Saudi Arabia's Vision 2030 is more than a blueprint for the future; it is a pledge to improve the lives of its citizens. A cornerstone of this transformative vision is the digital health revolution, which aims to harness cutting-edge technologies and artificial intelligence to redefine healthcare. However, challenges abound, particularly in ensuring that our healthcare workforce is well-prepared for this digital shift. Comprehensive training and educational programmes are not just beneficial; they are imperative. In fact, the success of this digital transformation hinges on the readiness of healthcare professionals to adapt and innovate.
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To contextualise this, let us examine Canada's digital imaging transformation in the early 2000s. Led by Canada Health Infoway, the initiative aimed for a 'one-patient, one-record' system. The goal was clear yet ambitious: enable seamless sharing of medical images across various healthcare institutions. The journey, however, was fraught with challenges. Hospitals were at different stages of technological adoption — some had already gone digital, while others were still using film-based methods. This disparity highlighted the need for a unified approach to technology adoption.
In collaboration with provincial governments, Canada Health Infoway orchestrated the transition from film to digital. This was not merely a technological shift; it was a paradigm change demanding a comprehensive skills upgrade. Healthcare professionals needed to master new digital standards like DICOM and HL7, as well as PACS Management. The challenges escalated when the transition expanded regionally, introducing new administrative tasks like ensuring data accuracy across multiple institutions. This regional expansion underscored the importance of a coordinated, multi-level approach to healthcare transformation.
Example 1: Managing 'stale data' — outdated information in the shared system — was a significant issue. This is typically addressed in two ways:
- Standards-Based Approach: If both the PACS and VNA support the IHE Profile for Image Object Change Management (IOCM), automatic updates between local and regional systems are possible.
- Non-Standards-Based Approach: This requires manual intervention from the local PACS team to correct or update the data in the VNA.
Example 2: Harmonising patient identities across institutions was another critical issue. In Ontario, Canada, two approaches were employed:
Probabilistic Patient Matching: Utilising an Enterprise Master Patient Index with a weighted demographic scorecard.
- Pros: Reduced likelihood of false-positive matches.
- Cons: Increased risk of false-negative mismatches.
Deterministic Patient Matching: Using government-issued identity cards.
- Pros: Lower risk of false-negative mismatches.
- Cons: Higher likelihood of false-positive matches.
So, what can Saudi Arabia learn from Canada's experience? First, technological innovation is just one piece of the puzzle. The human element — ensuring our healthcare professionals are proficient in both medical and digital skills — is equally crucial. Second, regional data management introduces complexities that require robust administrative and governance frameworks. These frameworks must be agile enough to adapt to rapidly evolving healthcare technologies.
The Healthcare Information and Management Systems Society (HIMSS) has outlined four levels of interoperability:
- Foundational: Basic requirements for secure data communication.
- Structural: Detailed data format and organisation specifications.
- Semantic: Standardised definitions and coding vocabularies.
- Organisational: Governance and policy frameworks.
Levels 3 (Semantic) and 4 (Organisational) present nuanced challenges in interoperability, requiring strong governance and communication skills. Semantic interoperability, for instance, involves applying localization rules to ensure that procedure codes and descriptions align with local PACS definitions. Some PACS systems require administrative correction for exams with unknown procedure codes before they become clinically usable. Ideally the VNA or a DICOM router can apply appropriate localisation rules specific to each institution’s needs.
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Another challenge is managing foreign exams to avoid Patient ID or Accession Number collisions. The DICOM tag, Issuer_of_PatientID (0010,0021) can be used to identify where the imaging was sourced, and Accession Numbers can be suffixed or prefixed to represent the originating institution, keeping in mind DICOM's 16-character limit.
Organisational interoperability, on the other hand, necessitates a focus on governance and effective communication among stakeholders. As Saudi Arabia stands on the cusp of its digital healthcare transformation, conducting a skills assessment of the existing workforce is vital. This will pinpoint areas where targeted coaching and educational programmes can be most effective, laying the groundwork for a successful transition.
In conclusion, as we strive to realize Vision 2030, let us remember that digital transformation in healthcare is not solely about technology. It is about fostering an ecosystem where technology and human expertise synergise to deliver unparalleled patient care. The road ahead is both exciting and challenging, and today's preparation will set the stage for tomorrow's success.
I am thrilled to announce that I will be speaking at the Riyadh Global Health Exhibition on the topic of education in imaging informatics. If you have any questions or would like to discuss this further, please don't hesitate to contact me at [email protected].
