It is not enough to choose the same software to have the same medical record or to be able to share clinical processes and data.
The centralization of purchases at the regional level has had a strong boost from the PNRR and the Consip digital health tenders. The greatest investments are concentrated in the hospital electronic medical record that some regions are acquiring through single specific contracts even if then broken down for each healthcare company which is the recipient of the available funds.
These contracts provide for a single contractor who contracts the obligation and the right to supply the same software solution to all the healthcare companies that request it. It is an attempt to homogenize if not standardize one of the most important software for patient diagnosis and treatment. The underlying goal is to be able to collect, aggregate and share clinical data in a simpler way than has been the case up to now. Motivation certainly shareable and useful.
By examining in detail the methods and requirements expressed in the technical specifications of the specific tenders, one realizes that the setting up of these tenders is not functional and coherent with the objectives described above. There is no common electronic health record design. Requirements describe basic features and functionality with which “build” e “customize” the medical records based on the needs of the individual healthcare companies and, within these, of the individual medical departments / specialties.
The lack of governance, perhaps shared, on what an electronic medical record must be, which data model it must have, which functions it must ensure, has meant that it was not wanted or was able to change the modus operandi that sees every healthcare company decide in autonomy how to set up and create one’s own electronic medical record. The result of this choice will be an extensive heterogeneity of data and functions, in truth nothing different from what already happens today.
Yet in the presence of an offer that sees today, also in response to market demand, software that are in fact configurable platforms for managing clinical data and documents rather than systems equipped with their own data model, clinical workflows and set of functions”smart“, the decision to acquire the same solution for all healthcare companies at a regional level had to be preceded and accompanied by a strong planning and government initiative with the participation of stakeholders, doctors in primis. A complex and not easy operation, which requires time, great skills and knowledge of the clinical domain.
Instead, the easiest path was chosen which preserves the status quo while introducing a really high risk. The selection of a single supplier, however large, per region, raises serious doubts about the real capacity of these to face such a broad and articulated commitment. Any difficulties or failures will affect all healthcare companies. This is an important risk that does not find, for the reasons set out above, any advantage in terms of homogenization and standardization of clinical processes and data.
All starting from the misunderstanding or, if you prefer, from the simplification that you just need to choose the same software to have the same electronic medical record throughout the region. To make the error more serious is the awareness that the experiences gained so far demonstrate how, even in cases where there is the same software (for example the analysis laboratory), networking and sharing data between these it is extremely difficult (different codings, different methods, etc..). The only exception concerns diabetes which, however, has a completely different history and type of software solution – a product and not a platform.