Technology in Health Care

Management:
Reality and Expectations

Manar Salamah
September,2023
 Services provided by a hospital incorporate elements which can be examined
objectively, subjectively or both. Every enterprise is actively concerned with quality assurance
by determining the quality of the commodity it produces and keeping in touch with consumers
to secure their maximum satisfaction.
As a result of advances in medical technology, introduction of complex diagnostic
and therapeutic procedures, introduction of high technology and other sophisticated elements,
some vital issues are being raised, such as:

 what is the quantum of output and degree of excellence of hospital service?

 What is the cost of operating the hospital?
 Is the hospital spending more because of inefficiency of hospital operation?
 Could the same quality of medical care be made available at lesser costs?
 What is the extent of patient’s satisfaction?
 What is the final outcome or end results in terms of indices like recovery rate, partial
recovery rate, death rate, complication rate, etc.?

Electronic monitoring is being increasingly introduced especially in intensive care and

postoperative recovery wards. The equipment varies from single units for individual patients to
large complex system giving multiple patient observations on viewing screens and recordings
and tracings on paper and tape. Even with sophistication in medical electronics which has
resulted in compact equipment small in size, space requirements for housing the equipment
are considerable. The guiding factor is that the equipment and the maze of cables and tubes
leading to and from it should not interfere with the free movement of medical and nursing
staff, with space available for wheeling-in more equipment if required.
The area required in patient rooms for single patient monitoring systems would be
larger by about 20 per cent than otherwise acceptable. For large multiple patient observation
systems, the planning, programming, design and installation of the equipment has to be done
during the initial stages of hospital planning to cater for appropriate electrical and equipment
cables as well as space requirements. Consultations with a hospitals engineer in conjunction
with the engineer of the equipment suppliers will have to be held.
Medical records is defined simply as a systematic documentation of a patient’s personal
and social data, history of his or her ailment, clinical findings, investigations, diagnoses,
treatment given, and an account of follow-up and final outcome. A medical records document
serves as: a clinical document—listing the clinical history, physical examination, investigations,
nursing records, etc. a scientific document—because it is used to study the patient’s condition
and progress through scientifically practiced medicine, and for research. an administrative
document—it helps administrative control, planning of services, budgeting, improving quality of
care, hospital statistics.

Telemedicine: Telemedicine's value is its ability to transfer medical data over long
distances. In the first decade of the twentieth century, telemedicine was first recorded in a
published report as electrocardiogram transmission over telephone lines. Maybe the earliest
known form of telemedicine was the transmission of information about health-related events
like outbreaks and epidemics using ancient hieroglyphic writing and scrolls. Telemedicine
was dismissed nearly 50 years ago because it was a cumbersome, unreliable, and expensive
technology. Telemedicine is now a viable, dependable, and practical technique because of the
rapidly developing telecommunications and information technology fields. Many different
medical specialties and practitioners have reported success with telemedicine.

Need for telemedicine: One of the most essential issues in giving the poor access to
high-quality healthcare is the technology used in telemedicine, which enables clinicians and
patients to be nearly anywhere. Due to the development of telemedicine, access to healthcare
in rural areas is no longer hampered by distance. Poverty, a lack of development, and civil
upheaval have an especially negative influence on India's North Eastern states. The region's
subpar infrastructure and low connectivity to the rest of the country are the main obstacles to
the growth and development of these states. Through the use of telemedicine and digital
pathology, many patients in these areas can obtain local care while consulting with specialists in
larger cities. Telemedicine technology, which might be incorporated into the current healthcare
delivery system, might be used to lessen the disparity in access to healthcare between rural and
urban locations. There are very few adequate primary healthcare facilities for the rural
population. Despite government and private sector attempts, the lack of access to high-quality
healthcare in rural and distant locations continues to be a problem.

It is time to evaluate present telemedicine initiatives, both public and private. The
evaluation's results need to influence changes to the law and legal system. The critical need
shortly is for medical practitioner training. Continuing medical education modules or "crash
courses" in telemedicine can help practitioners stay current with technological, ethical, and
legal issues by bringing awareness to their patients. Gains in telemedicine use in Palestine are
anticipated to continue, creating the ideal conditions for a more effective healthcare delivery
system.

Many practitioners were forced to enter the telemedicine field for the first time as a
result of the COVID-19 outbreak. Limiting patient interaction and contacts could reduce
transmission because several otolaryngology procedures could produce aerosolized virus
particles. Recent changes to Medicare fee-for-service billing, which enabled equal
compensation for virtual consultations, encouraged telemedicine as an economically viable and
moral response to the epidemic

The Palestinian Ministry of Health has launched the Health Sector Strategic Plan 2021-
2025, which made the main focus on the quality of services and client satisfaction. The Strategic
Plan included six goals, where the issue of governance was one of them. Health Informatics
represents the essential pillar of success in implementing and upgrading the governance system
within the health system. It includes a number of areas: technical transformation in the health
system, health information management and health research. The Ministry has made great
achievements in the field of health informatics, yet the magnitude of challenges remains large.
Among the key challenges are: keeping up with the rapid and significant progress in the field of
technology and its employment towards enhancing health services; considerable growth in the
level of leadership adoption and in the health system top management level to develop /
establish smart health information management system that would strengthen the health
service delivery system and health research system; achieve information & services integration
among all health care providers – governmental, non-governmental & private - up to having a
national e-health file; employ and direct health research efforts done by various research
institutions to improve the health services provided. As such, there was a need to have a clear
and comprehensive strategic plan for health informatics for the four years 2023-2025, including
all projects in the field of technical transformation, health information management and health
research, which was identified based on environment analysis and which would be linked to
clear achievement indicators. This strategic plan aims to achieve effective and efficient systems
to support health system decision-making, particularly in regards to medical and clinical
services, in addition to strengthening smart electronic services and telemedicine.
Vision:
Access to an effective and comprehensive Health Information Management System based on
digital transformation that support decision-making system driven by / relying on highquality
health information and indicators.

Throughout the previous decade, the Ministry of Health has been able to develop
gradually information systems and programs for hospitals, primary health care and
supportive/allied health and administrative services (in phases). It started by computerizing
administrative services to book hospital appointments and record PHC visits, right till it partially
reached the computerization of 46 information systems and programs, among which the most
notable are the E-Hos - hospital information system and the Clinic Care - primary care
information system, which were unevenly operated in hospitals and PHC centers for such
services as emergency, surgical, oncology, reproductive health, non-communicable diseases
and general medicine, as well as many in a number of financial and administrative programs.
 During the COVID-19 pandemic, support/allied health services programs were
strengthened, which were represented by the Central Laboratory Program, development of the
epidemiological investigation system, vaccination system7, as well as “Sahati” (My health)
application and platform that were developed as the first interactive health application for the
public to confront the COVID-19 pandemic and to address the rest of telehealth services needs,
in addition to providing COVID-related complementary services to national and government
institutions. In spite of all the successes that the Ministry has achieved in providing easy access
to computerized information or statistics that reflect health services coverage indicators, or
prevalence and incidence rates of some diseases, there are still many gaps, obstacles and
challenges that hinder access to a comprehensive digital information system capable of providing,
monitoring and measuring all approved national health indicators within high quality and through the
mechanisms of complementarity among all health care providers (government, NGOs, UNRWA, military,
and private) in the Gaza Strip. Among the most important of these constraints, which have been and still
remain, are:

• Weakness of the information & communication technology (ICT) infrastructure;

• Continued Israeli blockade on the Gaza Strip, which prevents, impedes and delays the entry of
ICT supplies and devices.
• Decaying and outdating of many computers, servers and networks;
• Lack of adequate funding to build a comprehensive information system
• Lack of a strategic plan outlining the path of digital transformation in the health system
• The magnitude of health services and multiplicity of their levels against lack of technical staff;
• Weak governance of the health information management system;
• Inadequate capacities and skills of health staff in dealing with information technology in
addition to their resistance to change;
• Poor documentation and data recording among health service providers;
• Weakness in setting operational definitions of some variables;
• Weakness in data entry and data transfer from paper forms to computerized forms, where, as
a result, confusion between the paper and computerized systems increases the workload and
exacerbates the size of input errors.

Through this strategic plan, the Ministry of Health aspires to reach to a point, where it
becomes capable of monitoring all national basic indicators related to the population health
status; health service coverage indicators; input, output and outcome indicators of the health
system performance, diseases risk factors indicators and public health determinants indicators.
It is worth mentioning that the Ministry of Health has initiated development of this Health
Information Strategic Plan for a period of four years targeting health service priorities that are
of concern for the health system and public health, so as to reach a point when decisions are
made based on reliable information, evidence and health indicators that would to contribute to
enhancing the health status level of the population and improving the quality of health care
services provided. The Ministry of Health also aspires to share information, health indicators
and various reports with all partners and donor organizations in order to improve coordination
mechanisms and strengthen the design, implementation and evaluation of health projects,
programs and interventions