"Good level of digitalization achieved"

The topic of "digitalization of the healthcare system" is a never-ending story. Switzerland is still struggling with the introduction of the Electronic Patient Record (EPR), while one major IT project follows the next in large hospitals. Elke Albrecht, CIO of the Solothurn hospitals, is right in the middle of these change processes. The medical IT specialist has been in charge of IT there for eleven years - and is still the only female CIO at a cantonal hospital in Switzerland.

Ms Albrecht, digitalization in the healthcare sector is a much-discussed topic. Let's take a look at the hospitals in Solothurn: What are the biggest digitalization projects there at the moment?

Elke Albrecht: The biggest project concerns our administration systems. We are in the process of replacing the SAP environment. This was introduced in 2015 and was my first major project at the time. The system has now reached the end of its life cycle and is being replaced by the next generation platform SAP S/4Hana. The project has been running for a year now, and we went live with it on the first weekend in November.

The migration to SAP S/4HANA in particular appears to be very complex. Many users therefore delay it for a long time and do not always feel well supported by SAP. How do you experience this? Is this migration going quite smoothly at the Solothurn hospitals?

Of course, there are many challenges because the project is highly complex. We have a large number of internal and external stakeholders. Many external partners are involved to support us. The workload for the employees involved is also high, both in IT and in the various specialist areas. This sometimes leads to a double burden, as day-to-day business has to continue. What's more, we don't just have this one SAP project, but others as well.

So there are also similar projects in the clinical sector?

Yes, because digitalization must also continue there. Based on our digitalization strategy, we have defined that we want to drive forward the digital transformation of the patient pathway. A number of larger and smaller projects are underway in this context. We have also further expanded the hospital information system (HIS) and equipped it with more and more functions in order to avoid media disruptions. The HIS is currently also being introduced in the operating theatre for anaesthesia at one of our sites, and other sites will follow by January 2025. The fact that we don't just have one site to serve - we have three acute hospitals plus psychiatry, and all of them need digitalization projects - doesn't always make things easy for IT.

This complexity: How do you manage such a project and how do you organize yourself?

The complexity was also evident in the introduction of the clinic information system. Our IT team is not so large that we can serve all locations at the same time. We therefore had to coordinate the entire rollout from site to site and also explain why the entire introduction could not be done at once. However, the great thing is that the specialist departments are always very interested and participate in advancing digitalization together with us from IT. Conversely, we have also experienced that a clinic at one location does not go along with us or expresses reservations. Then you have to stop the project there briefly and move on to the next location. If it is then established that it works and really brings benefits, the new system can still be set up at a later date.

You mentioned the digital strategy for Solothurn's hospitals. What are its key points and how far has implementation progressed so far?

The digitalization strategy is clearly based on the corporate strategy. This has three overall objectives: Service innovation, for example via new medical service offerings and areas that can be opened up via digitalization, then of course quality improvement and finally networking within and between the hospitals as well as with service providers such as nursing homes and Spitex and referring physicians such as GPs. I think we have now achieved a very good level of digitalization along the patient pathway. A great deal of digitalization is taking place, and not just in Solothurn's hospitals; I would therefore put a few question marks behind the claim that Switzerland is lagging behind in many areas.

But the last piece of the puzzle still missing is the EPD?

Exactly. Between 2015 and 2019, I was strongly committed to the electronic patient record and always believed in it, and I still do now. But after three or four unsuccessful attempts to implement it, I'm now glad that the federal government has decided to centralize the process. Otherwise the EPR will never get off the ground because of the cantonal spirit.

Another keyword: cyber security. If you imagine that surgical robots could also be hacked, it would be a horror scenario. What are the Solothurn hospitals doing in terms of cyber security?

It's not a question of whether something will happen, but when and what dimension an attack will have. We detect phishing attacks on a daily basis. The weakest link in the chain is the employees at the PCs. We are constantly carrying out training and awareness campaigns here. I think we have achieved a good level of awareness here. We can see this from the number of reports of suspicious emails alone. We have integrated a button in Outlook that you can use to report a suspicious email. We then analyze it and give the sender feedback. Of course, we also have a whole portfolio of technical solutions for cyber defense in operation. We work according to a recognized best practice model from the NIST (National Institute of Standards and Technology). We also have a hybrid SOC (Security Operations Center) that constantly monitors all our systems 24/7 and triggers an alarm if an anomaly is detected.

The healthcare sector is under public scrutiny due to rising costs. It is said that digitalization can have a cost-reducing effect because processes are automated. What can be said about the cost savings that have been achieved?

It is almost impossible to calculate the financial benefits of a business case. Advantages that may have a positive financial impact lie in the avoidance of media discontinuities, or multiple examinations can be prevented. In any case, the speed factor through greater efficiency and increased productivity is an issue. I question whether it is possible to provide the same services with the same number or fewer employees and thus make savings.

As Head of IT, you sit at the interface between hospital management and the political supervisory authorities. How do discussions take place at these levels? Do you occasionally take on a moderating role?

Less so from an IT and digitalization perspective. Of course, the topic of EPD is still present. I am in contact with the relevant authorities in the canton of Solothurn. However, quality is also a major issue at the moment. We have to report to the canton on this on an ongoing basis. There is also an exchange with our colleagues in the cantonal IT department. We have been a public limited company since 2006; although the canton is the sole owner, we are independent.

Then you also have sovereignty over which systems and solutions you use?

Exactly.

What other systems are in use besides the SAP I mentioned?

We are pursuing a platform strategy. We use four major platforms: SAP for the administrative area, KISIM in the clinical area, Synedra for our large universal archive and finally ServiceNow for enterprise service management. It started relatively small there, with a ticketing system, incident management and so on. Then financial management was added as a management tool for IT and we now have many other functions on the ServiceNow platform, including HR workflows. We recently went live with the expense workflow, and our intranet has been running on ServiceNow since the beginning of last year. Investment tools, project management, portfolio management, even in emergency services, logistics and purchasing: we now have a wide range in use on the ServiceNow platform.

What are the advantages of such a platform strategy compared to other options?

It's all about harmonization and standardization. Another goal is to keep our costs under control. Because with every additional system, interfaces are added, integration work is required and, ultimately, the solutions also have to be maintained regularly. This means effort, which also has a financial impact.

Not to mention the specialists that are needed. What is the situation in medical informatics in this respect? How do you recruit specialists for the rather specialized IT application area in the healthcare sector?

We have two business areas: One is medical informatics. This requires specialists for clinical systems and medical devices - from large radiology systems to the smallest blood glucose meter. These devices all have to be integrated into the systems somehow, and this requires specialists. We work closely with the Bern University of Applied Sciences in Biel, which trains medical IT specialists. We always have young people from there working with us on internships. The training course is dual, i.e. 50 percent of the students work in a company like ours. We have just employed our first graduate on a permanent basis and a second student is now joining us. The specialists need a good understanding of processes in the clinical areas. And it is very difficult to recruit new employees. The competition between hospitals for these specialists is fierce. The other area is administration with SAP and the other platforms mentioned. Here, too, the market for specialists has completely dried up. We are strongly affected by the fact that the baby boomers are gradually retiring. It is difficult to find a successor quickly.

How do you go about it? Do you retrain other employees for new tasks?

On the one hand, we recruit from outside, and on the other, we have defined career paths to show employees in both IT and other specialist areas prospects and development opportunities. In IT, such a path starts in support, at the service desk, for example. There are then various opportunities to switch to the specialist areas. If someone wants to develop further in technology, they can switch to systems engineering or medical informatics. This also works the other way round: employees can also move from nursing to medical informatics, for example.

As far as I know, you are the only female CIO at a Swiss cantonal hospital. To what extent do you see yourself as a role model for other female IT employees and managers?

That is correct: I am the only woman among all the IT managers of cantonal hospitals. Only in Ticino do I have another female colleague at a private hospital group. But to your question: I don't see myself as a role model because I'm a woman, but basically as a role model in a management position. I always have a little trouble with this discussion about women or men. There are many possibilities and opportunities for women. It is often the case that a position has to be filled by a woman. But then please do it on the basis of their qualifications, otherwise it can't work. Women have many opportunities, but often shy away from the responsibility or don't want to work full-time. 80 % is certainly still feasible, but I see anything below that as problematic. That makes it difficult for women to take on management tasks. But women work in all the teams in our organization, and they probably see me as a role model. We have also formed a small community, we go for coffee together, exchange ideas or sometimes have lunch together as a "women's group".

Digital transformation in the healthcare sector

The management of clinical devices is complex and requires various measures in the areas of security, compliance, governance and maintenance. These challenges can be overcome with ServiceNow's out-of-the-box Clinical Device Management solution using centralized digital processes. This means that patients and medical staff can be offered the best possible experience, investments can be protected and costs can be reduced at the same time.

> www.servicenow.com