End of the paper trail

The region’s healthcare sector is in the grip of a digital revolution, but can virtual hospitals really work? Daniel Stanton discovers the perks of paperless care.

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By  Joanne Bladd Published  August 29, 2006

The region’s healthcare sector is in the grip of a digital revolution, but can virtual hospitals really work? Daniel Stanton discovers the perks of paperless care.

“Middle Eastern hospitals have an incredible advantage - they don’t have a lot of legacy systems to deal with.”

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.

This is something that new developments in the industry are recognising. From a slow start, dogged by under investment and reluctant physicians, the healthcare industry in the Middle East is reinventing itself and opting straight for top-end technology.

According to Selim Edde, public sector vertical manager for Cisco, the change can’t come soon enough: “What has happened in the past is the industry has always been
under-equipped from a technology point of view, especially from an information point of view,” he says. “It has been understaffed and under equipped. This is a trend that is worldwide.”

For hospitals that want to upgrade, Edde explains, one of the biggest challenges is finding a network that can comfortably handle the vast volumes of data they generate. “We’ve developed something for hospitals called a medical grade network,” he explains. Coupling a sturdy system with high bandwidth, medical grade networks are designed to maximise access to data from any point on the system, vital when considering the high number of network users a hospital has.

“They need accurate information rapidly and 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 delivering x-rays or scans via internet, using a Picture Archiving and Communication System (PACS). A quicker and cheaper way of communicating results than using conventional film, PACS removes the costs and storage issues associated with hard film. It also helps make the phrase, “I’m sorry, we can’t find your results,” a thing of the past.

Cisco recently partnered with Beirut University Hospital to implement a form of PACS.

“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 state-of-the-art.”

Another major regional healthcare implementation was Saudi Aramco’s recent pharmacy solution, developed in conjunction with T-Systems. The system works to correlate 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 for T-systems, says the solution has already proved to cut waiting times and up staff efficiency.

“They showed that through the pharmacy solution, waiting time has improved from 15 minutes to six minutes,” he explains. “If a physician wants to prescribe an alternative medication then he can check everything with regards to the age, to the height and to the weight of the patient, and of course relating to the interaction between the different medications of the patient.”

A common hurdle for the healthcare industry is the task of combining cutting-edge solutions with technology that may be decades old. Most hospitals already have a Hospital Information System (HIS), the vast central repository for the data needed for the day-to-day running of the hospital, and all new technology has to link with it.

Adil Shah, finance manager for Al Mana hospitals in Saudi Arabia, is a case in point. The Al Mana group uses Sage Accpac products to manage its purchasing and warehousing, as well as its x-ray manufacturing division. It has around 100 Sage users, spread across four hospitals, four warehouses, and four offices.Shah is making efforts to ensure that his 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. 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.”

But not all hospitals are so streamlined. Mark Blatt, director of global healthcare strategies at 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 have the potential to be world-beaters through savvy 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. The Kingdom is considering an overall upgrade of its healthcare IT infrastructure, with plans to promote information sharing between rural clinics and city hospitals. Similar schemes, such as those implemented in Australia or Canada, have vastly improved patient care, by enabling rural GPs to tele-consult with specialists.

IT is designed to support, not replace doctor care|~|“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 at 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. “You can basically rely on the latest and greatest information at the point of decision. The future for healthcare, at least from a healthcare provider standpoint, will be mobilised.”

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,” explains 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.”

But the increase in use of mobile devices and wireless technology has led to a range of concerns, including maintaining patient confidentiality and ensuring adequate data protection. Ayman Majzoub, general manager at Pointsec MEA, firmly believes that hospitals should be doing more to protect their data.
“They (hospitals) 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.

Ironically, despite fears about unprotected patient records, another widespread issue for the healthcare industry is information sharing between hospitals. A lack of standardised hospital systems and processes means one hospital’s IT system may not ‘talk’ to another. As a result, users can find it difficult, or even impossible, to share data across healthcare providers. And if a single hospital is supporting several IT solutions, users within the same facility can find themselves unable to exchange information.

Qaisar Radwan is project manager, healthcare informatics, for ITQAN, a systems integrator that works on hospital databases in the UAE. He says that something 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.

An equally pressing issue, if the US trend is anything to go by, is the trend towards home-based patient care. Because this involves remote monitoring of chronic conditions and programme management, it’s vital that physicians are able to reliably access remote data. Partially as a response to ths problem, the Continua Health Alliance, featuring major IT vendors such as Intel, Cisco Systems, IBM, Philips and Samsung, was established last month. The Alliance 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 hopes that the project will help spur a similar standardisation in hospital systems.

“I think it’s going to be harder, but if Continua is successful it can be a model,” he says. “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.

“(For example) HL7 v3 RIM is a model that’s starting to develop for care. But you have C-DISC as a model that’s being developed for research, and they (the two systems) 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’.”

Technology is also being applied to areas of healthcare that have traditionally been low-tech, as part of the process of centralising patient information - for instance, with 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 at Zebra EMEA.

“Now 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 (a barcode) 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 where, 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 create barcoded labels with an anti-microbial coating that prevents bacteria from growing on its surface. It is hoped that this will help hospitals to eliminate one potential source of infection.

But 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 healthcare 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.”

However, it is up to vendors to justify the investment, particularly to hospitals that may have less funds available. Supporters point to the dramatic changes in working practices within digital hospitals, arguing that the initial investment is recouped through more efficient physicians, better patient care and lower working costs. Take Oklahoma Heart Hospital, one of the world’s first digital facilities. Created at a cost of US $75 million, the hospital boasts a system that automates every aspect of patient care, from scheduling visits, to online prescribing, to the remote transcribing of their notes. As a result, the hospital doesn’t support any full-time administrators, instead directing funding into better nurse: patient ratios.

The aggressive use of technology also has another benefit; lower nosocomial infection rates. Because patients are in and out of the hospital twice as fast, explains Cindy Miller, director of infection control, they are far less likely to contract an infection. And the available technology means any infections that do occur are identified and dealt with more quickly.

“In the old world, I would be at least one month behind in analyzing charts of patients who had acquired an infection in the hospital,” Miller explains. “With our systems, on the same day I can go back to our staff or the physicans and deal with it.

“I can look at 100 records in two hours. In my previous jobs, that would take a week.”

But, for dubious physicians, seeing is believing, so Intel is hoping to show exactly what its systems can do by creating a working Middle East hospital; healthcare providers will be invited to see a truly digital hospital in action.

“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.”

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