; from isolation to networking; from the bottom-line and profit to community good; and from competition to collaboration (Cholewka, 2006). In tandem with these goals, is the major focus of the WHO for restructuring post-Soviet healthcare systems for sustainable development that directs the reorganization of medical care towards health promotion, prevention, and primary healthcare through the application of eHealth strategies. The WHO defines eHealth as "the use, in the health sector, of digital data--transmitted, stored and retrieved electronically--in support of health care, both at the local site and at a distance" (WHO Department of Essential Health Technologies, 2004). But Richardson expands this definition by implying that eHealth is "not only the application of new technologies, but also a fundamental re-thinking of healthcare processes based on using electronic communication and computer-based support at all levels and for all functions both within the healthcare service itself and in its dealings with outside suppliers" (Richardson, 2002). By definition, this eHealth strategy would most likely have to incorporate community participation and intersectoral cooperation and involve four categories: clinical application (telemedicine), healthcare professional continuing education, public health information and education for patient empowerment, and public health policy development (Richardson, 2002). However, in order to satisfy increasing consumer demands for better healthcare within available resources, Jones et al (2006) believe that policy makers must ensure the effectiveness of eHealth by steering the right mix of eHealth applications to achieve the goal of increasing benefits at stable costs and supporting investment in eHealth by providing the appropriate legal and economic investment environments that facilitate innovation (Jones et al, 2006). Thus, eHealth complements the WHO focus on the sustainable development of primary health care, that is, a participatory process that involves the community in the design and implementation of healthcare promotion and development activities. In 1978, the concept of Primary Health Care was adopted in the Alma Alta Declaration at the World Health Organization-UNICEF Conference at Alma Ata (now Almaty), Kazakhstan as follows:

* Challenges society to address the socioeconomic causes of poor health and makes provision for basic health needs,

* Encourages community empowerment (ensuring that people are fully able to manage resources that are available to them),

* Provides comprehensive quality health care including promotive, preventive, curative, rehabilitative and palliative services,

* Demands concerned and accountable health worker practice,

* Prioritises the people who are most disadvantaged ensuring that health care is accessible, equitable and affordable to all,

* Recognises the importance of integrated service provision from primary to tertiary levels of care within a coherent health system, and

* Promotes inter-disciplinary, multi professional and intersectoral collaborative teamwork for development (National Progressive Primary Health Care. Retrieved August 14, 2006, from http://www.hst.org.za.pphc/phcdef.htm).

Tisch and Wallace (1992) stress that in order for development to be sustained the following issues must be addressed:

* Projects should utilize existing local leadership instead of creating new structures that may not be socially or historically sustainable,

* Projects should stress intersectoral participation,

* Accountability for project implementation should be intersectoral and not merely the responsibility of a few people,

* The donor agency and project staff should practice an open management style that includes project beneficiaries to help ensure a wide base of participation and support,

* Existing institutions should not be bypassed to create new institutions (except when these institutions prove to be inefficient and ineffective),

* Projects should build local capacity to provide technical assistance services, and

* Since sustainability is not an automatic byproduct of project activities, it should be consciously planned and nurtured (Tisch & Wallace, 1992, p. 42).

In some cases sustainability efforts can be eased through government decentralization of the control of the functions of the healthcare facility to allow greater efficiency of operations. By controlling finance, personnel, and operations locally, facility managers can react faster to environmental changes and make decisions that are advantageous to the organization and community. In...