One third of the time of medical advice is spent on keeping medical records and performing administrative activities, according to the report of the Supreme Audit Office. Maciej Miłkowski, Undersecretary of State in the Ministry of Health, in response to the publication of the Supreme Audit Office, emphasized that the activities of the Minister of Health, improving the work of the healthcare system, were prepared and implemented in a manner meeting the expectations of service providers.
For the first time in Poland, the Supreme Audit Office examined the effectiveness of the use of time devoted to medical assistance for patients. The findings of the Supreme Audit Office show that administrative tasks are often introduced by means of legal acts that do not relate to the functioning of the health care system.
An example was the imposition of an obligation on a primary care physician to issue a medical certificate stating that the health condition of the person who granted the power of attorney to collect postal items at a post office makes it impossible or significantly hinders the collection of a letter in person at a post office.
NIK: a third of the time of a medical consultation is spent on keeping medical records
According to the inspectors, such a situation requires the Minister of Health to analyze the applicable legal regulations in terms of reducing administrative time-consuming in medical facilities, so as to increase the effectiveness of patients’ treatment.
The findings of the inspection show that nearly one third of the time of medical advice is spent on keeping medical records and performing administrative tasks. It is even worse during teleportation – according to NIK auditors, only 57 percent of the time spent on consultations remains for the medical service itself.
It was pointed out that “the reason for a significant burden on medical personnel with administrative activities is, inter alia, the fact that [placówkami opieki zdrowotnej – przyp. red.] and outpatient specialist care did not ensure full use of the available tools – especially IT tools – supporting the work of medical personnel in performing administrative tasks.
NIK: medical staff charged with performing administrative tasks
The Supreme Audit Office notes in its report that 86 percent. of the entities inspected, the possibility of relieving the work of doctors was not used by granting medical assistants appropriate authorizations to issue e-leaves, e-prescriptions and e-referrals. “The possibility to order nurses and midwives to independently continue the treatment of patients was not used, if they met the required qualifications” – writes the Supreme Audit Office.
The Chamber also noted that “medical secretaries, registrars and medical statisticians, intended to support medical personnel in administrative work, were employed to a limited extent”. “As a result, the medical staff was burdened with performing administrative tasks, including reporting and registering patients” – reads the report.
The findings of the Supreme Audit Office also show that “in 91 percent of the audited health care facilities, medical personnel, especially nurses, but also doctors were entrusted with administrative duties consisting in the preparation of statistical reports and the implementation of contracts for the provision of services concluded with the National Health Fund”.
In half of the inspected establishments, the visit was not registered electronically, and in 41 percent. there was a lack of software enabling sending notifications to the patient and updating the visit status (in the form of SMS or e-mail).
NIK: temporary restrictions on the availability of services during the epidemic
During the COVID-19 epidemic, seven out of 22 inspected centers (32%) found cases of temporary limitation in the availability of services due to the suspension of some clinics and non-compliance with the adopted schedule. In 14 percent The entities were temporarily limited to providing only life-saving services and for urgent patients. As explained, these changes were taken from the recommendations of the National Health Fund in the field of preventing, counteracting and combating the coronavirus epidemic.
Teleporada, as a new form of providing medical assistance, in the first half of 2020 accounted for a quarter of all medical consultations provided. Compared to the first half of 2019, the number of consultations provided by the inspected medical entities was lower by 15%. in POZ and by 26 percent. in AOS.
NIK asks for an analysis of the scope of duties of medics
In connection with the results of the inspection and the related findings, the Supreme Audit Office requests the Ministry of Health, together with organizations representing the medical community, to analyze the scope of administrative duties of medical personnel and reduce them to the necessary minimum, and to accelerate the process of computerization and automation of information flow in the health care system.
In order to improve the organization of work in entities providing outpatient health care services, the Supreme Audit Office directs requests to the management of medical entities for the full use of IT tools and the implementation of appropriate solutions supporting the work of medical personnel, in particular integrating the IT systems used with laboratory and diagnostic imaging systems – for their direct feed with research results.
It also recommends the implementation of electronic recording of outpatient visits, with the possibility of sending notifications and updating the visit status (in the form of e-mail or SMS) – in order to provide the doctor with information about registered patients and to limit the number of cases when a patient signs up for an appointment and forgets it.
It also points to the need to maintain uniform rules for keeping medical records in electronic form and to eliminate ineffective practices of creating the same document in electronic and paper form, in order to ensure consistency and improve the flow of information between individual organizational units of the medical entity.
Response of the Ministry of Health to the NIK report
In response to the information from the Supreme Audit Office, Undersecretary of State in the Ministry of Health, Maciej Miłkowski, issued a letter in which “he assessed the application as illegible and unjustified, which results from the failure to indicate in the information of the Supreme Audit Office specific data regarding the failure to act on the part of the minister of health, subject to inspection” . He emphasized that “the responsibility for the management of a non-entrepreneur medical entity is borne by its manager and it is he who makes decisions on personnel matters and is responsible for employing people with the required qualifications at individual positions, as well as decides to introduce new solutions to improve the work of medical personnel, taking into account applicable legal regulations in this regard “. Maciej Miłkowski pointed out that the Ministry of Health and the National Health Fund “as an institution that accounts for the provision of health services, have no influence on the organization of the internal organizational structures of the service provider and the method of their management”. “Interference in the task of computerization of service providers and the employment structure (apart from the personnel directly providing services under the concluded contracts in accordance with the required regulations) are beyond the competences of the Ministry of Health and the National Health Fund” – we read in the reply sent on behalf of the Ministry of Health. It was added that “the duties and tasks of the management of the medical entity include, in particular, the employment of auxiliary and administrative staff supporting medical workers”.
Main photo source: Paweł Supernak / PAP