Continuous disruptions of the system
A non-stop issue of prescriptions, difficulties with getting medicines and interferences in the system are common for doctors and patients after the e-health has broken down. Even though the State Enterprise Centre of Registers has been cleaned and e-health is working again, the doctors are open: the system is not working properly until now. “At best, I evaluate the work as satisfactory. It always slows down at noon. The activity of e-health must be improved.” Antanas Jokšas, the general practitioner of A. Jokšas Family Health Centre, is open. The worst thing is that a poorly working system is stealing time from doctors which is already very limited. “The worst thing about e-health is that it is slow and has difficulties often. A half of all the time meant for the patient is used for works on e-health,” the doctor Algirdas Mačiulaitis regrets.
When receiving and describing one patient, doctors had to use even 3 programmes until now. It is a difficult task. A description is entered; treatment and referrals are prescribed into e-health. Sick leave is written in the programme of “Sodra”. Finally, all diagnoses are entered into “Sveidra”, a programme of Territorial Health Insurance Funds (HIF). Vida, a general practitioner who didn’t want to be introduced (her real name is known), thinks that the systems should be joined. “Less talk, more work – we need an active leader. Next year it will be compulsory to use the e-health. Strict instructions to enter all sick leaves have already been introduced this year; however, the situation is not moving towards this. The requirements overcome our physical abilities. The biggest clinics are served by private IT companies in order to embrace everything. It is not cheap. Let’s count how many millions will we need to invest into this system? Of course, this would be done at the expense of the salaries of employees and their well-being.” she says. The time of doctors and the data of patients entered into the system simply disappears. Audrius Kazlauskas, the head of Medicus LT clinic, confirms that as well, “The data of the 20th of July has disappeared; you never know when the information entered can disappear. The doctors are worried about their work.”
Lack of responsibility
Daiva Kazlauskienė, the president of the Association of Diagnostics and Medical Institutions, notices that the Ministry of Health and State Enterprise Centre of Registers do not take responsibility for the difficulties that arose. “The Ministry of Health held itself with importance when the servers of e-health crashed. It recommended returning to issuing paper prescriptions and calmly announced the terms of renewal of the system,“ she says.
The patients also suffered some difficulties: some health care institutions issued prescriptions, others offered to go to pharmacies to buy a piece of reimbursable medicines. They had to pay full price for the latter. If the patients want compensation, they are offered to go to HIF; however, a lot of documents will need to be filled in. Not every senior will manage to handle that.
It seems that a range of problems could be avoided: only spare data servers should be taken care about. According to D. Kazlauskienė, private health institutions are already using programmes for a long time where patient registration, filling in record cards are active after the failure. Spare data copies are used for such cases. Doctors ask: why e-health did not have this significant function?
Overtime
Doctors and heads of medical institutions fear such faulty performance of the system, the safety of the data of patients and increased workload. The Unfortunate situation is clearly shown by statistics: on a regular day about 50 thousand medicines are bought with electronic prescriptions! When e-health has crashed, paper prescriptions were issued, and when e-health was repaired, they had to be included into the system. It is impossible to have time for everything; therefore, doctors are forced to work after their work hours.
General practitioner Vida also supports the colleagues. “We always had to deal with various situations, adapt to the wishes of patients and all changing orders. But this year surpassed everything. We do not look into the patients’ eyes. They remain alone with their problems since doctors are occupied with everything but the treatment“, an experienced doctor resents the increased workload. “The system has faults every day, there is no normal and consistent work. The number of cards that needs to be sorted out is increasing every day. Even in the past week we could not issue a new reimbursable medicine, only the medicine that was used for a long time could be issued, but the problem was solved this week,“ Renata Undžė, the head of Varpas Family Clinic, has said. “We don’t do anything except for issuing prescriptions: from electronic to paper ones, from paper ones to electronic. Maybe a post of clerk can be established ?“ ironically says Ingrida Kelbauskienė, the general practitioner of Family Clinic of I. Kelbauskienė. Vytautas Brazauskas, the head of the cabinet of general practitioner in Tilžės str., Šiauliai, is not afraid to share with the numbers, “Each of our doctors held 960 virtual and contact consultations during July: the workload is exhausting; however, no one solves the problem.”
Irina Kim, the director at interim of Telšiai Family Clinic, is sure that, “The responsibility for disruptions of the system should be carried out by the Centre of Registers and the inability to cope with failures should be carried by the management of the country.“ Unfortunately, the doctors still feel the indifference from the officials.
Threat of fines
It is true when someone suffers, others can make money out of it: when the system broke down, a gap for trespass appeared. A part of patients, who were issued with paper prescriptions for medicines, did not buy them. When e-health was repaired, they repeatedly got electronic prescriptions, thus they could buy a double amount of reimbursable medicines. What does it mean? Nothing else than responsibility imposed: if patients misuse prescriptions, punitive damage will be paid by medical institutions.
There are even more financial challenges: the Ministry makes high claims and threatens fines for clinics. “The Ministry of Health requires serving patients and providing direct services. However, it stays alert to detect those who do not wear protective gloves. Then it puts on fines reaching thousands. The Ministry criticizes bravely but at the same time it does not provide a smooth provision of services and makes our work more difficult,“ the president of the Association of Diagnostics and Medical Institutions is surprised.
Doctors are sure that the situation is gloomy and there are more questions than answers. They are asking why e-health is functioning badly so far. It is unclear if the servers of the Public Enterprise Centre of Registers have enough space for saving data. When the second wave of coronavirus comes, distant consultations and limitations must be bought back and it means one more challenge for e-health. Therefore, one of the most important questions is left hanging in the air: what will the Ministry of Health do differently this time?
