Surgical Systems

The Middle East’s healthcare sector has been promising to embrace information technology for some time. However, these promises have only recently started to become a reality.

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By  Patrick Phelvin Published  December 22, 2003

|~|amr-mostafa_200w.jpg|~|Amr Mostafa, general manager, Healthcare Solutions|~|Despite the claims of healthcare information systems (HIS) vendors that their products can accelerate treatment, reduce operational costs and help healthcare providers meet ever more stringent international medical standards, the benefits of IT in Middle East hospitals have failed to materialise as quickly as they have in Europe or the US. Until recently, the majority of healthcare centres in the region relied on a few standalone, non-integrated IT systems at best and reams of paper kept track of patients and controlled supplies and medical stocks. Three main factors contributed to this delay. First, the legislative and legal framework surrounding HIS implementations had to be defined. In the United Arab Emirates (UAE), for example, the government had to decide whether to deploy a HIS from one vendor across all of its hospitals or allow each institute to select its own system. Secondly, vendors had to adapt their operations to fit the region’s specific needs, a process that was often more lengthy than anticipated. “A system that is implemented in Europe or the US does not hold up really well in this environment,” says NV Ravikumar, Medicom’s Middle East director of marketing & business development. “The training requirements are different, the change management is different and unless the end user is able to use a system that meets their day-to-day business processes and the regulations in this part of the world, they will not see any benefit in using a system. [In this region] there is sometimes a lot of gap between what the software vendor provides and what the user really wants,” he explains. In addition, HIS implementations are complicated and take time. As they are typically rolled out over a period of up to five years, healthcare providers are only now starting to realise benefits from systems that were signed for in the late 1990s. Added to this, vendors were approaching a market that was new to such solutions and naturally cautious. Many of these issues now appear to have been overcome, and despite the sector’s relatively slow start in the Middle East, several multi-million-dollar HIS projects are now beginning to yield results as their first and second phases are delivered. Recent months have seen the completion of a number of implementations and several projects reach key stages. For example, a Medicom solution has been successfully implemented across Qatar’s entire healthcare infrastructure, which consists of three hospitals and 23 primary healthcare centres (PHCs), while Jordan’s King Abdullah Hospital is currently undergoing a US$1.5 million HIS project. In Dubai, a project to roll out an HIS across four hospitals and 20 PHCs controlled by Dubai’s Department of Health and Medical Services (DOHMS) has reached phase three, while the UAE’s Ministry of Health (MoH) has implemented a Medicom HIS in 15 hospitals and PHCs under its control at a cost of US$8 million. The first stage of the MoH project saw the solution deployed to handle patient information, such as outpatient encounters, bed management, admissions and transfers between wards. During the second stage, hospitals automated their pharmacy systems, stock control and drug dispensing procedures. This project is being extended with the implementation of the vendor’s laboratory suite of modules in five MoH hospitals, such as the General Hospital at Madinat Zayed in Abu Dhabi. These modules are designed to enable hospitals to automate lab processing, create improved tracking of results, provide quicker response to physicians and support regulatory compliance efforts. The results of implementing an HIS where no integrated system has been before are most tangible in the region’s busiest healthcare centres, such as the Al Jazeira Hospital, which is the primary referral centre in Abu Dhabi. At Al Jazeira, the HIS now deals with information from more than 200,000 registered patient files, with an average of 75 daily new patients, 315 daily appointments, 465 out-patient visits, 350 out-patient prescriptions, 170 in-patients, 20 daily admissions and 55 in-patient prescriptions. The laboratories generate an average of 322 registered specimens from the various departments every day. “Information technology has become an integral part of the hospital’s resources in almost all departments. Our goal is to create an environment that will further improve our patient care through the availability of the right information, at the right time and the right place,” says Mohammed Abdulalla Al-Dhahiri, Al Jazeira’s IT director. “In particular, we wanted clinical information and hospital performance reports to be at the fingertips of our medical staff and management to enable them to maximise their efficiency while making critical decisions,” he adds.||**|||~|amritchopra_200w.jpg|~|Amrit Chopra, CEO, Medicom|~|The MoH says it is has already achieved return on investment (ROI) on its outlay, and is already enjoying the benefit of soft returns such as improved quality of care. “The ROI has already been realised and demonstrated in the cost savings since the pharmacy dispensing and stock control has been done through the system,” says Mustafa Khatib, manager, application section at the MoH. “The soft benefits of the system are the standarisation of operational procedures across the hospitals, the availability of timely and accurate statistics and management data, the streamlining of outpatient appointments and an increased IT awareness among clinicians and administrators,” he adds. Despite its benefits, the implementation was not without its complications, one of which was the building of an interface between the HIS and the ministry’s Oracle Financial patient database. Interfacing between the HIS and external government agencies is an essential part of a local HIS and care must be taken to see it is done properly. “There are a lot of issues involved in HIS interfacing. When you are dealing with things like medical stock you have to make sure the right kind of matching takes place and the right kind of interface takes place. The requirements of the users are fairly involved and complex,” says Amrit Chopra, Medicom’s CEO. “In each place where we do the implementation we realise that the software product is only one side of the coin, the other side of the coin is the implementation aspect, key to that is willingness to listen to the customer, and trying to understand what the end user really wants,” he adds. An ability to adapt to changing market conditions during an implementation is also essential as fast-paced technology trends can overtake long-term HIS projects as they are rolled out. A key example of this is wireless infrastructure, which was a dot on the horizon when DOHMS signed for its Siemens core healthcare solution and Misys integrated lab solution nearly five years ago. As such, phase three of the project, which involves the implementation of patient support systems and is due to start now, has been altered as the application is put onto wireless notepads, something that will allow physicians and nurses to amend medical records at the bedside, thus improving efficiency, data accuracy and patient care. “Doctors are the most difficult part of an HIS implementation because it’s difficult to get them to sit at a keyboard and enter information. They consider time spent at a keyboard a waste of time, it is better for them to sit at a bedside,” says Amr Mostafa, general manager of Healthcare Solutions, which is adapting and implementing the HIS for DOHMS. “Now the doctor has to write notes and go back to his desk to input the information into the patient’s file, if he wants to check patient information [at the bedside] he has to take a print out with him or he has to go back and check on the system. With wireless communication and the notepads he will be able to connect to the system wherever he is in the hospital,” he explains. Wireless and other technological developments mean IT in the healthcare sector is destined to grow rapidly in the Middle East over the next few years. Another factor pushing the market forward is that governments in the region have realised the importance of such systems, not only in terms of cost savings and efficiency but also in terms of demographics and emergency planning. The recent SARS virus in South Asia brought home the importance of having up-to-the-minute healthcare information on hand 24-hours a day. Mostafa argues that the virus compelled a change in the mindset of those in power, who went from viewing HIS as an expensive luxury to an absolute necessity. “There are few HIS systems in place in the region that can help the hospitals and the decision makers make informed decisions. Let’s say SARS came here, governments need the right statistics to be available. They would need to know how many people have it to develop a contingency plan and what resources are available. You cannot take informed decisions without an HIS,” he says. Coupled with the need for accurate data, a number of other developments in the region’s healthcare systems are likely to develop the market. Insurance-driven billing systems, which are well established in the US, have just started to make their mark here. “We expect to see a lot of changes happening in insurance-related areas as the market matures,” says Ravikumar. “The growth in the Middle East market will be in an increasing amount of clinical usage as systems grow and evolve from satisfying the basic administration needs into getting the clinicians to use the system. [There also will be] a move towards integration of systems within a province so that benefits like reduced drug procurement costs can be realised,” he adds. However, while HIS technology seems to provide huge opportunities in terms of cost savings, added efficiency and improved healthcare, there is also scope for these complicated and lengthy projects to go wrong. A recent study by Gartner on the global HIS market showed that while spending is going up generally, few implementations are resulting in cost savings for healthcare providers, indicating that the Middle East market’s initial caution may have been prudent. The analyst house reports that the investments being made today are often too reactive and narrowly defined. Moving forward, analysts advise healthcare providers to ensure investments are fully aligned with a comprehensive IT and business strategy, and that they focus on measurement and value. “A healthcare organisation’s differentiation and market survival will require IT’s measurable contribution to the business,” says Dave Garets, Gartner’s group vice president. “Organisations that succeed will take a more businesslike approach to all IT investments, including projects with risk outside of their historical comfort zones.” ||**||

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