While visiting healthcare facilities and talking with quite a few PACS administrators, it was again amazing that major manufacturers do not make an effort to determine the local requirements for a different culture such as that of Arabic countries. It is critical for medical devices and PACS software to support Arabic names, as there are no one-to-one translations from Arabic to English. Therefore, a person would have to show up in a worklist with both the Arabic name and its English translation.
Several of the major vendors are not making an effort to implement this, which by definition rules them out from any opportunity in this huge market. I believe this is one of the reasons that smaller companies such those based in Egypt or Turkey can be more effective in this region, along with the fact that their support can be better as well.
Herman Oosterwijk of OTech.
In addition to not meeting local requirements such as supporting the native character set, there are many complaints from the user community about the poor service and support by European and U.S. healthcare imaging and IT vendors. Again, it is amazing that these companies don't make the effort to properly train and recruit engineers and professionals with the same level of competence and skills as in their mother countries.
I have had the opportunity to meet and train many professionals from the Middle East, and I can assure you that these are among my best students; many of them trained at some of the top U.S. universities. Therefore, they have the same technical skills as engineers in Western countries.
To be successful in the countries of the Middle East, and I assume it applies to other regions as well, such as the Asia-Pacific region and possibly Eastern Europe, vendors need to learn what the local requirements are, customize their systems to meet those requirements, and train a local technical staff that can support these complex systems. As the market for some of the healthcare imaging and IT systems such as PACS are maturing in the U.S. and Europe, the opportunity for growth is definitely among the emerging countries.
Saudi Arabia's e-health program
There are enormous potential rewards for vendors that are able to catch a share of this rising market. Saudi Arabia has started a national e-health program, which set aggressive goals to double the number of beds, add another 50 new hospitals to the existing 260, and connect them all seamlessly, with every provider using a unified medical heath record by 2020.
To facilitate this, Saudi Arabia joined the Integrating the Healthcare Enterprise (IHE) organization in early 2013 and hosted the HIMSS Middle East conference that I attended. The country is making major investments in setting up a health information exchange that allows electronic health records to exchange information for Saudi citizens, immigrants, and visitors.
This effort will be accompanied by many new HIS and PACS installations and healthcare infrastructure improvements. Every effort is being made to apply the lessons learned by other countries, notably the U.S. and Canada, and leverage the standardization efforts by the IHE organization.
The Saudi Ministry of Health (MOH) is responsible for 60% of the healthcare in Saudi Arabia, while the remaining 40% is split by other ministries such as the Ministry of Interior taking care of the security forces, army, and the private providers. The MOH is in the process of specifying which IHE profiles make sense based on their specific-use cases, some of which require minor adjustments.
For example, the country has a central registration of persons who all have a unique ID (including visitors, who are identified by their visa numbers). This can be used to query from the yet-to-be implemented registries for medical records, which can then be retrieved from the several repositories.
The very aggressive and ambitious healthcare IT effort will connect the hospitals to three major data centers, all through the Saudi Health Information Exchange (HIE). This HIE will not only function as the central repository and registry, it will also be able to run national e-health applications such as e-referrals.
Need for standardization
The standardization of vocabularies and terminology for procedures, results, etc., is critical to this effort. For example, if a request for a lab test is to be sent to another lab, with the results sent back to yet another hospital, one had better make sure there is agreement about the test specification and clear definition of the results so they can be interpreted electronically by the receiving electronic medical record. The implementation of HL7 version 3, Clinical Document Architecture (CDA) release 2, will be a part of the required functionality to exchange documents between the facilities and the respective HIE.
The facilities themselves are divided into four layers. The first layer is the primary care physician. He or she will refer a patient to a hospital if needed, which is the second layer. The third layer consists of specialist hospitals for specific diseases and specialists, while the fourth layer contains the so-called medical cities, which deal with the most difficult cases.
It does not make sense to repeat the connectathons to test the different IHE profiles to be used to connect all these systems, as most of the vendors have tested these rigorously at locations in the U.S. or Europe or at other connectathon venues. However, to make sure that the local extensions are correctly implemented, the idea of a "projectathon" has surfaced. This activity will retest the necessary extensions based on the use cases applicable to the local environment.
The Saudi government is very serious about the requirement to support the standards as defined by the IHE modified subset. It has plans to set up a testing laboratory, and it might even put import controls in place to prevent any devices that don't comply with standards from entering the country.
There is still a lot of work to be done by the Saudi government, such as finalizing the IHE subset of the profiles with their local extensions and modifications, setting up the certification labs, and, obviously, selecting the vendors. Procuring all the necessary systems and managing the implementation is a major effort.
The good news is that in many cases, the hospitals are not burdened by the need to migrate data, as they can start from scratch. In addition, applying lessons learned from other countries and using an extensive set of profiles from the well-proven and tested IHE specifications should help. This should allow the Kingdom of Saudi Arabia to be able to jumpstart these implementations and potentially meet its aggressive goals to be totally health-connected by 2020.
Herman Oosterwijk is president of OTech, a healthcare imaging and IT company specializing in EMR, PACS, DICOM, and HL7 training.
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