Digital information systems can help to process information and facilitate communication and collaboration. As such, they can have a role in improving quality across health systems and, more specifically, in cancer care. This article will explore how Portugal and Austria used them to expand their work in different action areas in cancer control: i) Portugal invested in primary prevention through the implementation of an immunization information system that compiled information from multiple providers, and ii) Austria created a cross-hospital digital platform to make communication and exchange of information between facilities providing cancer care easier and therefore improve patient care.
Portugal’s immunization information system compiles data from state and private providers
Europe’s beating Cancer Plan (EBCP) outlines improving vaccination coverage as a key strategy to prevent vaccine-preventable cancers. Boosting HPV vaccination adherence can lead to the elimination of cervical cancer, among others such as certain head, neck and anogenital cancers and is a crucial component of primary prevention of cancers with an infectious cause. As such, the EBCP sets out a target for Member States of achieving HPV vaccination rates of 90% for girls and to significantly increase the rates for boys by 2030
A barrier often mentioned to the success of vaccination programs is the fragmentation of data when countries have multiple providers as it makes it challenging to identify specific needs. In Portugal, this had also been mentioned as a barrier to as vaccines are administered in both state and private settings and the previous national immunisation system did not compile all these different data sources.
To overcome this, the country created an immunisation information system that centralised information from both state and private providers. The information system allows healthcare professionals to monitor vaccination records and inform public health teams of vaccination coverage rates, providing information for tailoring initiatives to improve vaccination adherence (for example, targeting a specific geographic area). It also allows residents in the country to access their full vaccination status, with reminders to parents or legal guardians in case of delayed vaccinations with a proposed schedule for HPV vaccine administration .
This system has allowed for continuous tailored strategies that have helped, alongside the country’s free and universal vaccine program, maintain the country’s high immunization coverage for the HPV vaccine, with coverage for the HPV vaccine above the average for the EU and above WHO’s minimum target of 90% in girls as per the recommendation in EBCP.
Austria created a digital platform for hospitals to exchange patient information more seamlessly
Cancer care is notoriously complex as it can involve a diverse array of professionals from different professions and specialisations across different levels of healthcare. For example, early diagnosis can be done at a primary care level followed by treatment and follow-up in more than one hospital. Adequate and timely information exchange is then needed to provide quality care.
In Austria exchange of information and structured collaboration between facilities had been identified as a facilitator to improving quality of care with one survey finding that cancer patients in the country perceived the communication between the different specialists involved in their care as insufficient.
As the country’s health system is organized by federal states, the Upper Austrian region implemented a regional oncology network, the Upper Austrian Tumour Centre, to make the most of Austria’s regional organization. The network which started with 7 hospitals has spanned to all 14 hospitals involved in cancer care in the region.
This initiative included a cross-hospital digital platform to make exchange of information more seamless and improve coordination of care and patient transfers. To overcome issues with interoperability between different systems, the different stakeholders in the region agreed on a set of guidelines and procedures to address logistic, legal and ethical issues that could arise from the transfer of patient’s data between institutions. Additionally, a common long-term vision shared by the different institutions has improved efficiency and sustainability of the initiative by pooling resources and engaging in common annual budgeting.
Legal and technical mapping is needed prior to implementing digital information systems
As these cases show, a-key question that should be addressed before implementing an
information system is who needs what information and in which
circumstances. Such mapping allows policymakers to understand what legal
and technical requirements should be taken into consideration.
Legal questions
around data privacy and property should be answered. In the example of
Portugal, one of the main requests for the new immunization information system
was to be able to share information between state and private providers. As
such, responsibilities for private providers including in the case of mergers
or acquisition by other groups, for example, should be clarified by
policymakers.
Technical considerations should be carefully evaluated as well. In Austria understanding who can access what information in a patient’s electronic record is key. However, to make healthcare truly patient-centric, the record needs to include the relevant medical history in the different settings the patient needs care from. These two considerations need to be carefully balanced out when planning an information system. Also, technical questions include adapting the interface to the information different users might need. In Portugal, the immunization information system is used both by the population and by healthcare professionals.
New technologies are already changing the landscape for information systems
This article only focused on information systems already in use by Portugal and Austria. With innovation such as artificial intelligence (AI) there are new areas under expansion that were not considered here. For example, AI is already helping to advance cancer research by processing large amounts of data, identifying patterns or making predictions. Understanding how these new technologies can be adapted into public policies to improve cancer outcomes in an equitable manner will be a new challenge for European countries.
Conclusions and policy considerations
The examples
from these two countries show how digital information systems can be integrated
in cancer control efforts in different phases and for different purposes. From
strengthening vaccination efforts to improving patient-centred care. Policymakers
will find it useful to take into account that a solid digital infrastructure
can improve quality in cancer control by improving communication between care
providers. It can also lead to more efficient health systems by allowing more
seamless and less resource-consuming data exchange.
Despite being implemented in different areas of cancer control, in both countries part of the success of these programs relies on strengthening communication and exchange information between different providers. To make the most of such exchange, detailed legal and technical analysis should take place to make different information systems communicate all while protecting patient’s rights.
References
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