by Dari Alhuwail

Globally, the toll of diseases has become virtually unbearable and their proliferation among growing populations threatens the economies of many countries. Therefore, several healthcare systems are launching various initiatives for healthcare reform. In the State of Kuwait, the demand for healthcare services has been on the rise as the population continues to grow older and live longer. Additionally, the dramatic changes in the population’s socioeconomic status in the post-oil era have promoted a sedentary lifestyle and an intake of high-calorie foods. Such a lifestyle has promoted the extensive spread of non-communicable diseases such as diabetes, hypertension, and cardiovascular diseases, which are claiming large sums of money and more importantly, the lives of many people. Healthcare reform efforts – targeting higher quality of care, improved health outcomes, and reduced costs – become a top priority to address these challenges.

Today, digitally-enabled healthcare services are an essential building block for safe, efficient, and effective healthcare-service delivery in light of the rising burden of disease. The successful and effective adoption of digital health tools by healthcare institutions can support healthcare reform efforts. Digital health solutions can automate the collection of structured electronic data and capture it throughout the patient’s journey in the healthcare system. These solutions enable the healthcare organisation to collect and monitor dynamic quality measures over time. Additionally, such tools can also eliminate duplication and waste in care delivery (e.g. making the results of prior diagnostic tests, such as labs or x-rays, and interventions available at all points of care) and help reduce medical errors and improve patient safety.

Yet, in Kuwait, the current levels of adoption and maturity of digital health tools and systems are limited. Proper information governance through information management practices is an important precursor for the successful and effective adoption of digital health tools and systems. Unfortunately, little is known about the pressing challenges, gaps, and opportunities concerning information management practices in Kuwait’s healthcare institutions. The aim of this empirical research is to:

• Uncover the status-quo of information management practices in public hospitals.
• Offer recommendations to improve information management practices and the Digital Health Maturity.

With proper ethical clearance, anonymous data collected by Quality and Accreditation Directorate at Ministry of Health pertaining to the compliance with the Information Management standard at public hospitals. The dataset covers two accreditation cycles with cycle one taking place in 2012-2013 and cycle two taking place in 2016-2017.

The evidence highlights that Electronic Health Records (EHR) adoption levels in public hospitals vary greatly. Only two hospitals seem to have integrated their EHRs with other digital systems (e.g. Radiology and Laboratory Information Systems) within their institution. The rest of the hospitals have ‘fragments’ of digital solutions that perform specific functions. The evidence also suggests that hospitals are making progress with respect to their information management practices. However, it is clear that hospitals struggle with defining clear leadership and strategic directions for digital health and informatics. Additionally, informatics education and training for staff is insufficient. Analytical reports that help with real-time decision-making and long-term planning are either not produced or not solicited. While the privacy and security of health information is a top priority, it is not clear how records are protected universally across the hospitals.

These findings offer important policy recommendations to improve Kuwait’s Digital Health Maturity. The following is a brief review of these recommendations:

1. Regulators should spearhead a national strategic digital health and informatics plan and disseminate it publicly. To create this plan, it is necessary to be inclusive of all healthcare stakeholders, including patients or their advocates. This plan should focus on improving patients’ experience while improving healthcare-process efficiency and reducing costs. Important guidance on data governance and cybersecurity should be included in this plan.
2. The regulators should define clear clinical informatics leadership roles (i.e. Chief Clinical Informatics Officer, Chief Nursing Informatics Officer, etc.) and integrate these roles in the organisational structure of the institution with the proper approvals from the Civil Services Commission. Today, there is no path or recognition in the organisational chart for such roles.
3. Hospital leaders should foster an enabling eco-system for health informatics within their institutions. This includes training for staff on the appropriate use of digital health and informatics tools. Additionally, this eco-system should effectively leverage the analytical insights from the digital systems and use these insights for purposes of planning and decision-making.
4. Healthcare institutions should be involved in continuous assessments to uncover their digital health maturity. Not only will these assessments allow the institutions to uncover their strengths and areas of improvement, but they will also aid in prioritising which issues or areas to focus on. The HIMSS EMRAM evaluation and a variant of the NHS Digital maturity assessment are recommended.
5. Academic institutions, mainly Kuwait University and the Public Authority for Applied Education and Training, should integrate health informatics training into the academic curriculum for all health and allied-health disciplines. This will help prepare the future workforce to work with digital health solutions and truly embrace the power these provide for enhancing healthcare delivery.

The socio-economic context of countries in the Gulf Cooperation Council, including Kuwait, necessitates the implementation of these recommendations. The oil-rich states continue to face a range of grand economic challenges in the form of continuous stagnation of oil-prices, sluggish economic diversification and rising fiscal deficits; we can no longer afford not to leverage digital and health informatics solutions to aid healthcare reform efforts. Today, digital and health informatics solutions act as the circulatory system of the modern healthcare system, transporting necessary information to the various parts of the whole. When the arteries of this system are ‘constricted’ or ‘clogged’ with absent, fragmented or isolated information systems, the consequences are dire! It is time to reform healthcare with the help of informatics.

Dari Alhuwail is an Assistant Professor in the Information Science department at Kuwait University. His research focuses on health informatics. He is currently a Visiting Fellow at the Middle East Centre.