Poland a few years away from digital health opportunity

By Jonah Comstock
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JONAH_COMSTOCK_HEADSHOTRecently, I was able to spend three days in Poznan, Poland attending the , including a one day conference on Hospital Building and Infrastructure. Poland hosted the conference -- and invited international journalists to attend -- because of the growing medical device market in the country: Poland's medical device exports were worth $524.2 million in 2011, five times the $100 million they were worth in 2002.

But even as Poland ships its medical devices abroad, including 8 percent to the United States, the situation at home is complicated. Poland has a mix of publicly and privately funded hospitals, and most are just on the cusp of the technological leaps United States hospitals have made in the last 20 years.

One hospital IT vendor from Asecco, the company that provides information systems -- including EHRs, billing systems, and appointment booking -- to more than 50 percent of the country's hospitals, estimates that 80 percent of Polish hospitals are still using paper records. Poland's government has just recently mandated a switch over to EHRs, with the ambitious goal of completing this switch in two years. Two years after that, the government wants all those records to be interoperable on a health information exchange.

But the information systems vendors I spoke to at the conference were highly skeptical about the government deadlines. For one thing, no one was clear on either what would happen to hospitals that failed to meet the deadline or how hospitals that did would be rewarded. Also, even the government-funded hospitals aren't necessarily receiving funds to make the transition.

MioCare Z100"Especially public hospitals, they can manage the money, but only in parts," Mateauscz Malicki, a commercial consultant at Alma, another information systems provider, told me. "Sometimes they can get it from the city or from EU projects, but it all takes time."

Similar measures are in place with regards to tracking systems for patients and medical devices. Piotr Kalicki, Healthcare Business Development Manager at Zebra, said that a January 1, 2014 mandate required that all hospital patients be tracked with barcodes. Other rules already require hospitals to keep careful track of all devices and equipment, something that's increasingly being done with computers and barcodes -- but not with wireless technology like RFID tags, as we've seen start to take hold in the United States.

In addition, Kalicki said some people were concerned that Poland hadn't followed the example of the UK and mandated a standard bar coding system. By allowing each hospital to choose their own, they might be making phase two of the EHR integration process harder than it needs to me.

There were not a lot of mobile devices at SalMed, but using them for EHR access was one exception. Most HIT groups at SalMed had tablet interfaces available for physicians. As might be expected, the iPad was less prevalent than it is here in the United States. Several companies made use of the MIO care Z100 dedicated healthcare tablet.

"The next thing is the tablets," said Malicki. "The doctors like them so it's easier to convince them." He said BYOD wasn't so prevalent in Poland; most hospitals wanted to contract for hardware as well as software.

When it comes to nurse call and hospital communication systems, though, Polish companies are just now starting to implement first generation mobile solutions like Ascom, which uses the same communication protocol as a cordless phone. Vendors considered Bluetooth and cellular systems to be unsecure and unreliable.

All this is not to say that I didn't see any innovative technology at SalMed. A lot of what was new and interesting, both at the larger conference and the hospital infrastructure event, was technology for the operating room.

photo (3)I've written in the past about companies like GestSure, using the Microsoft Kinect to create a hands-free interface so surgeons can interact with computerized imaging systems without having to scrub out. A Polish company called Alvo is using the Kinect for a similar technology for autopsy rooms, called the Nebropath Pro-One. With a surprisingly intuitive gestural interface, a doctor can scroll through photos, adjust the temperature in the room, activate an ambient microphone for dictation, or even remotely adjust the height and orientation of the operating table.

A lot of the infrastructure conference focused on how to renovate existing hospitals to fit new surgical tech in old operating rooms. Speakers from Drager and Siemens talked about how everything can be wired through and mounted on the ceiling to maximize space and patient access.

Video conferencing technology, too, was much discussed and also largely wired. Stijn Catrysse, the director of surgical imaging at Belgian technology company Barco, was at the infrastructure conference pitching an internet protocol-based system for all video in the OR -- including endoscopic cameras as well as room-based cameras for teaching purposes.

"If you build an operating room today, and two years later you build another one, they need to talk to each other," he said. "You need to be able to set up a fluent communication and collaboration between these rooms and between the people working in them."

Barco puts all the surgical video online, but it's not wireless -- instead all the video is sent through high-bandwidth fiber optic cables. This allows all the video within the hospital to be transmitted uncompressed, without lag or latency.

"For an endoscopic surgeon, when he looks inside the body of the patient, he wants it to be realtime," Catrysse said. Barco only compresses the video to transmit it to other hospitals.

Overall, hospital technology in Poland is improving and improving fast. Yet it's still mostly wired, and many technological jumps are still an uphill battle for public hospitals struggling with the costs of innovation. If the government manages to support and goad Polish hospitals into faster adoption of health IT, Poland could find itself a ripe market for the growing number of mobile and digital health companies here in the United States.

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