How is examination with expensive medical devices organised?

The National Audit Office conducted an audit to assess availability of examination with expensive medical devices (angiography equipment, gamma camera, computer tomography equipment, etc.) and provision of preconditions for qualitative diagnostics using such devices. “Auditors identified a lack of control of the flows of patients waiting for diagnostics with expensive medical devices and artificial formation of queues in many cases. Also, the capacity of the devices has not been fully used, there are no clear indications for their use and no common methodology for the description of examination. All this limits the availability of examinations and lowers its quality”, said Auditor General Giedrė Švedienė summing up the audit results.

Several factors were identified which reduce availability of examination with expensive medical devices. There is no common patient flow management system, so neither the doctor forwarding patients for examination, nor the patients have up-to-date information about the actual queue in other medical institutions. Medical institutions do not follow a practice of registering patients for examination in other public health institutions. Without having enough information, patients are not always able to choose the medical institution which would perform the required examination promptly, cheaply and in close proximity. Consequently, the longest queues for scheduled examination build up in the largest medical institutions of the country. Also, 45 percent of the surveyed medical institutions pointed out a shortage of doctors-radiologists; however, no measures are taken to exchange images of examination by electronic devices and without engaging radiologists from other medical institutions for remote description of the examinations.

Clear indications of when expensive medical devices should be used, which are the same for all medical institutions, would help ensure uniform availability and quality of services and reduce queues for patients of different medical institutions. The currently used list of indications set by the Minister of Health is not exhaustive and needs to be revised.

The audit also revealed that medical institutions are not interested in performing more examinations than planned because in such cases they receive less payment for the services provided. Therefore institutions take administrative measures to regulate the number of expensive examinations during the current month – forming queues for examination or offering paid services to patients. In addition, in order to improve the availability of services, medical institutions should consider the intensity of the use of expensive medical devices, analyse their loads, and specific measures for the rational use of expensive devices.

Countrywide-approved diagnostic and treatment methodologies would ensure uniform and improved quality of diagnostics with expensive medical devices and facilitate the doctor’s decision on the specific examination to be carried out for the patient and on the specific devise (with certain technical characteristics) to be used for the examination.

According to experts engaged for the audit, there are cases when patients arrive with examination results to another medical institutions and have to repeat the analysis because of failure to describe it in detail.  Adoption of general requirements for the description of examination would improve the level of detail of examination, eliminate the need for repeat examination, and ensure that patients receive effective treatment as soon as possible.

The auditors also pointed out the issue of safety of expensive medical devices. Irregularities related to work with expensive medical devices are identified in half of the checked medical institutions. Risk of failure of devices has not been properly managed: one-third of certain expensive medical devices have been operated for more than 10 years, however, only half percent of all surveyed institutions are planning to upgrade the existing equipment or buy new devices.

With a view to ensuring availability and quality of examination with expensive medical devices, the National Audit Office made recommendations and suggestions to the Ministry of Health, the State Health Care Accreditation Agency, and medical institutions using expensive medical devices.