Symptoms of change

Healthcare in the Middle East is at the forefront of technology, thanks to forward-thinking by government and private healthcare providers alike. Daniel Stanton takes the temperature in the region.

  • E-Mail
By  Daniel Stanton Published  July 2, 2006

|~|Dr-Mark-Blatt-(1).gif|~|Mark Blatt, director of global healthcare strategies, digital health group, Intel|~|If systems let down a business, it's a disaster, but if systems fail at a hospital, lives are on the line. IT in the healthcare sector has a critical role in ensuring fast, reliable information and as such needs to be highly available and robust, something that new developments in the industry are recognising. After a history of under investment, the healthcare industry in the Middle East is now going straight to top-end technology and getting better, faster.

Selim Edde, public sector vertical manager, Cisco, says: "What has happened in the past is it has always been under-equipped from a technology point of view, especially from an information point of view. It has been understaffed and under equipped. This is a trend that is worldwide." Part of the solution for hospitals that want to compete is to ensure that they have the strongest possible network in place.

"We've developed something for hospitals called a medical grade network," he says. "Basically, if you think of it, a hospital is open for life. It's open for life because it's there to give life, but it's open for life because as soon as it opens its doors it never shuts, ever ever again."

Medical grade networks offer greater resilience, coupled with high bandwidth, to ensure high availability and allow hospitals to have access to vital data from any point on the system.

"They need accurate information rapidly, accurately, with a high level of integrity, interactivity, resilience, and security," says Edde. "Our customers tell us that network reliance is increasing within the healthcare system."

One particularly bandwidth-hungry use of the network is to deliver x-rays via internet, using a Picture Archiving and Communication System (PACS), a quicker and more cost-effective way of communicating the results than using conventional film. A form of PACS was recently implemented by Beirut University Hospital.

"Imagery in the hospital is very important," says Edde. "Cooperating with state of the art partners, we managed to create a filmless hospital, a paperless hospital. They leapfrogged. They forgot about the legacy systems and looked at the state of the art."

Another major regional healthcare implementation was Saudi Aramco's recent pharmacy solution, developed in conjunction with T-Systems. The system correlates patient data with pharmaceutical information to ensure that prescriptions are always delivered at appropriate times, in appropriate doses, to the right patients.

Behrooz Shariat-Torbaghan, area sales and partner manager, sales healthcare, Middle East. T-systems, says: "They showed that through the pharmacy solution waiting time has improved from 15 minutes to six minutes. If a physician wants to prescribe an alternative medication then he can check everything regarding to the age, to the height and weight of the patient, and of course relating to the interaction between the different medications of the patient."

Aroma Software, a UAE-based developer, is currently trying to put together a database of all 6,000 medications licensed in the Emirates. Roman Konovalov, managing director, Aroma software, says: "The drug database for the UAE is one single place where information on all drugs approved by the Ministry of Health will be stored. So we are going to put on their drug formulae indication, contraindication, whether it's recommended to use or not recommended to use, drug-drug interactions because if you take two drugs they might interact with each other and it might affect the patient, and any reaction side effects, everything that pharmaceutical companies would like to inform doctors and patients about. Some doctors are downloading a drug database from the US and it's not what's used here. Some other doctors use books that they bought in the UK in 2003 so they're already three years old."

The software, codenamed Snowhorse, is currently in its beta version and is being tested by medical professionals. Konovalov says that apart from being updated regularly, the application will have other benefits.

"Let's say you select three or five medications for a patient," he says. "You select all five and you can check for interactions between them, so its not like you have to go to a reference book and search for all five."

T-Systems also offers other solutions to manage healthcare processes, such as surgery. "The surgery component covers the whole appointment, and the radiology for these appointments: when the patient has the next appointment for the radiology session or the next follow up for the surgery," says Shariat-Torbaghan.

"It tells you not only the doctor who's going to perform the surgery but the operating theatre. You can schedule these, monitoring the progress of the surgery. It means that you can coordinate your operating theatres. If it is going to be ready earlier than planned then you can prepare the next session. If it is going to take longer then you can monitor it and postpone the following session. "The next point is writing and having the findings and the reports of the surgery and everything is recorded to the patient file. The major focus of the system is the patient."

The Hospital Information System (HIS) is the central repository for all of the data needed for the day-to-day running of a hospital, but many healthcare managers in the region are seeing a need to further integrate it with their other systems to maximise efficiency.

Adil Shah is finance manager for Al Mana hospitals in Saudi Arabia, which uses Sage Accpac products to manage its purchasing and warehousing, as well as its x-ray manufacturing division. Al Mana has around 100 Sage users, spread across four hospitals, four warehouses, and four offices across the Kingdom.

Shah is making efforts to ensure that its systems become better integrated with other departments in the hospitals. "Our HIS is completely integrated and my function is to liaise with them and ensure that at the end of the day the HIS becomes more automated and paperless," he says.

"Information from one end to the other end can be easily accessed," he says. "The core areas are integration and insurance information. There's a trail from one end to the other end: you can go back to the point when the patient walks in, you can call up his contact form and be in contact with the patient, you can trace right up to that point.

"This gets accumulated into a database where we maintain detailed information about different records of the transaction, it gets summarised and then it comes to our financials."

Mark Blatt, director of global healthcare strategies, digital health group, Intel, says that hospitals often have state-of-the-art technology running alongside hardware that might be 20 years old. "Sometimes you walk into hospitals and they look like museums, they have one of everything," he says.

However, Blatt believes hospitals in the Middle East now have the potential to be world-beaters through the use of technology. "The Middle East is to some degree looking at what Western hospitals are doing, but the Middle East has an incredible advantage - they don't have a lot of legacy systems to deal with," he says.

King Fahd and King Faisal hospitals in Saudi Arabia are using Intel systems in their recent redevelopments, which will see them adopt more mobile point-of-care technology, remote monitoring and integrated delivery systems.

In addition, the Kingdom is looking at its healthcare IT infrastructure as a whole. "One of the visions in Saudi was to connect 200 hospitals to allow sharing of information in more rural areas with the specialists in Riyadh to improve care for the primary care hospitals in the outlying settings," says Blatt. "They're talking about how to improve quality of service and how to develop a national infrastructure."

Garbis Bedoian, healthcare industry manager, Intel EMEA, says that Intel has made a particular commitment to using mobile technology to make life easier for doctors and nurses. "The quality of work, the decision-making process has been improved by using mobile technologies because you can have information available on demand wherever you are," he says. "The future for healthcare, at least from a healthcare provider standpoint, will be mobilised.

“You can basically rely on the latest and greatest information at the point of decision."

||**|||~|Ayman-Majzoub-MD-Pointsec-M.gif|~|Ayman-Majzoub, managing director, Pointsec.|~|As well as increased availability of information, mobile access to centralised information also cuts down on the administrative burden. "We're not trying to change the way healthcare will be delivered from a physician, but we want to support him in his daily work to be more efficient," says Bedoian.

"He should not work two or three hours a day only on paperwork and administrative work. We have been working on some projects where we have reduced the amount of administrative work for a nurse by 25% and only because the doctor is using mobile technology."

With the increase in the use of mobile devices and wireless technology, Ayman Majzoub, general manager, Pointsec MEA, believes that hospitals are not doing enough to protect their data. "They are using more and more storage media to store and share info with their colleagues across the organisation, so there has been an explosion of devices," he says.

"Hospitals are becoming more and more mobile. I think it is fair to say that there is nothing more private than your medical information, but almost nothing is being done to secure your medical records and your personal health records by hospitals around the region. Data can live on these mobile devices without any security."

He recommends protecting against physical loss of devices containing healthcare information through measures that can range from encryption to what amounts to a self-destruct option: if a device leaves the hospital network for a specified amount of time, it wipes its hard drive and locks itself.

A particular problem for healthcare is that hospital systems and processes have not been standardised, despite years of trying. The Continua Health Alliance, featuring major IT vendors such as Intel, Cisco Systems, IBM, Philips and Samsung, was established last month and aims to create guidelines to ensure interoperability between home healthcare systems, which use remote devices to manage chronic conditions and personal fitness outside hospital.

"Continua is dedicated to the idea that we will build a common data framework for medical monitoring in the home environment," says Intel's Blatt. He thinks that the project could help spur standardisation in hospital systems. "I think it's going to be harder, but if Continua is successful it can be a model," he says, adding that there is reason to believe that standardisation in hospitals could soon become a reality. "As clinical trials become more and more complex to do you're starting to see a driving force behind standardising research and combining research with point of care technology."

He says: "HL7 v3 RIM is a model that's starting to develop for care, you have C-DISC as a model that's being developed for research, and they don't talk to each other. This is not good. So the very good news here is that in January this year HL7 and C-DISC announced a BRIDG harmonisation language between HL7 and C-DISC so we're actually starting to see some of the major standards organisations saying 'we've got too many standards, let's see if we can harmonise'."

Qaisar Radwan is project manager, healthcare informatics, for ITQAN, a systems integrator that works on hospital databases in the UAE. He says that something also needs to be done to centralise national patient information.

"Countrywide, we don't have something like unique patient ID over all the country," he says. "The information between different hospitals and the medical reports and the patient history needs to move with the patient wherever he goes to, so whatever the hospital is he can get treatment there.

"I believe this is priority number one, to make the linkage between all hospitals in terms of the IT, rather than physical files, between different hospitals and referrals. Each hospital has its own small database with a limited functionality. There is no information shared between hospitals. This is the main problem in the UAE healthcare sector."

Radwan hopes that ITQAN will be able to improve this situation. "In the UAE we have almost all of the government hospitals as our clients right now, so we are talking to them to create this kind of cloud for information sharing and communication between all of them," he says. However, nothing has been approved yet and hospitals currently have access only to their own databases and health card data from the Ministry of Health.

"We are creating an opportunity for the country to move ahead rather than just specific hospitals," says Radwan. He anticipates that a centralised record of patient information will be available in the UAE within three to five years. Saudi Arabia is also planning to share patient information between around 200 of its hospitals.

Technology is also being applied to areas of healthcare that are traditionally low-tech, as part of the process of centralising patient information - for instance, on patient identification wristbands. "Traditionally, they would have been handwritten and there are some major issues with that in terms of legibility, durability and also just misinformation being written onto a wristband," says Aileen McHugh, vertical marketing manager, Zebra EMEA. "Printers can be connected up to the patient administration system and details of the patient demographic and the patient number can be extracted from the system and then printed in durable form on a wristband."

Despite newer developments, McHugh expects that hospitals will continue to use barcodes on wristbands and other records. "I think we'll see barcodes being used for the immediate and long term future in healthcare," she says. "It's a very reliable, simple technology and it's also very cost-effective. RFID will never replace barcodes. There are some processes, for example, labelling of blood samples that are going to the lab for testing, that will never be cost-effective to use an RFID label."

Zebra recently released printers that produce barcoded labels with anti-microbial coating that does not allow bacteria to grow on the surface. It is hoped that this will allow hospitals to eliminate one potential source of infection.

With so much new technology Ade Adeyemi, director of global enterprise product management, Misys Healthcare, believes that escalating costs are becoming a major problem.

"There is a huge emphasis on payment by results in health systems across the globe," he says. "Typically costs are reduced when a patient is properly sequenced through the health care system. Misys has focused its efforts on this issue by building intelligent solutions that continually monitor, report on and improve clinical practices across the healthcare enterprise."

Misys Optimum, its solutions suite, aims to address this by using its architecture together with web technology to allow clinicians to make informed decisions quicker at the point of delivery.

However, it is up to vendors to justify the investment, particularly to hospitals that may have less funds available. Intel is hoping to show exactly what its systems can do in a working Middle East hospital.

"We're working on a feasibility study to establish a 1,000 to 1,200 bed hospital in Dubai," says Intel's Bedoian. "The goal is basically to use this hospital here as a showcase and a blueprint for the Middle East, to demonstrate what it is about when we talk about mobility, what it is about to talk about integrated services, integrated health, connected health, PACS, and wireless. We want to demonstrate that by a real running environment with real doctors and real patients. The goal is to have the groundbreaking ceremony by October this year."||**||

Add a Comment

Your display name This field is mandatory

Your e-mail address This field is mandatory (Your e-mail address won't be published)

Security code