Administrative tasks are often implemented by legal acts which are not related to the functioning of the health protection system. An example of that regulation is an obligation imposed on a general practitioner to issue a medical certificate confirming that the health condition of a person who authorised another person to collect a parcel in a post office makes it impossible or very difficult to collect that parcel from the post office in person.
That situation requires the Minister of Health to analyse applicable laws in terms of limiting time consumption of administrative tasks in medical facilities to make patient treatment more efficient.
An important reason why medical staff is overloaded with administrative work is that heads of primary healthcare and outpatient care facilities did not ensure full use of available tools, especially IT tools to support medical staff in administrative duties.
The great majority of audited facilities (86%) did not use the possibility to relieve doctors by authorising medical assistants to issue electronic sick leaves, e-prescriptions and e-referrals. Also the possibility to order qualified nurses and midwives to continue patient treatment on their own was not used.
Not many medical workers – such as secretaries, admissions clerks or statisticians were hired to relieve medical personnel of administrative burden. In 9% of facilities medical admissions clerks were not employed at all, medical secretaries in 68% and medical statisticians in as much as 73% of facilities. As a consequence, medical personnel had to do administrative work, including reporting and scheduling doctor appointments. In 91% of the audited healthcare facilities, nurses but also doctors were entrusted with administrative tasks, such as preparing statistical reports or reports related to performance of medical service agreements with the National Health Fund (from Polish: NFZ).
According to NIK, this approach limited efficiency of medical services and indicated that the healthcare facilities personnel was not properly managed.
Medical facilities had IT systems at their disposal which provided ample opportunity but were not properly used. The systems were not integrated with medical testing systems (in nearly 60% of the audited facilities) or with medical imaging systems (82%). Also, they were not directly fed with test results. Besides, in 23% of healthcare facilities there was no flow of data among individual locations (branches). As a result, it was difficult to quickly obtain medical information needed to take decisions in outpatient care.
In most of the audited facilities not all requirements or organisational and technical conditions to keep medical documentation in electronic form were met. Reasons included distrust of IT tools, absence of mobile devices to register medical data or gaps in IT systems.
In half of the audited facilities medical appointments were not scheduled electronically, whereas in 41% there was no software to send notifications to patients or update the appointment status (in an sms or e-mail). In 23% of facilities, not all IT system modules and functionalities purchased by the facility were used.
Medical documentation was often kept in paper, which is time-consuming and hinders access to data. Documentation was also kept in the hybrid environment (i.e. in paper and electronically). This, however, posed a risk that documents developed in two forms may be inconsistent.
According to the survey of medical staff in the audited facilities, the IT systems used to provide outpatient care services were helpful and intuitive. The majority of personnel (nearly 90%) was trained to handle those systems and over 60% of respondents handled the systems on their own.
The NIK survey reveals that computerisation reduces time consumption considerably. E.g. it takes on average 33% longer to issue a medical imaging referral in paper as compared with an e-referral. Issuing medical test referrals takes nearly 26% longer, and as for referrals to hospital this time is nearly 41% longer for paper referrals.
During the COVID-19 epidemic, in 7 of 22 audited facilities (32%), outpatient clinics were temporarily closed and medical services were not provided as scheduled in some cases. In 14% of the facilities the services were limited to life-saving interventions and urgent cases. They explained that the changes resulted from NFZ’s recommendations due to the COVID-19 epidemic prevention, counteracting and fighting.
Online consultation as a new form of providing medical assistance made up ¼ of all medical consultations in the first half of 2020. Against the first half of 2019, the number of medical consultations in healthcare facilities was 15% smaller in primary healthcare and 26% smaller in outpatient care.
Recommendations
Minister of Health
NIK recommends taking the following measures (in cooperation with organisations representing medical environment):
- analyse the scope of administrative tasks assigned to medical staff and minimise it;
- speed up the process of computerisation and automation of workflow in healthcare.
Heads of medical facilities
To streamline work organisation in entities providing outpatient care services NIK recommends as follows:
- full use of the capacity of IT tools and implementation of adequate solutions to support the work of medical personnel, the following in particular:
- integration of the existing IT systems with medical testing and medical imaging systems – so that they are directly fed with tests results;
- implementation of the online appointment scheduling systems (for outpatient appointments) with an option to send notifications to patients or update the appointment status (in an sms or e-mail);
- introduction of standardised principles of keeping electronic medical documentation and elimination of ineffective practices of developing the same document in electronic and paper form, to ensure consistency and streamline workflow among individual organisational units of a medical facility.
