Digitalizacija zdravstvenih sistemov je priložnost in izziv

Sodobna tehnologija vstopa na vse več področij našega življenja, tudi v medicino in zdravstvo. Digitalne rešitve naj bi ponudnikom zdravstvenih storitev poenostavile delo, pomagale pri hitrejši diagnostiki, s sistematizacijo podatkov spodbujale preventivo in opolnomočile bolnike. Teoretičnih pozitivnih učinkov informacijskih sistemov v zdravstvu ni malo, kot tudi ne izzivov za informacijska podjetja, ki novodobno zdravstvo podpirajo z razvojem e-rešitev in zalednih sistemov. O tem, kako realizacija potencialov novih tehnologij poteka v praksi in kakšno je sodelovanje med zdravniki in IT-jevci pri nas, smo se pogovarjali s Tomažem Furlanom, direktorjem podjetja Lucis, ki rešitve za zdravstvo izdeluje že od leta 2011.

Podjetje Lucis se je v zdravstvo podalo precej pred popularnostjo digitalnega zdravja, ki smo mu priča zadnja tri leta. Kakšna je bila vaša pot?

Pred skoraj desetimi leti je UKC Ljubljana objavil razpis za prenovo radiologije, na katerega se je prijavil naš poslovni partner, podjetje Interexport. Ker je to podjetje tudi zastopnik svetovne korporacije AGFA, ki se z informatizacijo zdravstva ukvarja že od devetdesetih, je bila prijava zanje razumljiva. Mi smo se projektu priključili kot podizvajalci in delovanje zdravstva začeli šele spoznavati. Tedaj razviti sistem za radiologijo še danes uporablja večina slovenskih bolnišnic, prisoten je tudi v nekaterih zdravstvenih domovih; prav tako je še vedno uspešno tudi naše sodelovanje s podjetjem Interexport in z AGFA.

Danes je naša vloga na trgu precej drugačna, saj smo v tem času sodelovali pri nekaterih ključnih projektih in se postopoma specializirali za razvoj nišnih rešitev v zdravstvu. Nekateri med njimi so Telekap, razvit v sodelovanju z Nacionalnim inštitutom za javno zdravje. Telekap preko videokonferenčne povezave omogoča zdravljenje bolnikov z možgansko kapjo tudi v bolnišnicah, kjer nevrolog ni vedno prisoten. Sistem v okviru Nevrološke klinike Univerzitetnega centra Ljubljana danes povezuje že 12 slovenskih bolnišnic. Za Splošno bolnišnico Slovenj Gradec delamo na projektu Fabry-Care, namenjenemu bolnikom s Fabrijevo boleznijo in na projektu Record-KLB, ki sistematizira obravnavo bolnikov s kronično ledvično boleznijo. Za Onkološki Inštitut smo pripravili rešitev za register raka SLORA, za Nevrološko kliniko pa register kapi.

Zdaj ste v zdravstvu že skoraj desetletje. Kako vidite porast konkurence in naraščajočega števila novih igralcev na trgu?

Digitalizacija zdravstva ne sprejema rešitev iz danes na jutri. V prvi vrsti je pri vsakem projektu potreben za preskok v miselnosti. Tehnologiji mora podpreti reorganizacijo vrste zahtevnih procesov. Eden ključnih izzivov v zdravstvu je predvsem povezovanje sistemov, saj je podatkov danes ogromno, problem zdravstvenih informacijskih sistemov pa je v razpršenosti teh podatkov. Zato je naloga informacijskih podjetij, da jih naredimo čim bolj uporabne in predvsem enostavno dostopne.

Tako kot drugod po svetu je tudi v Sloveniji zdravstvo specifičen in kompleksen sistem, ki zahteva veliko vsebinskega znanja in interdisciplinaren pristop. Na trgu je zagotovo veliko dobrih IT ekip, a projekti v zdravstvu ne potrebujejo zgolj izvajalca, temveč ustreznega sogovornika, ki bo na realen problem iz zdravstva odgovoril s tehnološko ustrezno rešitvijo. Ta mora biti tudi uporabniku prijazna ter omogočati širitev. Zato mora vsak sistem temeljiti na razmisleku o dolgoročnem vplivu in širitvi na vse več uporabnikov ter tudi na druge ustanove. Za razvoj tovrstnih rešitev so v prvi vrsti potrebni usposobljeni kadri, a tudi znanje, reference in razumevanje zdravstvene stroke, ki pridejo z izkušnjami in postopno rastjo. Zato se porasta igralcev ne bojimo.

Glede na to, da ne delate zgolj v zdravstvu, kakšna so vaša opažanja glede razlik med informacijskimi rešitvami za različne industrije?

V zdravstvu je podrobnemu zajemu zahtev za posamezni projekt potrebno nameniti več časa. Naš cilj je namreč, da končna rešitev na enem mestu združuje vrsto funkcionalnosti, ki odražajo in prepletajo delovne procese različnih deležnikov. Pri načrtovanju je ključno sodelovanje s strokovnim osebjem, kar v praksi pomeni veliko preživetega časa ob uporabnikih na njihovem delovnem mestu. To omogoča poglobljeno spoznavanje posameznih procesov, ki je nujno za zagotovitev uporabnikom prijazne in učinkovite digitalne rešitve. V nadaljevanju projekta pa s takim pristopom le redko pride do situacij, ki jih v fazi analize že nismo obravnavali ali predvideli. Tudi zaradi specifike zdravstva se projekti vpeljujejo v t. i. mehkih zagonih, kjer rabo rešitev najprej predvidimo v omejenem obsegu, saj tako lažje obvladujemo morebitna tveganja in tudi obremenitev uporabnikov samih.

Kakšni so vaši cilji v prihodnje, je v njih tudi tujina?

70% našega dela je v zdravstvu, 30% pa na drugih področjih, kar je za nas tudi najbolj optimalno. Z vidika podjetja je zdravstvo v Sloveniji zahtevno, ker spada v javni sektor. V javnem sektorju so cikli naročil in predaje bistveno daljši kot v zasebnem sektorju, kar kompenziramo z zanimivimi projekti iz drugih strok. A vendar ravno na digitalizaciji zdravstva v Lucisu gradimo kredibilnost in prepoznavnost, v tem pa smo dobri tudi zato, ker nam delo v sektorju predstavlja izziv in strast.

Po naravi sem realist, ki gleda in deluje na dolgi rok. Pomembno mi je, da imamo v ekipi dobre odnose, da s strankami gradimo zaupanje, ki vodi v dolgoročno sodelovanje in da se rast zgodi postopoma. Tako je ta bolj obvladljiva, storitve pa ostajajo na nivoju. V tujini zato običajno delamo s partnerskimi podjetji, ki bolje poznajo specifike trga, mi pa se priključimo kot podizvajalci. Prihodnost je zato tudi precej odprta.

V podjetju imate izkušnje tudi z blockchain tehnologijo. Kako je vpeljujete v zdravstvo in kakšna pričakovanja imate od nje?

Kot storitveno informacijsko podjetje moramo dobro slediti napredku v lastni stroki in konkurenčnost ohranjati z obvladovanjem novih tehnologij. Poleg dolgoletnih izkušenj na področju uporabe programskega jezika Java in sorodnih tehnologij, poznamo in uporabljamo tudi vse ključne standarde na področju informatike v zdravstvu (DICOM, HL7, IHE in FHIR), kot eni prvih v Sloveniji pa smo znanje ekipe nadgradili s certifikati s področja tehnologije veriženja blokov (ang. »blockchain«) in prepričan sem, da smo tudi zato danes možni poiskati odgovore na izzive podjetij iz raznovrstnih industrij. Sam sem tudi član in predstavnik Slovenije v evropski strokovni delovni skupini EBSI ESSIF User Group, ki deluje v okviru Evropskega »blockchain« partnerstva (European Blockchain Partnership).

Pridobljeno znanje o »blockchainu« trenutno uporabljamo v vlogi zunanjega izvajalca, predvsem v partnerstvu s podjetjem Netis blockchain technologies, ki je v Sloveniji pionir razvoja na tem področju. Sočasno raziskujemo tudi možnosti v zdravstvu, saj lahko tehnologijo apliciramo na vrsto rešitev, kjer je pomembno, da so podatkovne baze varne, podatki pa dostopni več uporabnikom ali sistemom hkrati. Uporaba je zanimiva tudi v obliki bolnikovega nadzora in upravljanja lastnih podatkov, saj je že več farmacevtov prišlo do spoznanja, da bi bilo smiselno spodbuditi bolnikov z nagrajevanjem za zbiranje in testiranje podatkov.

Slovenija je majhna, igralcev pa relativno veliko. Vidite druga podjetja kot konkurenco ali kot partnerje?

Razvoj informacijskih sistemov danes ne predstavlja zgolj tehnološkega, temveč predvsem poslovni izziv, ki zahteva znanje strokovnjakov iz različnih področij. Zato lahko uspeh zagotovi zgolj formiranje interdisciplinarnih skupin. Tudi zaradi nuje po integraciji zdravstvenih rešitev mora obstajati povezovanje med proizvajalci, zato v Lucisu verjamemo v sodelovanje in predvsem v kakovost izvedbe.

Kaj vam predstavlja največji izziv?

IT v zdravstvu je v Sloveniji podhranjen, mi pa imamo specializirane IT strokovnjake s tega področja, ki so naša dodana vrednost in nam omogočajo stabilno rast. Pomanjkanje kadra je sicer vsesplošen izziv IT podjetij, zato kot delodajalec nenehno razmišljam o tem, kako kader ustrezno izobraziti in tudi obdržati. Menim, da je ključno, da mladim ponudimo možnost za učenje, dovolj izzivov in tudi stabilnost, ki jo prinašata redna zaposlitev in stimulativno plačilo.

Običajno zato nove sodelavce iščemo že med študenti, ki jih ustrezno izobrazimo in usmerjamo na karierni poti. Ključen dejavnik, da z nami ostanejo, je, da se ujamejo z ostalimi člani ekipe. Takšen način nam je tudi ljubši kot hiter porast števila zaposlenih, ki s sabo prinese vrsto izzivov, a dolgoročno morda ne vzdrži. Seveda pa bomo morali kadrovskim vprašanjem in motivaciji zaposlenih v prihodnje nameniti še več poudarka, saj konkurence ne predstavljajo zgolj domača, temveč predvsem tuja podjetja.

Digitalization of healthcare is an opportunity and a challenge

Modern technology is affecting various aspects of our lives, including medicine and healthcare. Digital solutions are supposed to help with faster diagnosis, encourage prevention through early detection, and help to empower patients. In many cases, healthcare IT solutions became a daunting added task for healthcare workers. Healthcare IT companies need to consider various aspects of healthcare work to create solutions that support clinicians and are seamlessly integrated into clinical workflows. We talked to Tomaž Furlan, the CEO of Lucis, providing IT solutions for Slovenian healthcare system since 2011. Tomaž talked about the specifics of technology implementation in healthcare, and the nature of collaboration with doctors in Slovenia.

Lucis became a healthcare IT player long before digital health became a popular industry. What got you interested in the sector?

Almost ten years ago, the University Medical Centre Ljubljana advertised a tender for digitalization of radiology. Our business partner, Interexport, submitted an offer since they were the distributor for AGFA. AGFA has been involved in healthcare IT since the 90'. We joined the project as subcontractors and that was the beginning of our journey in healthcare. The radiology systems we helped design at the time is still used by the majority of Slovenian hospitals and some community healthcare centers. We are still collaborating with Interexport and AGFA.

Up to this day, we designed several products: Telestroke - a telemedicine solution providing patients who suffered a stroke, high quality care even when a neurologist is not present in the hospital. Telestroke connects the Clinic of Neurology in Ljubljana with 12 Slovenian regional hospitals. Other projects include the Fabry-Care system for patients with Fabry disease (a progressive, inherited, multisystemic lysosomal storage disease characterized by specific neurological, cutaneous, renal, cardiovascular, cochleo-vestibular and cerebrovascular manifestations), which we are designing in collaboration with the hospital in Slovenj Gradec, Record-KLB systematizes care of patients with chronic kidney diseases, Cancer Registry designed for the Institute of Oncology, and Stroke registry designed for the Clinic of Neurology.

Almost a decade has passed since your entry to healthcare. What are your observations of the growing number of newcomers and rising competition?

Despite constant demands for speed and agility, digitalization of healthcare doesn’t happen overnight. Healthcare projects need more than a contractor, they require a partner that will be open to learn about real problems in healthcare and how to support them with successful solutions. Primarily, healthcare digitalization demands a shift in the mindset. Complex healthcare processes need to be reorganised and optimised with the support of IT. Development of such solutions requires highly specialized workers with rich knowledge and understanding of healthcare. The only way to obtain deep insight is through years of experience. Additionally, no provider can design all solutions for all healthcare specialists. Hence numerous providers are an imperative as is the collaboration among them. One of the key pains of healthcare IT is lack of connectivity and interoperability among these systems. Healthcare IT companies need to make the data easily accessible to authorized parties to maximize the potential of data. For all these reasons, we are not afraid of newcomers.

Healthcare IT is the main segment of your business, but not the only one. How would you compare healthcare IT projects with IT projects in other sectors?

70% of our work is in healthcare, 30% in other sectors. This distribution is optimal for us, because from the business perspective, working in healthcare in Slovenia is difficult, since healthcare is a part of the public sector. The procurement and sales cycles in the public sector are longer compared to projects in the private sector. The optimal solution for us is to complement our presence in healthcare with interesting projects from other sectors. Our credibility and brand awareness are growing with our work in healthcare, though. We are motivated to work in healthcare IT because it is an appealing industry with important societal impact.

How much time passes from the signing of a contract to project finalization in healthcare, according to your experience?

Compared to other sectors, preparation of technical specifications in healthcare requires more time. The final solution needs to combine several functionalities in one place, to support different stakeholders that are involved. The planning phase of any IT project in healthcare must include medical staff to obtain the understanding of work processes in healthcare. We spend a lot of time observing the users in their work environment during planning. This way, we avoid surprises after solution implementation. Healthcare is a sensitive industry affecting human lives. Therefore, IT projects need to be implemented gradually, not to overwhelm and overburden the users. Solutions need to be implemented on a limited scale before widespread adoption.

What are your future goals? Are you looking at scaling abroad?

I’m a realist by nature, preferring long term business stability with steady growth. My priorities are a strong team and building trust with our customers. This leads to long-term collaborations and steady, manageable growth. Outside of Slovenia, we work with partner companies as subcontractors. The options in this segment are quite open.

You also have experience with blockchain technology. How do you integrate it into your solutions?

As a service IT company, we need to keep track of all the progress in our field to stay competitive. Alongside years of experience in Java programming and related technologies, we know and use key healthcare IT standards (DICOM, HL7, IHE in FHIR). As one of the first in Slovenia, we upgraded our knowledge with blockchain technology, which enables us agility in responding to latest challenges of our customers from various industries. I am also a member and Slovenian representative of the European workgroup EBSI ESSIF User Group, working under the European Blockchain Partnership.

We mostly develop blockchain solutions in partnership with Netis, the pioneer blockchain company in Slovenia. We are simultaneously researching opportunities of the technology in healthcare. Blockchain can be applied to a range of solutions, where database security is key alongside the need for multiple user or systems access to data. Blockchain offers an opportunity to give patients control over their data, and several pharmacists are aware that testing and data collection could be improved if patients were offered incentives for data sharing.

Slovenia is a small country with a relatively large number of players. Do you see other companies as partners or competition?

IT systems development is not only a technological but also a business challenge, characterized by the demand for highly specialized employees from various fields. Success can only come from interdisciplinary teams. Because healthcare systems need to be integrated, I believe good collaboration needs to exist among IT providers. Cooperation and quality execution are among the core values of our company.

What is your current biggest challenge?

There is a lack of healthcare IT specialists in Slovenia, so we see our highly specialized employees as a strong added value helping us grow. Shortage of IT specialists is a common problem among IT companies, forcing me as an employer to constantly examine the best approaches to attract, educate and keep valuable employees. In my opinion, giving students an opportunity to learn and work in an exciting industry, constantly faced with interesting job challenges, is a good value proposition for new employees, alongside a good salary and the stability assured by regular employment.

Our recruiting strategy is to find students interested in our field of work. We direct them in their career path while being mindful that they fit in the existing team. We prefer this approach of steady growth to quick increases in the number of employees, which brings along a lot of business challenges and might not work long term. We are aware of the need to constantly re-think our work and employee satisfaction, given that foreign companies present more serious competition for specialized workers than other Slovenian companies.