The digital doctor: how electronic health records are transforming health care in Ukraine

Electronic Health Records, which store patient data into a single digital register, have been working in Ukraine for more than a year now. But what exactly does the system entail, how do you use it, and how does it benefit doctors, patients and the state? 

At the beginning of 2018, Ukraine stopped using paper documentation in the field of health care. This decision involved the creation of a “single digital medical platform”, a new system of electronic data on the health status of a particular patient.

The system started operating in March 2019 in test mode: the Ministry of Health (MOH) together with the National Health Service of Ukraine (NHSU) launched the option of maintaining Electronic Health Records (EHR) through medical information systems. 

Family doctors, therapists, and paediatricians connected to eHealth could enter patient information by creating an EHR. In turn, information about referral to specialists, diagnoses, prescribed treatments, etc., became available to patients. 

But where did the concept of EHR come from, how does this digital system work, and how will it benefit all Ukrainians without exception?

From ancient Egypt to the present

It is believed that ancient Egypt was one of the first countries where patients’ health records started to be recorded, dating the tradition of documenting a person’s medical history back several thousand years.

As for using electronic tools, American physician and entrepreneur Lawrence Weed first introduced the concept of “electronic health records” in the mid-1960s.

As early as 1972, representatives of the Regenstrieff Institute in Illinois developed the first electronic health record system based on the Weed’s concept. Given the quality and efficiency of computer equipment at that time, use of EHR was limited at first.

However, the rapid development of semiconductor technologies, microprocessors and software in the late twentieth century has significantly improved new EHR systems, with EU countries beginning to roll out effective EHR management systems from 2010.

What are the functions of EHR?

Technically, EHR is the only information resource that allows both physicians and patients to have constant access to the treatment history. The main advantage of the EHR is the exchange of all patient data between different medical institutions and specialists.

In practice, EHR allows Ukrainians and medical professionals not to use paper health records and to seek medical services in the hospitals that suit them best, regardless of the place of registration or current residence.

One of the EHR’s advantages is the increased level of patient privacy. According to Dmytro Chernysh, director of the NHSU Health Development Department, unlike with paper health records, which can be viewed by any medical or even non-medical staff, only specific doctors have access to the patient’s electronic data.

“The family doctor sees all the information about the patient and the attending physician sees the information related to the necessary treatment,” Chernysh explains. Thus, when a patient comes for a consultation, for example, to a neurologist and provides the code of the e-referral, the neurologist opens the patient’s general information and a specific record of the family doctor with a referral to a specialist.

“If this is a history of typical visits, the neurologist will see his previous records. However, he will not see records of other doctors, for instance, another neurologist or a surgeon. But if a neurologist needs to look at the patient’s medical history in order to provide a better treatment, to learn if the patient saw a specialist such as an allergist, the doctor will have to ask the patient for permission to access specific data and enter codes into the system in order to see the specific data he needs,” says Chernysh.

In this case, access to the codes works like a normal two-factor authentication: the patient receives an SMS-message with a confirmation code to access personal data. The patient should tell the code to their doctor, after which access to the additional data will be open.

In addition, EHR data can be used by insurance companies, health statistics agencies and other governmental or non-governmental organisations responsible for health care.

 Are Electronic Health Records popular and effective? 

According to the World Health Organisation, there has been a steady growth in the implementation of national EHR systems over the past 15 years. In 2011-2016, the rate of such growth was 46%.

Of course, implementation is primarily in middle- and high-income countries, which can create an effective digital register and provide doctors with the tools to complete it. 

But thanks to initiatives such as the European Union’s EU4Digital, countries such as Ukraine are receiving assistance for the development of such systems.

“The Ministry of Digital Transformation enjoys the most fruitful cooperation with the EU4Digital project,” says Mykhailo Kiktenko, eHealth coordinator and Governmental Expert on European and Euro-Atlantic integration at the Ministry of Digital Transformation of Ukraine. “With the direct assistance of EU4Digital, we have already piloted the use of various technologies such as eInvoicing and eSignature and achieved solid results. Recently established cooperation on eHealth makes us certain that we will achieve exceptional results in this area, which will help Ukrainian citizens reap the full benefits of the EU-Ukraine Association Agreement.”

Those benefits will make a significant difference to the delivery of healthcare across the country: “The great advantage of electronic health records is that they will not disappear anywhere, because they are stored in the central eHealth database,” Dmytro Chernysh explains. “Most of us have faced a situation where a paper health record card was lost in the hospital and all the necessary information about vaccinations, chronic diseases, hospitalisations and more disappeared along with it. But for us to be properly treated, to prevent potential problems, medical history must be preserved in its entirety. This is exactly what electronic health records and an electronic health card provide,” Chernysh adds.

When did the EHR management system start working in Ukraine and how to use the card?

As of March 2019, the EHR management system has been operating in Ukraine in test mode. Initially, physicians received only basic functionality and the option to enter data on patient treatment through medical information systems.

Over the last year, all the necessary patient information was entered into the EHR, thus replacing paper records with digital data. 

The EHR of each patient who has signed the declaration on choosing the primary care physician is automatically made available to specialists through the medical information system and is stored in eHealth. The NHSU plans to create a patient’s user account, which will allow to submit the declaration online, monitor their data in the EHR, save referrals, prescriptions, treatment, make an appointment and so on. 

“We plan to launch the patient’s user account next year. The service will allow the patient to submit the declaration online, see his own electronic health record, which will store his electronic prescriptions and referrals. In addition, the patient will be able to log into his account and check who had access to his data and when,” emphasises the director of the NHSU Health Development Department.

In some cases, properly completed patient EHRs can save lives: thanks to doctors’ quick access to patient records, it is possible to get basic information about victims in emergencies, for example, when a person is involved in an accident and needs a blood transfusion.

“In the form, any doctor can see a person’s last name, first name and patronymic, date of birth, blood type, weight, height, which vaccinations were made, whether the person has allergies (so the doctor will know which drugs can be administered and what to expect), whether there were surgeries (they can affect the process of medical care). Every doctor has access to this form,” says Dmytro Chernysh. 

Kyiv resident Anastasiya Ryzhkova signed a declaration with a family doctor a few months ago and was given the opportunity to review her EHR in the Helsi.me system. According to her, the introduction of such technologies, undoubtedly takes time because it is often difficult for older doctors to understand the digital registry and provide services quickly.

Anastasiya explains that due to the fact that health records are new to older professionals, there are still queues in the hospitals.

But the advantages are clear: “Thanks to the Helsi.me system, I can easily find and order medicine online in any pharmacy, make an appointment with any specialist in a private or public clinic, or choose a doctor based on their experience or feedback from other patients. You can even order an insurance service on the website, which is very convenient,” she says. “Undoubtedly, it would be very good if such digital registers were used by all doctors and patients at once, and such systems would work without errors. Everyone will benefit from this. Now, unfortunately, eHealth services need time to get refined.”

She is convinced that the possibility of entering data into the EHR is a move in the right direction, because now, thanks to systems such as Helsi.me, it is possible to at least find the contacts of doctors and the cost of their services, rather than contact an unknown specialist in the closest hospital. 

How will EHR help Ukrainian doctors?

If the benefits of an effective digital medical information system are clear to patients (lack of paper certificates, protection of personal information, convenient use of medical services, etc.), the benefits of electronic health records for physicians may not seem so obvious. But this is only at first glance.

In reality, the EHR frees doctors from the daily task of filling out piles of documents, and allows them to focus on providing quality services to their patients.

A healthcare professional can get the patient’s complete medical history in just a few clicks and make the right decision about further treatment. This minimises the risk of errors in records, incorrect decision due to human factors and generally improves the quality of service.

“The patient’s family doctor or attending physician has access to the patient’s electronic health card. If necessary, the doctor will be able to print a consultation opinion, which will contain the reason for treatment, diagnosis, treatment or referral for additional examination. All this is thanks to electronic health records,” explains Dmytro Chernysh.

Vita Oleshchenko, a family doctor with five years of experience, who works in a private medical facility in Kyiv, recalls that she started working with the medical information system that allows electronic health records to be entered about a year and a half ago, at the very beginning of its existence in Ukraine.

“This system makes work much easier, first of all, in terms of writing certificates, referrals, conclusions, etc. It is also convenient for patients, as they no longer need to work out their doctor’s incomprehensible handwriting, and it is also possible to make an appointment and plan visits to hospitals online,” says Oleshchenko.

According to her, among the key problems of electronic health records now is the lack of the function of filling in electronic sick leaves and issuing certificates – this still needs to be done offline.

Also, prescriptions can be prescribed online only under the “Affordable Medicine” programme, but not any other drugs. “It would be good if the NHSU took care of these and other problems,” Oleshchenko adds.

How does the state benefit from EHR?

A transparent digital register of patients’ health data not only allows for proper monitoring of the state of health care in the country, but also significantly reduces the risk of corruption between patients and doctors.

If the system works properly, the patient receives a general referral to a medical service, not to a specific doctor. As a result, data on each examination and treatment is stored automatically, patients cannot and do not need to pay doctors separately, and all doctors’ decisions get supported by a reliable evidence base.

According to the NHSU statistics, most referrals under the EHR system in Ukraine have so far been consultation (almost 8 out of 13 million). According to Dmytro Chernysh, the most popular specialists were neurologists (about 700,000 e-referrals), ophthalmologists (almost 600,000 e-referrals), surgeons (580,000 e-referrals) and ENT specialists (540,000 e-referrals). 

“By analysing such information, local authorities can predict which specialists need to be recruited to work in local hospitals, what new equipment is needed to build a competitive and efficient health care facility,” explains a representative of the NHSU. “Or, thanks to electronic data we can see the number of declarations from primary care physicians and decide on the involvement of new family doctors, therapists or paediatricians to work in a specific location.”

A future of seamless integration

EU4Digital is working with Ukraine as well as other countries in the Eastern Partnership region, to ensure that health information exchange and management systems are in harmony with EU best practices and with neighbouring countries. This would mean that data conforming to the same norms is interoperable among various organisations, stakeholders and even across borders, which is important in providing better care for patients, no matter where they are.

“Interoperability will improve the health of every citizen in the Eastern partner countries,” explains Martynas Daugirdas, eHealth expert for the EU4Digital facility. “Our vision is that in 10 years’ time, when a patient from Country A needs urgent care in Country B, healthcare providers will have immediate access to information on which medications the patient is sensitive or allergic to. This summary of a patient’s health condition is crucial when making urgent life or death choices that characterise the healthcare sector.”

To support this effort, the EU4Digital eHealth team has conducted an analysis of the current state of play of eHealth in the Eastern partner countries, and identified each country’s challenges and priorities. The set of guidelines will serve as a basis for establishing cross-border standards, considering legal, organisational, semantic and technical interoperability categories and related aspects. 

“The health care of the future can be imagined as seamless patient mobility from provider to provider, country to country, as well as health care provision continuity and informed decision making for better health outcomes,” says Daugirdas. “Cross-border eHealth infrastructure will allow a Ukrainian citizen travelling abroad to receive prescribed medication from a local pharmacy. The sharing of patient summaries will help doctors to understand patients’ medical history and avoid mistakes when prescribing medicine.” 

EU4Digital aims to extend the benefits of the European Union’s Digital Single Market to the Eastern Partner states, channelling EU support to develop the potential of the digital economy and society, in order to bring economic growth, generate more jobs, improve people’s lives and help businesses in Ukraine and the other Eastern partner countries – Armenia, Azerbaijan, Belarus, Georgia and the Republic of Moldova.

Find out more about EU4Digital at https://eufordigital.eu/

The full story was published on nv.ua