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Why are sectoral players not banging on the door for a hospital reference architecture?
The domestic health IT sector market is fairly limited, and suppliers have already largely divided the market among themselves. There is movement, of course, and the development needs and opportunities created by the National eHealth Infrastructure (EESZT) have given some companies room to grow in recent times. However, it can be argued that this market is not that enormous.
Why bang on the door for something that was not necessary for sectoral solutions? Who can spare time and energy besides performing actual tasks to think with a future-proof mindset?
Of course, more and more private care providers of complex services have kept emerging recently, but this does not represent a huge expansion of the market. The number of smaller private providers is also gradually increasing, but their IT needs are rather less complex than those of private hospitals. Currently, the market is not booming with development opportunities and greenfield investments, even though technology would be knocking on these doors with new possibilities and directions. The question, "Whose job would it have been to lead the way and set a unified direction?" is a deceptive one. On the one hand, it suggests that there were no central sectoral or even market directions to lead the way. On the other hand, it ignores the fact that this is an evolutionary issue. Each sector has to go through its own developmental phases, and this is no different either abroad or in our country.
In Hungary, the sectoral governance, including the NEC, National Public Health Centre (NNK), National Institute of Pharmacy and Nutrition (OGYÉI), and National Directorate General for Hospitals (OKFŐ) actors, defined a number of measures, reporting or data supply obligations, etc., which were designed to encourage the suppliers of medical or other operational support systems used by healthcare organisations to further develop their solutions, modify them and add new functions.
Thanks to these centralised measures, for example, domestic health care and in particular health informatics have a tool, an identifier that enables to recognise patients and their associated service identification, and this is the social security number. Some West European countries can only dream of having such an option one day.
The various electronic imaging, laboratory and other systems have also generated development needs. Their integration was expedient or necessary to implement, and of course we should not forget the many requests from customers.
These changes were somehow implemented by the different development teams to the best of their knowledge. Of course, it was possible to find international patterns, supplier recommendations, and central specifications, but the solutions obtained were nevertheless visibly heterogeneous.
Suppliers did not bang on the door, and over the years they even got used to working their own way, making minor or major modifications to the existing systems to perform their actual tasks, with as little cost expenditure as possible.
The central government clearly attaches great importance to sectoral IT development, as in the past years significant EU funds have been invested in this area, and the IT development tasks of the healthcare sector are an important part of the much-expected resilience package.
Is it clear to everyone which system elements, which data, and which data links are affected by these improvements? Is it clear to both central and local system developers what the impact of each development need and its implementation is/will be on the sectoral data assets?
Needs and challenges come fast and require quick, cost-effective solutions, but understandably everyone has his/her own local interests at heart. It might be worth providing a structure, a map, on which everyone can find his/her positions and see areas and links that are missing or need improvement.
Is there still a need for a hospital reference architecture?
Progress will not stop, and sooner or later it will even accelerate. The government's intentions (even if their detailed breakdown is not yet fully visible at the moment) point in a clearly visible direction.
These are reflected in both communication and planned developments:
the requirements set for digitalisation
the development of digital solutions to strengthen primary care
the digital support for the healthcare system
public health promotion through digital solutions
sectoral development tasks to improve data asset management
In addition to government intentions, EU resolves and development orientations are also gaining strength, such as:
European Health Data Space – EHDS
The EU4Health program
The Horizon Europe program
Changes are coming, and these changes will be reflected through the sometimes softer, sometimes more pronounced coercive, compelling force exerted by rules and legislative provisions, development projects and requirements in the tasks of those who manage, operate and develop IT in the sector.
The question is how to delimit tasks and subtasks well, how to define requirements well, and how to ensure that many systems work together so that the data flow is ultimately combined into coherent and meaningful information. A common map is needed to efficiently implement the developments ahead in a short time, avoiding unnecessary detours.
It is the responsibility of IT practitioners to signal the need for unified, well-defined directions, and widely communicated central and local reference architecture plans. And in turn, it is up to IT managers in the sector to point out the door or doors to knock on, because the interested parties can get answers. To do this, of course, they must be ready with the answers.
About authors
Zoltán Tim has been working in the field of information security, IT and security management systems for 26 years. In this context he has developed IT architectures for domestic and international companies, typically to increase operational efficiency, security and compliance. He has experience and certifications in audits, risk management, compliance, strategy development, process organisation, regulation, system implementation.
György Lokodi has been working in health informatics for more than 10 years. He participated in the establishment and implementation of the Electronic Health Services Space (EESZT), developing accreditation methods for connected systems, conducting system assessments, and implementing or replacing IT systems in multiple hospitals.
