Bytes & Bandages

The growing expense of healthcare provision is forcing the region’s governments to integrate clinical data and billing systems in order to cut costs and boost efficiencies.

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By  Neil Denslow Published  December 22, 2002

I|~||~||~|Traditionally, healthcare organisations have focused their spending on clinical equipment rather than IT support systems. However, the growing cost of healthcare provision is forcing the region’s governments to integrate clinical data and billings system to enhance decision making and reduce inefficiencies.

The Kuwaiti government, for instance, is undertaking a huge IT project to improve patient care and to reduce hospital running costs. The five-year plan encompasses the full range of healthcare automation, from clinical management within hospitals and primary healthcare centres, to the creation of a nationwide patient master index for non-nationals living in the country.

“The government of Kuwait has tried to get the best services for our patients and one of the things that will improve the service… is the IT system. Our patients are the most important thing for us and we have to do whatever we can do to get the best service for them,” explains Salah Baquer, director, information department, Ministry of Health, Kuwait.

Key to the entire healthcare information system project is the integration of data for both clinical and financial purposes. The Ministry of Health is achieving this by working with Al Babtain to implement a host of Siemens Medical Solutions (SMS) clinical management modules at primary healthcare centres, hospitals and on the national level. These will then link together to create a master patient index containing both medical records and billing details.

“Our main goal is to get one single electronic file for each patient. If they go to any hospital or primary healthcare centre, or they have insurance… it is
all [recorded] in one single internal file,” says Baquer.

Dubai’s Department of Health & Medical Services (DOHMS) has already implemented an SMS integration engine, which brings together all clinical information. “At the end [of the process], we have a unified presentation of the clinical information in a clinical workstation, where the physician is [also] able to… place an order for a radiology or lab test, for instance,” explains Sina AbdulAziz Khoory, DOHMS’s IT director.

The Kuwait project is seeking to achieve this level of integration by implementing different SMS modules at three levels of the organisation. Two years into the five-year plan, all 75 of the primary healthcare centres in the country have received a basic package of the pharmacy, registration, doctor and nursing system modules. In phase two, the 20 plus hospitals will receive the full range of modules, encompassing all medical departments. “We started [originally] with the primary healthcare systems, and they all now have a system. Now we are starting with the hospitals,” confirms Baquer.

All information generated by these systems will be centrally stored on two HP ES40 server clusters. The remote offices will access these via a nationwide intranet, while the hospitals and primary healthcare centres will be extensively networked with both fixed and wireless connections.

Healthcare staff will be able to access the central records through the use of patient health cards, which will be issued to 1.5 million non-nationals living in the country. Issuing these cards will also be simplified by the project, as the Minsitry of Health has deployed an integrated SMS health card management module, which is set to go live in a couple of months.

Prior to this implementation, getting a health card was a complex affair. People first had to visit a bank to make the payment, then get an application form typed up, before visiting the health insurance department to complete the process. This, however, will now be completed in a short visit to one of the 22 issuing offices. “With the new project, you will only have to go to one place and the whole process will take only 10 minutes,” say Baquer.

The health cards will be linked to the patient master index, which will contain both clinical data and billing information. Medical records and billings need to be inter-linked, as any action will impact on both areas. For instance, when a doctor orders a blood test, it needs to be recorded in the patient’s medical record as well as triggering a bill for the payee, whether it be an insurance company, the patient, or another party.

The healthcare information system should enhance medical care, as notes will no longer be scatter around different hospitals and healthcare centres. Doctors will instead have access to all of the patient’s records, which will ensure that expensive tests aren’t repeated as well as enhancing physicians’ decision-making.

“The benefits to the nation are enormous,” say NV Ravikumar, director of marketing & business development, Medicom. “They are able to offer a better quality of care to the patient because irrespective of where the patient has gone in the past few episodes… the physician is able to get all the information out. And since all the information is there he is able to give a better quality of care,” he adds.

||**||II|~||~||~|Despite these advantages, only a limited number of fully integrated healthcare information systems have been implemented anywhere in the world. The main hinderance to implementations is the fact that clinical and billings information both present separate and extensive integration challenges, which are only now being overcome by vendors and end users alike. “It’s been very slow, but we think the technology has gotten to a point where it is going to be able to handle a lot of this, and so we expect to see more of a pick-up in its use,” says Tom Handler, research director, Gartner Group.

The challenge in integrating clinical data is the sheer complexity and range of information, an integrated system needs to support. A system needs to recognise, for instance, that bacterial endocarditis is both a cardiac disease and a bacterial disease, which may trigger other complications. This is just one example out of a near infinite range of medial conditions and symptoms.

“A laboratory system is a very serious thing. It doesn’t always go through a simple calculation like a HR package, logistics or payroll,” notes Hamad Al Daig, executive director IT affairs, King Faisal Specialist Hospital (KFSH).

Diagnosis is, however, just one area of medical care that needs to be integrated within a healthcare information system. The sheer breath of tasks to be encompassed is most easily seen by what it has to replace — a traditional paper chart. The paper record fulfils a host of functions, such as being a record, a communications tool and an ordering mechanism.

“There are a lot of tasks and a lot of things going on within that paper chart,” notes Handler.

The challenges of integrating clinical data are exacerbated by the lack of standards across the industry. Standards are key to integration, but the medical sector is notoriously lacking in them. For instance, at a basic level, different doctors may call the same condition by different names, such as kidney stones, renal stones or renal calculus. Physicians may then also decide that the same condition needs different remedies or different procedures.

“You have that across the board,” says Handler. “[For instance,] a group of physicians at one hospital thinks that in order to treat a patient in the Emergency Room, there are ten things you need to know. Then another group comes along and says, ‘it’s not those 10, it’s these 15’,” he explains.

Given these difficulties, Gartner contends that any healthcare information system is limited to just one organisation. The size of the organisation, however, can range in size from a single private hospital to, as in Kuwait, an entire national healthcare system.

The same is true of insurance billing systems, as these need to be customised to a meet the specific needs of each organisation or country. The different laws and payment systems in each country affect what information needs to be sent where, and who pays what percentage of the bill. “Worldwide, it is proven that you cannot get standardised billing systems. It’s very country-specific, not even regional,” says Amr Mostafa, general manager, Middle East region, Al Babtain Trading, SMS’s regional distributor.

However, the need for a comprehensive national billing system is growing, as the rising cost of healthcare is forcing governments within the region to phase out free or subsidised treatment and turn to private insurance companies. “Insurance is becoming a fundamental part of any healthcare information system, so it also has to be part of the national health information system,” notes Ravikumar.

The Kuwaiti plan reflects this, as a key part of the project is to automate the management of billing insurance companies. Aside from easing administrative headaches, the system will also improve cash flow at the Ministry of Health. “We need an accounting system for the Ministry of Health and it’s relationship with insurance companies. It’s a huge system [overall, but] especially the accounting system, which is very important for getting our accounts right and as fast as we can,” explains Baquer.

Information flow within the organisation will therefore be key to the success of the system, with integrated data a vital prerequisite. This will also enhance patient care, by ensuring that the doctors have access to up to date medical records, no matter where the patient was treated last.

“All the hospitals should have a strong information basis… and the ultimate goal should be to create an electronic patient record, which will speed up looking for patient information and therefore patient care,” says Khoory. “Having that information at the right time in the right spot is very important,” he adds.||**||

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