We have a great healthcare system, how do we make it better?

If we created a technical team purely focused on Providing Ubiquitous Care, we can improve the effectiveness of the health system by several orders of magnitude

Over the past several years, our family has been the beneficiary of Malta’s great healthcare system. It warms my heart to know that when, sooner or later, someone I care about will inevitably find themselves in need of some form of medical treatment, a well functioning system is in place to assist them.

Our current infrastructure covers all expenses, resources and staff. Based on financial estimates from the 2021 budget, the total recurring spend on health services is at 758 million euros. As a direct result, we have access to medicine that can alleviate, or outright cure, suffering from most ailments. Even in the case of rare and terminal diseases, the system is able to extend our lives significantly while retaining a decent quality of life.

None of the above would work if we did not have some amazing individuals who sacrifice their time, energy and even personal lives to deliver extraordinary levels of care. Frequent personal incidents have brought me to this realisation - we have a great healthcare system and this is truly something to be thankful about.

While sitting by a loved one in hospital or while fretting at home about what I could do to help in their struggles, I often fantasize about what we could achieve if we made technology a core function of our health care system.

Rather than tenders and contract works for distinct technical projects, I hypothesise that if we created a technical team purely focused on Providing Ubiquitous Care, we can improve the effectiveness of the health system by several orders of magnitude.

What do I mean by Ubiquitous Care?

Upon entering a clinic or Mater Dei hospital, we know we are going to receive a great service. Cracks from the stress of overworked staff rarely surface - this is not to say that the staff is not constantly working under high levels of stress, but they somehow manage to do a tremendous job at hiding their inner struggles behind a smile and ever caring hands. While I am sure we can do tangible things to improve the reward structure for such heroic feats, and however important I believe that is, it will not be the focus of this write up.

The term Ubiquitous was popularised in the world of technology with reference to software which operates in the background without the user having to directly interact with it. It refers to things which are present and found everywhere.

By providing ubiquitous care, I envision a healthcare system that constantly works even beyond the walls of our medical facilities. I believe that this can be achieved by making technology an integral part of our healthcare operation management.

Sporadic case information, medical history and lack of visibility

At some point or another, we’ve all heard about a medical file which got lost. To be fair, it is amazing that this does not happen more often than it does. Progress had been made in the area of digitisation with the introduction of the MyHealth.gov.mt portal back in 2012. Unfortunately it seems evident that this system does not have many active resources behind it. 2012 is a very long time ago when it comes to technology, and from the clear deficiencies in design, functionality and usability, it seems that there is no active commitment to improve this system.

Modern systems require regular updates with frequent tweaks to ever optimise the end user experience. If anything ought to be constantly pushed one step further with the goal of betterment, it should be our central health information system. With data often not being up to date or shared appropriately between different departments, it seems that the MyHealth platform is not as central as it should be.

What could MyHealth 2.0 look like? How about a mobile app as easy to access and use as Facebook is? You can either choose to install the app on your own phone, or in the case of the less tech savvy demographics, maybe we could provide a specialised government issued ‘MyHealth Tablet’. Such a device needs to be specifically built for ease of use, just like an amazon kindle is specialised for book reading. With a long battery life, highly specialised software and a significant focus made on accessibility, utility and ease of use - at the cost of any other frills.

The MyHealth app would be your one and only own medical file, on which you can find and securely access all your centralised medical history with just a few taps on the screen. The uses for such a device, within a healthcare context, are many.

Complex instructions on treatment and medication

After a discharge from Mater Dei hospital, our family had just undergone a very stressful time during which we feared the worst. In such circumstances, it comes as no surprise that neither the patient nor their relatives are in a state of mind to fully grasp the complex regimen of medication that needs to be self-administered on a daily basis thereafter.

Turns out that incorrect use of medication by the patient is a very common cause of inadequate treatment - and how can anyone blame the patient? It can get very complex with a huge cocktail of pills, each with their own schedule. Getting confused and taking 1 pill instead of 2 for several weeks can have some dire consequences while in a best case scenario only reducing the effectiveness of the treatment.

Turns out not everyone has this luxury of friends or relatives who can take an interest in their wellbeing - therefore I believe that this specific problem deserves our attention.

Might the MyHealth system double down as a pill reminder and medication tracker? Many apps already exist for this - but setting it up requires initiative by the end user who most probably has no clue that such systems even exist.

What if your doctor or specialist could pre-set your medication schedule directly on the system? This feature, along with the active participation of health care professionals, should be inbuilt into MyHealth 2.0. Such data can obviously come in handy when compiling a case summary or informing future decisions for the same patient.

Messy appointments and scheduling

Appointments can be a headache, especially for individuals with various active medical conditions. The current system operates with a very effective mix of postal notifications, SMS, telephone calls and even email. This works well but some faulty appointment scheduling remains - a personal experience with the involvement of the wrong kind of Oncologist comes to mind - by a stroke of luck this incident did not have the dire consequences it could have. I believe that with better access to information and communication between departments one can also improve this aspect of our healthcare system.

Specialist input and coordination

Due to the very nature of their skill set, medical specialists are very busy with a high demand for their services. Some patients require a mix of various different professors. These experts are already highly organised in discussing and coordinating efforts between them, yet from the patient’s point of view it becomes extremely difficult to understand the recommendations and strategies being employed by the different specialists.

An overview of the patient’s situation therefore becomes extremely difficult to construct. Even as a software engineer trained in organising complex processes, it was very difficult for me to visualise the case of a close loved one. Ultimately I resorted to highlighting excerpts from the more recent medical case summaries, googling for definitions of several three-letter acronyms and drawing a stick-figure diagram to visualise the various complications. The least I could do in a somewhat helpless situation was to provide some clarity to the rest of the family.

Is there a way to distill such information into a digestible format? Could the patient perhaps benefit from a concept similar to that of an ‘Account Manager’, that is an individual dedicated point of contact for this patient? Might the ‘account manager’ better monitor the overall strategy with regards to the patient’s wellbeing?

We are extremely fortunate

Truth is that we are all extremely fortunate to be born into a country where we have enough luxury and privilege to allow us to take medical services for granted. It is only thanks to this privilege that people like myself can use some time to ideate about improvements to an already effective health system.

In my view, every little gain that we make in this area has an immeasurable impact on the quality of life for many people. Should we not strive to have the best health care system in the world? If this is not an area worth pouring the fruits of our economy into, then what is?

Perhaps it is time to take medical care to the next level. I find inspiration in the below words by Dr. Paul Farmer and hope that we can go a step further from providing care onto providing accompaniment.

To accompany someone is to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and an end. There is an element of mystery and openness. I’ll share your fate for awhile, and by ‘awhile’ I don’t mean ‘a little while.’ Accompaniment is about sticking with a task until it’s deemed completed by the person accompanied, rather than by the accompagnateur. Dr. Paul Farmer