Towards a post-corona care model

Now that the first wave of COVID is over and we are already entering the second wave, Jan Flament, CEO of Geel Hospital, explains how his hospital is facing the challenges of the corona crisis and is continuing to roll out the electronic patient file HiX at the same time. He is also looking ahead to the healthcare of the future.


Predicting inflow with data models

"These have been interesting months. On the one hand, it was extremely hectic, yet on the other hand, it has never been so quiet in the hospital. There were few patients, but the required level of care was considerably higher. In short order, we had to rebuild the operation of the hospital with the necessary flexibility to be able to scale up and down departments according to what was needed.

Specifically, of course, a large test capacity was required in the lab, but data use also suddenly became much more relevant. For example, Bernhoven hospital, in collaboration with the company Performantion, has developed a model for determining the expected patient influx. On the basis of these statistical models in combination with projections and data from, for example, Wuhan, Lombardy and New York, we were able to better estimate what was ahead of us in Geel.

Back to the essentials

For me, the positive side of the crisis was that health care regained its focus. It felt good to spend a few months working exclusively on what it is essentially about: getting and keeping the patient healthy. A doctor literally said to me, "This is the first time since I was an assistant that I have been this involved in health care again. I've really enjoyed it." I think the past crisis period has been incredibly compelling, no matter how hard it was at the same time.

The interaction with general practitioners and residential care centres may have had a somewhat shaky start because there wasn't a history of cooperation and also because the government was too narrowly focused on hospitals. But the residential care sector and the GPs have made an indispensable contribution, for which we are extremely grateful to them. We have also been able to set up a better collaboration with the first line, with a joint triage centre for patients, for example. We are going to expand that cooperation even further.

Innovative daring

The crisis offered an excellent opportunity to try new things. If you give people the necessary time and freedom, their creativity will automatically lead to beautiful solutions. Suddenly there were a lot of possibilities and no one wondered if we had enough budget for that. Something that used to require dozens of meetings was now immediately possible. Talking or teleconsultations had been going on for years, but now the introduction and even the reimbursement was arranged in about a week.

There are even more excellent examples. When a shortage of oxygen pumps was imminent, our doctors came up with a solution to deduplicate devices. They posted a video on YouTube for other healthcare providers to benefit from, and a week later I got a phone call from ABC News. In the meantime, this has been spun off and a joint research project has started between Flemish, French and American universities. As a medium-sized hospital, it is very nice to be able to create such amazing things.

An important impulse was that the fear of change faded into the background because the urgency was so high. We are sometimes more afraid of an unjustified expectation than of the real problems we see.

Lessons for care policy

I think the main lesson from the recent period is: the system no longer works. In Belgium we have different policy levels that need to find a compromise for everything. There is a lack of clarity about responsibilities and every level can block decisions, so that valuable time was lost during this crisis as well.

You can also see the same compromise system in healthcare. The division of powers is unclear. According to the latest hospital network legislation, both the Board of Directors and the Medical Board can now block decisions. I am very much in favour of integrated decision-making with the medical staff, but I do not understand why it then needs to take place in a separate meeting. Put the different parties together and really let them decide together. Clarity and unity of command are needed. Care policy must change and I hope that we will make use of the current dynamics.

We know that our health system in its current form can no longer be financed. We operate on a performance basis. The more diseases you detect and actions you perform, the more income you generate. There are enough models on how to work cheaper, but they will not be introduced as long as the performance model is maintained. We have to change our perspective: how can we best use healthcare in service of our society, our 'shareholder'? The government must have the decisiveness to adjust the financing model. But it is also the duty of the sector to speak out and participate in a structural, fundamental shift.

Telehealth and monitoring

The focus will shift from curative care to monitoring health status. Actually, there is now better preventive maintenance on your car than on your body - not a nice thought. You will be notified if the oil needs to be changed or about anything. You don't get those warnings for your body, while all the tools are available. These monitoring tools need to be better integrated into healthcare. Apps and other digital assets can offer fantastic added value, but we must be careful not to lose quality. There must be a good regulatory framework with which this quality can be tested. As a rule, innovations cannot be contained in a framework, so it is going to be difficult, but it is necessary.

The belief in telehealth, e-consultation and other digital solutions for remote care is growing. We will have to break through certain habits. Corona has ensured that healthcare providers have been introduced to new forms of care. Although there is a lot of focus on the new solutions, I see that there are also caregivers, administrators and politicians who now mainly want to go 'back to normal'. I think we should be more pragmatic about this and embrace the change without wanting to throw everything from the past overboard.

A surgeon from our hospital is using remote care in a very valuable way. So far, on average, he performed only one surgery on every seven consultations he took. But with a few simple questions, he can usually judge whether someone should (immediately) have surgery or not. Because he can see fewer patients due to COVID, he now first conducts a teleconsult with which he determines whether the patient needs to be seen urgently, it isn't that urgent or not at all. Fewer people have to come to the hospital. The surgeon has increased the ratio of interventions in the number of consultations to one in four. He can now invest more time and energy in surgery and thus help more patients.

Realisation of a strong IT base

A lesson we learned from the crisis is the importance of an integrated approach to healthcare. Now it seems that everyone works for themselves and patients randomly visit different care providers. If the national health care organisation was a company, then it was really a hugely inefficient company. All healthcare providers must work together towards one joint end product: the health of the patient. Delivering quality care is only possible if you involve the entire care spectrum and digital tools such as an integrated file can help with this.

We at Hospital Geel strongly believe in a fully integrated IT system as the basis for providing the best care and opted for HiX from ChipSoft. Our hospital has been working with ChipSoft since 2010 and already uses a number of partial files from the EPD, for example in the OR, the A&E and nursing departments. Thanks to the consolidated data, we had a lot of information available during the crisis, which was important for timely and adequate action. I saw many great innovations in HiX hospitals that work with the fully integrated file. But because we are not that far along yet, we, unfortunately, could not yet take advantage of all the new possibilities.

At the beginning of the crisis, we decided to continue implementing HiX because we value the importance of this project so highly. The entire file will go live in the autumn, so our focus was mainly on the continuing the rollout. Due to the circumstances, we have had to do a lot online, which is not always ideal when clearing processes. Nevertheless, the implementation went smoothly. The progress we continue to make is also an indication of our positive partnership. We enjoy a pleasant, future-proof cooperation at all organisational levels.

This crisis period will have a major impact. We're moving to a different way of working. This presupposes great adaptability. Confidence is needed in new technology, but you also need a good framework. It's still a bit of a search to find the best ways for us to get started exploiting all the possibilities. But that's what it's always about: adapting to an ever-changing reality."

Jan Flament, CEO of Geel Hospital (Belgium)