Once there is a vision for the ideal health system and before creating an action plan, the current state of the system must first be clear. Diagnostic testing plays a key role in health care and treating diseases; the same is true for a country’s DT processes. No one would start a medical treatment without understanding the details of their condition. No doctor would prescribe a course of action without looking at the patient’s test results. This also holds for a DT, where the leaders of the process are both patients and doctors. Without a correct diagnosis, they run the risk of acting blindly and perpetuating the system’s chronic maladies, despite the high cost of the measure they take.
How do we diagnose the system’s health?
Recently, the IDB, along with other institutions like the PAHO developed a series of tools to help countries identify their current situation in relation to their vision for the future state of health care and each component of that goal.
Jennifer Nelson, Health Specialist, Digital Solutions, IDB
What are the critical factors thar increase our odds of success of digital transformation?
"A portfolio of proyects in each of the 6 dimensions aligned with the goals and objetives of the national digital health agenda supports a holistic and sustainable transformation process"
“A correct diagnosis
is three-fourths the remedy."
- Mahatma Gandhi-
First, there are two central characteristics of a more effective process: the diagnosis should be holistic and systemic. DT projects often fail because they focus on “transforming” just one aspect of the system. For example, they center on assessing computer or software gaps, without considering the current digital skills of patients or human resources or the present state of health care processes or governance.
¿So what goes into a proper diagnosis? It should evaluate the six key dimensions of DT: governance, people and culture, informed health policy and practice, infrastructure, infostructure, and applications and digital services of the sector. While the tools recommended below sometimes serve more than one function, they have been categorized according to their primary evaluative purpose.
Governance and management
What is it?
The governance structure is the mechanisms, processes, and institutions whereby all stakeholders and participants in the national health system align their interests, exercise their rights, meet their obligations, resolve their differences, and oversee its operation. Governance is the framework allowing all participants to coordinate their work.
How is it assessed?
The digital health regulatory map is the key tool. Other valuable resources for specific implementation areas are maturity models, including the Digital Electronic Health Records Maturity Model and the information Systems For Health Maturity Model (IS4H-MM).
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People and culture
What is it?
This dimension encompasses all actions related to communication and adoption of the DT strategy by citizens. It also includes all steps required of healthcare human resources, who have to acquire digital and change management capacities in their daily activities. Key aspects like empowering the sector and citizens to achieve country’s vision and strategy, as well as participation and commitment from all members of the ecosystem also fall under this dimension.
How is it assessed?
There are standardized surveys like the one developed by the Regional Center for Studies for Developing the Information Society (CETIC) and the Telemedicine Maturity Model developed by the PAHO and IDB that contain the questions needed to construct validated indicators on healthcare staff and patients and their relationship to digital tools. The National Health Service’s (NHS) digital community of interest alalso has useful resources.
Informed health policy and practice
What is it?
This dimension involves using information to govern the health system and to track and monitor the country’s public health.
How is it assessed?
The maturity models listed in the people and culture dimension can also be used to measure this dimension, since they collect information about generating and using digitalized information to make public health decisions. Additionally, there are two models proposed by HIMSS: one on supply chain (CISOM) and the other on the capacity in your organization for the use of analytics (AMAM)
Digital infrastructure
What is it?
The required technology, in terms of Internet access, storage, processing, devices, etc.
How is it assessed?
Specialized survey tools, like the one developed by CETIC.BR have been used in Brazil since 2013 and in Uruguay since 2014. Another diagnostic tool is INFRAM, developed by HIMSS, which evaluates and maps the technological infrastructure capabilities required to achieve the clinical and operational objectives of an organization.
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infostructure1
What is it?
Infostructure is the technological components needed to develop the digital health system’s syntactic and semantic interoperability processes, like medical information repositories; patient, product, and place directories; use of medical terms; components related to controlling the informed consent of patients; mechanisms to protect the privacy and security of access to the platform; and rules for sharing the different types of electronic medical documents.
How is it assessed?
Through specific interoperability maturity models, like IDB’s tool for the social sector or the one developed by MEASURE to calculate the maturity of the health sector’s interoperability. For assessing data protection, options include using ethical hacking or the cybersecurity self-assessment tool developed by the IDB.
Applications and Digital Services of the Sector
What is it?
The software applications that need to be developed, integrated, upgraded, maintained, and launched to improve health care. The main tools in this sector include EHR, telemedicine applications, or artificial intelligence software.
Tool for assesing the maturuty level of health institutions to implement telemedicine services
See here.
How is it assessed?
The telemedicine maturity model developed by the IDB and the PAHO, as well as the IDB’s National Electronic Health Record Maturity Model and Scorecard for Electronic Health Record Systems are good starting points
In medicine, a fast and accurate diagnosis can mean the difference between life and death. Similarly, the difference between a successful and failed DT lies in constant, reliable, and accurate assessment of health systems using tools specifically created for that purpose.
