“Ne morem razumeti, kako je zdravstvo lahko v digitalni kameni dobi”

Simon Rekanovič je 28-letni specializant radiologije, z za svojo starost bogato zgodovino izkušenj s tehnološkimi inovacijami v zdravstvu. V petem letniku študija je s prijatelji začel izdelovati različne medicinske naprave za domačo uporabo. Kasneje je ustanovil Viverius - Inštitut za razvoj Digitalnega zdravja, med drugim kratek čas delal v pospeševalniku Startupbootcamp Digital Health Berlin, svoje znanje poglobil tudi s certifikati poslovnih šol in se udeležil več s strani Evropskega Inštituta za inovacije in tehnologijo (EiT) organiziranih izobraževanj za razvoj tehnologij in poslovnih modelov. Maja bi moral potovati v Estonijo, da bi v osmih bolnišnicah in na ministrstvu za zdravje pobližje spoznaval estonsko zdravstvo, vendar je projekt odpadel zaradi pandemije s COVID-19. 

Simon trenutno dela kot dežurni zdravnik na Koroškem in kot specializant radiologije v UKC Ljubljana. V kratkem pogovoru je opisal svoj pogled na tehnološke inovacije v zdravstvu ter vsakodnevne težave s tehnologijo, ki jo kot zdravnik uporablja v vsakdanji praksi.

Vaša dosedanja karierna pot izžareva interes za vnos tehnoloških novosti v zdravstvo in medicino. Gre za specifiko mlajše generacije? Koliko interesa za inovatorstvo opažate pri svojih kolegih?

Interesa za inovatorstvo je za moj okus med študenti medicine presenetljivo malo. Razloge za to bi iskal v več dejavnikih: med študenti praktično ni razumevanja zdravstvenega sistema, saj izobraževalni program ne vključuje predmeta, ki bi govoril o razmerju med plačnikom, izvajalcem in prejemnikom - pacientom. Področij kot so podjetništvo, ekonomika, optimizacija procesov in podobno, se v času študija ne dotaknemo. Ko začneš delati v zdravstvu, je dnevnih obremenitev enostavno preveč, da bi imel čas in energijo razmišljati še o inoviranju ali ustanavljanju lastnega podjetja. Veliko je tudi nezadovoljstva z zdravstvenim sistemom. Po drugi strani vidim, da če se pogovarjaš z zdravniki in jim postavljaš odprta vprašanja, ti bodo točno povedali, kaj jih moti, in kako si predstavljajo, da bi recimo računalniški sistemi delovali drugače.

Kakšne so vaše konkretne izkušnje s tehnologijami z vidika dežurnega zdravnika na lokalni ravni in na drugi strani kot radiologa na UKC Ljubljana?

Zaradi vseh tehnoloških rešitev, ki so postale del našega vsakdana pri nakupovanju in drugih storitvah v vsakdanjem življenju, kot zdravnik težko razumem, zakaj je zdravstvo v  digitalni kameni dobi. Računalniki in računalniški programi delajo počasi. Dnevno, ne tedensko ali redno;  vsak dan (!) ogromno časa porabim za čakanje, da se neka stran ali program naloži. Podatki niso povezani, zato moramo veliko uporabljati telefone in s pomočjo klicanja različnih  delavcev in oddelkov iskati izvide in podatke o bolnikih. Konkreten primer: pri meni je pacient, za katerega piše, da je bil slikan tudi na Kliniki Golnik. Klicati moram posebno številko za podporo, da lahko ob pisanju izvida na našem strežniku vidim njegovo radiološko sliko. In to je že med zglednejšimi možnostmi izmenjave podatkov.

Pri spletnem nakupovanju je uporabniška izkušnja izdelana, v zdravstvu pa imam občutek, da niso upoštevani osnovni koncepti oblikovanja in procesne optimizacije. Klikov je bistveno preveč, poleg tega, da računalniki med uporabo zmrznejo in jih je potrebno izključiti in ponovno vključiti. Na lokalni ravni ogromno stvari še vedno poteka na papirju. Ko danes k meni na urgenco pride bolnik, o njem in njegovi zdravstveni zgodovini pogosto ne morem vedeti ničesar, če mi tega ne pove sam ali prinese izvidov seboj.

Vas je vse to, glede na to, da spremljate tehnološki razvoj v industriji, presenetilo, ko ste po študentskih letih začeli opravljati specializacijo?

Vsekakor sem si predstavljal, da so v praksi stvari drugačne. Ogromno izvidov iščemo iz papirjev. Razumem, da je sistem v ustanovi kot je recimo klinični center zaradi velikosti in financ težje vzdrževati kot manjše sisteme na lokalni ravni. Prav zato menim, da bi lahko v manjših ustanovah in zdravstvenih domovih, kjer je zaposlenih manj, hitreje uvajali in testirali novejše, uporabnikom bolj prijazne rešitve. Največja sramota moderne medicine je zahtevan čas, ki ga pred bolnikom zdravniki preživimo za ekranom. Najhuje pri tem pa je,  da polovico časa porabimo za logiranje, ponovni vklop računalnika, večkratno vnašanje podatkov in tako naprej.

Inovatorji radi rečejo, da tehnologija ni problem, da je problem kultura in uvajanje novosti med uporabnike. Iz vašega pripovedovanja se sliši, da tehnologija vseeno je problem.

Težava je, da veliko programov ne zmanjšuje zdravnikovega dela, ampak ga povečuje. Če zdravniku, ki je že obremenjen in obupan zaradi vseh klikov in slabe uporabniške izkušnje, ponudite nov program, ki zahteva še več klikov, seveda ne bo navdušen. Če mu prestavite rešitev, ki bo optimizirala procese, pa bo  že bolj zainteresiran. Če se pogovarjate z zdravniki in jim postavljate odprta vprašanja, bodo tudi sami zelo dobro povedali, kako bi si želeli, da bi programi izgledali, kje bi lahko bili boljši.

Ste kdaj svoje znanje in izkušnje poskusili aktivno prenesti v prakso, do vodij oz. odločevalcev, ki lahko vplivajo na opremo in programe, ki jih zdravstveni delavci uporabljajo?

Seveda, a zaenkrat neuspešno. Pri tem moram poudariti, da vidim ogromno možnosti in vselej rad spregovorim o tem. Številne možne izboljšave z nekaj uporniške inovatorske žilice vsakodnevno tudi aktivno iščem in v tem uživam. Na žalost pridobljenih izkušenj v našem prostoru v večji meri še nisem uspel uspešno deliti s kolegi v stroki ali z odločevalci. Mogoče sem v našem prostoru v očeh mnogih še premlad, da bi me vprašali za mnenje in bi lahko res pripomogel k spremembam na bolje. Med delom v tujini sem marsikje naletel na nekoliko drugačen odnos, ampak prepričan sem, da se bo miselnost tudi pri nas spremenila, ideje in predlogi pa padli na plodna tla.

Kaj ste odnesli iz dela pri pospeševalniku Startupbootcamp (SBC) Digital Health Berlin?

V SBC Berlin sem delal kot svetovalec dvanajstim startupom. Izkušnjo izjemno cenim, saj mi je dala vpogled v delovanje startupov v zelo različnih fazah razvoja. Eni so bili šele na začetku svoje poti, drugi že pri širitvi na trgu. Videl sem, kako specifično je področje medicinskih naprav, kakšno investicijo časa in sredstev zahteva že zgolj certifikacija produkta. Opazil sem, kako odločilnega pomena je bila pri uspehu posamezne ekipe miselnost. Trdna volja, vztrajnost in komunikativnost so se izkazale kot ključne vrline uspeha. Ekipe, ki so zgolj pilile svoj produkt, čeprav je šlo za strokovne in zapletene inovacije, so bile pogosto manj uspešne kot ekipe, ki so imele medicinsko manj zahtevne rešitve, a so bile bolj osredotočene na predstavljanje, testiranje rešitve, pogovore z zunanjimi sodelavci, investitorji, uporabniki, s čimer so iskali svoje mesto na trgu in kljub negativnim odzivom niso izgubljali motivacije. Kot drugo, me je presenetilo, kako finančna organiziranost ni bila odločilna pri uspešnosti podjetij. Nekdo z odličnimi analizami stroškov ni bil nujno tudi odličen v poslu, pomembnejše je bilo širše razumevanje razvoja in vizije prihodnosti posameznega produkta. Morda sem zaradi možnosti istočasnega opazovanja dvanajstih različnih zgodb bolj kot prej dobil tudi vpogled in občutek kako zelo pomembno je preverjanje potrebe po produktu na trgu. Lahko imaš prebojni izdelek, a nimaš ustreznega trga. To je kruta usoda, ki doleti veliko prebojnih inovacij.

Zaradi pandemije s koronavirusom je digitalno zdravstvo doživelo razcvet: kar naenkrat so bile sprejete številne spremembe kot je porast telemedicine, za bolnike praktično komuniciranje z zdravstvom prek maila in podobno. Kako opazujete ta hitri vzpon? Je bil to pritisk, ki ga je potrebovalo zdravstvo za hitrejšo vpeljavo digitalnih storitev?

V času epidemije COVID19 sem delal v ambulanti za respiratorne infekte in vročinska stanja, kjer sem pokrival populacijo 22.000 prebivalcev Mežiške doline. Na določene dneve smo z ekipo treh zdravstvenih delavcev obravnavali tudi po 170 klicev in testirali po več 10 oseb. Poudariti moram, kako zelo so nam že dostopne rešitve olajšale delo; pogosto na način, ki si ga predhodno niti nismo predstavljali. Ogromno primerov smo rešili po telefonu, bolniki so nam na lastno željo določene spremembe poslali kar preko telefona ali e-pošte. Skoraj nemudoma so vsi zdravniki sprejeli e-kartoteko kot alternativo, ki je primernejša in enostavnejša. Vsekakor je to na številnih področjih tlakovalo pot za sprejemanje digitalno zdravstvenih rešitev, številne zasilno uvedene spremembe pa bodo sedaj zagotovo tudi ostale - njihova uporabnost je bila po sili razmer dokazana v praksi.

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"It is difficult to accept the digital stone age in healthcare."

Simon Rekanovič is a 28 years old radiology resident with - given his age - rich experience in the digital health space. He began developing medical tools for home use while he was a student. He later founded an Institute for development of Digital Health - Viverius, worked for Startupbootcamp Digital Health Berlin Accelerator and participated in many programs organised by European Institute of Innovation & Technology (EiT). In May, he was supposed to visit Estonia, to observe and learn about healthcare digitization from the health ministry's perspective and based on insight from eight hospitals, but the visit got cancelled due to COVID-19 pandemic.

Simon currently works as a GP and ER doctor on a local level and as a radiology resident at the tertiary University Medical Center Ljubljana. In this short interview, he talked about his view on entrepreneurship in healthcare and his experiences with healthcare IT and technologies in his medical practice.

You seem to have a strong interest in the adoption of new technologies in medical practice. Is this a common characteristic in younger generations? How interested in innovation are medical students?

The interest in innovation is quite low in my observation. I would attribute this to several factors. Firstly, medical students lack insight into the structure of the medical system. The curriculum is focused on medicine and does not include an understanding of the healthcare system. Nobody teaches about the relationship between the payer, provider and the patient. Economy, entrepreneurship, process optimization, are also left out of our formal education process. Once you start working in the clinical practice, there is no time to think about innovation as you are already overburdened with the work at hand. At the same time, dissatisfaction with the healthcare system and healthcare IT is strong.

What are your experiences with healthcare IT? How would you compare the state of technology on the local level and tertiary level?

Given all the technological novelties that are present in our everyday life, I have a hard time accepting the digital stone age healthcare resides in. Computers and computer systems are slow. I have to restart the computer daily because it freezes. Too much time is spent on clicking and waiting. There is too much time-waste while patients are sitting in the waiting room. Data is scattered all around; we still search through paper records and use the phone to reach people with the information we need in a given moment. As you can imagine - you might call one department only to be redirected to another, etc. Huge time wastes.

The user experience is well designed in areas like online retail. In contrast, it seems that architects of healthcare IT solutions ignored the basic design concepts and process optimisation ideas, causing medical staff a lot of frustrations.

Knowing the trends in digital health and various technologies in development for healthcare, did the reality of doctor's everyday workflows surprise you?

I did not expect things to be as bad as they are. We still use a lot of paper, search through paper records, etc. I can understand that maintaining an IT system in a tertiary institution may be more difficult compared to smaller local health centres. It is, for this reason, I believe smaller institutions with fewer employees could start introducing new, modern systems. In my opinion, the time the doctor spends behind the screen, in front of the patient is the greatest disgrace of modern medicine. Perhaps this would bother us, doctors, less, if we didn't spend half of the time looking at the screen due to logging issues, resetting computers and programs and repeated data inputs.

Innovators like to say that technology is not a problem, that the reason new technologies are not used in practice is the culture, resentment of the workers to get used to new work processes. From what you're saying though, it sounds like technology is a problem.

The problem is that many software applications don't decrease the workload; on the contrary, they significantly increase it. Therefore, if you want to offer a doctor, who is already overburdened with everyday responsibilities and frustrated because of IT, a new program which demands even more clicks, the doctor, of course, will not be supportive of your idea. If you present a solution that optimizes processes, she will be more interested. If you talk with doctors and ask them open-ended questions, you will see they have a very clear idea of how the system should look like to be more helpful to them.

Did you ever try to transfer all your findings of digital health innovation to practice, talk to leaders and decision-makers that can influence what hardware and software medical staff use?

Of course, but so far, unsuccessfully. I'm sad to say that I have so far not been able to share many of my experiences with my professional colleagues and decision-makers. My impression is, that I am often seen as a too young professional to be asked for opinions. While working abroad, I have encountered a different attitude. I am sure the mentality will change here eventually and enable our ideas and proposals to be heard.

What was your takeaway from your participation at Startupbootcamp (SBC) Digital Health Berlin?

I worked in SBC Berlin as a consultant to twelve startups. The experience gave me an interesting insight into startups in very different stages of development. I learned how very specific is medical device development, and how costly already at the certification level. I was also able to observe the influence of a mindset on the team's success. Perseverance, strong communication skills and faith into one's own success turned out to be crucial for success. Teams that focused mainly on improving their product were much less successful compared to those that met more people, tested their pitch, got feedback and clarity regarding their product-market fit. I was also surprised how having a broader overview of the product's runway was almost more important than focus on deep analysis and financial projections. Research first, do the calculations later. Perhaps, because I was looking at twelve different stories simultaneously, I was able to get a better insight into the importance of a constant re-evaluation of the product-market fit. You can invent a breakthrough product, but lack market needs, and consequently fail.

Due to the coronavirus pandemic telemedicine and digital health solutions surged. Suddenly, electronic communication with doctors and telemedical solutions became adopted and some estimates predict that all this will contribute to faster adoption even after the crisis. What are your observations? Is this the push healthcare needed to embrace digitization?

During the epidemic I worked in the doctor’s office for respiratory infections providing care for 22.000 inhabitants of Mežiška Valley. We would receive up to 170 calls and test ten or more people for coronavirus daily. I must emphasize that existing solutions significantly eased our work, often in a way we couldn’t even imagine before the epidemic. We solved many cases through phone calls or emails. Almost all doctors embraced electronic records as a simpler, more appropriate option of care management. This made way to digital solutions and some changes are definitely here to stay.