The obstacles
Currently, in many localities, especially at the grassroots level, the server system, terminal equipment, and internet connection are still incomplete and not reliable enough for operation.
According to Dr. Le Van Cuong, Director of the Thanh Hoa Department of Health , although information technology infrastructure has been invested in, it still lacks uniformity across different levels of healthcare, especially in some commune health stations in remote areas. Unstable internet connections and limited computer and server equipment affect the implementation of electronic medical records and data connectivity.
Digital transformation in healthcare requires significant resources, but for many autonomous public hospitals in groups 3 and 4, financial regulations only allow for recurrent expenditures, not investments. Therefore, they still have to wait for "support" from higher authorities. Many facilities face difficulties and uncertainties in investing in projects to meet electronic medical record standards due to high professional requirements and limited resources.
Furthermore, a challenge for public hospitals is the lack of a pricing framework for information technology services within the cost of medical examinations and treatment. Therefore, health insurance cannot reimburse services using software such as image storage, digital signatures, and data storage for patient records. Many things could be done, but many hospitals hesitate to do so for fear of lacking a legal basis.
Another "bottleneck" is software selection and implementation. The market currently has many businesses providing electronic medical record solutions, each with different architectures and data standards, and not all of them are suitable for the actual situation at each unit. Hospitals have to research, test, and adjust internal processes, but not all software meets their needs. "Replacing software in hospitals is very difficult because medical examination and treatment is a continuous process that cannot be interrupted, especially transferring data from old software to new software," shared Dr. Nguyen Ngoc Vinh, Deputy Director of Ba Vi Hospital, Hanoi .
Furthermore, the bidding, procurement, and pricing processes for software are difficult to implement due to the difficulty in determining and quantifying software evaluations. According to the Department of Science and Technology and Training (Ministry of Health), the implementation of software development, appraisal, approval, bidding, and supplier selection faces many difficulties in many localities because the procurement and leasing mechanisms for information technology services are constrained by numerous regulations.
If infrastructure and software are the "hardware," then the work habits and digital capabilities of the healthcare team and patients are the "living software" that determines the success or failure of digital transformation. Many doctors and nurses have worked for decades with paper records and patient files. Now, the requirement to completely switch to a digital environment, digitally sign documents, and store them on a system will be very difficult without decisive leadership and thorough training.
Furthermore, the IT skills of healthcare staff vary considerably across different levels of healthcare, easily leading to data errors in the initial operational phase. Many hospitals have only a few IT staff members who have to manage the entire system, while the public remains unfamiliar with digital services.
Multiple solutions need to be implemented.
To address the aforementioned issues, according to Mr. Nguyen Le Phuc, Deputy Director of the Department of Science, Technology and Training (Ministry of Health), relevant agencies will develop and revise legal documents on the application of information technology in medical examination and treatment, updating the regulations in the Law on Medical Examination and Treatment of 2023; develop and issue detailed regulations on the pricing of medical examination and treatment services, including both health insurance-covered and private medical services, incorporating the cost structure of information technology applications; and issue pricing for medical examination and treatment services using RIS/PACS systems and medical image management instead of film and paper printing at medical facilities. Amend and supplement legal documents such as Circular No. 53/2014/TT-BYT and Circular No. 54/2017/TT-BYT to standardize the definition, technical standards, and legal validity of electronic medical records, digital signature authentication, and electronic signatures for patients. With clear legal frameworks, hospitals will no longer be confused in implementing information technology applications.
The issuance of economic and technical standards for digital services in medical examination and treatment will serve as a basis for hospitals to conduct accounting and, more importantly, to attract private investors to participate in building a smart healthcare system. Simultaneously, minimum IT personnel standards at hospitals and attractive incentive policies are needed to attract high-quality IT engineers to commit to the healthcare sector long-term.
Another point is to standardize the technical aspects and quality of the system, establish standards for data connectivity and interoperability between software; criteria for evaluating the quality of hospital information systems, and criteria for safety, security, and confidentiality of personal health information. Along with this, the government needs to allocate resources to support hospitals facing difficulties in implementing electronic medical records; and organize training, workshops, and forums for sharing experiences.
According to Mr. Le Van Cuong, unit leaders need to identify digital transformation as a key task in management and medical examination and treatment. Units should be grouped, appropriate implementation roadmaps developed, and inspection, supervision, and evaluation of the progress of electronic medical record implementation at each unit should be strengthened. Regarding infrastructure and software, priority should be given to investing in networks, servers, and terminal equipment at departments and health stations; in areas facing difficulties, IT services can be outsourced to ensure regular upgrades. Training courses on digital skills should be organized for doctors, nurses, and management staff; "digital competence" criteria should be included in annual evaluations; department and ward leaders should be required to set an example in using digital systems; and dedicated IT personnel should be recruited and employed at each unit…
Source: https://nhandan.vn/kho-khan-trong-chuyen-doi-so-y-te-post930115.html
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