Hospital IT

 
Going digital

Deciding to implement a good Hospital Information System is an expensive outlay, but there are some key reasons why implementing an HIS should be given serious consideration by all medical facilities, big and small. A good HIS will do these things for the facility: it will improve efficiencies; reduce costs; enhance patient administration and billing processes; assist physicians, nurses and administrators with a variety of tools to improve productivity and decision making; improve patient safety and reduce medical error; and collect, archive and analyse data to improve workflows, organisational management and quality of care.

These are all very attractive benefits, but the move from a traditional paper-based hospital to a modern, hi-tech, all digital, shiny new facility can be quite daunting. Beside the expense, it would seemingly involve a fair bit of disruption to the day-to-day running of the facility during the implementation process as well as the more tricky transformation of the organisation, requiring a thorough change in the way things are done, in the culture of the organisation, which will necessitate re-education and training of all staff on how to use the new IT. However, as we progress further into the digital era, it is a change, a transformation, that will continue to beckon and if you choose wisely the company to implement this change for you, they will guide your institution as seamlessly and effortlessly as possible through this transformation.

In the following article Middle East Health speaks to Philips and Siemens to delve into the workings of their new hospital IT products.


IntelliVue Clinical
Information Portfolio

Philips Healthcare has developed a range of IT products for health care, including RIS, PACS, mini PACS, Cardiology informatics, Cardiovascular informatics, Obstetric solutions, and VisiCu for the ICU, among others. The global corporate has a premimium Clinical Information System for Anaesthesia and Critical Care called IntelliVue Clinical Information Portfolio or ICIP. Middle East Health spoke to Philips’ Diederik Zeven to find out more about this product.

Philips’ IntelliVue Clinical Information Portfolio (ICIP) is a software suite designed to centralise patient data so clinicians have access, from virtually anywhere, to the information they need to make clinical decisions. Vital signs, bedside device data, labs, pathology reports, medication orders, planned interventions, and more are included in the chart, helping to eliminate transcription errors, improve patient safety, standardise clinical protocols, increase efficiency and reduce costs.

ICIP was born out of the company’s original CareVue Chart, which has a specific focus on critical care. The company rebranded the IT solution three years ago to reflect a more portfolio-orientated platform which supports the addition of a range of similar clinical applications. Critical care is the first of many applications to be housed within this platform.

“This next addition to this system will happen this year with the integration of a new anaesthesia record developed on the platform which incorporates the well known CompuRecord – the anaesthetic information system,” explained Diederik Zeven, senior director and general manager Middle East, Philips Healthcare.

ICIP is an enterprise-wide clinical information system designed to cover most clinical areas of the hospital, explained Zeven.

The system’s interface has been designed by clinicians to ease the technology adoption process. The system is web-enabled using Internet Explorer and can be accessed from virtually anywhere. ICIP uses Microsoft Windows terminal services technology, as well as Citrix Thin Clients, to enable support of Thin Clients like wireless tablet PCs. This enables easy, direct, and fast access to patient data during rounds or consultations.

“The strength of the product is its ability to be totally integrated. It is also configurable for all processes to suit the clients’ needs.”

ICIP interfaces with all major Hospital Information Systems. It conforms to HL7 data exchange so that it can communicate with other hospital systems, such as Hospital Information Systems, Laboratory Information Systems and Pharmacy Information Systems.

HL7, or Health Level Seven, is a nonprofit organisation that develops international healthcare standards for the exchange, integration, sharing, and retrieval of electronic health information. Hospitals and other healthcare provider organisations typically have many different computer systems used for everything from billing records to patient tracking. All of these systems should communicate, or interface, with each other when they receive new information, but not all do so. HL7 specifies a number of flexible standards, guidelines and methodologies by which various healthcare systems can communicate with each other.

ICIP tools

ICIP has a range of tools including clinical decision support, order management and data analysis.

Clinical decision support tools function by continually checking accumulated data in patient charts for significant confluences of data. For example, if a patient begins to show warning signs of sepsis, ICIP generates a clinical advisory for sepsis and suggests further steps. Clinical advisories can alert physicians and nurses to changing or unstable patient conditions, new information, and documented interventions. The clinical advisories run in the background all the time, although they can be deactivated discretionally.

ICIP systematises clinician orders for medications, infusions, interventions, exams, therapies, and more. Nurses can see updates to a drip concentration or medication frequency on the flowsheet as soon as the order is entered. Reminders and worklists help caregivers administer orders on schedule. The solution works with pharmacy information systems, automating medication orders and reporting back to the clinician when a medication has been given.

Hospital administrators and unit managers can use the application’s complete archive to analyse and report on any charted data.

Data protection


To ensure security of information the system is totally HIPAA compliant (HIPAA is the Health Insurance Portability and Accountability Act – passed in the US in 1996, and which now incorporates regulations for the protection of an individual’s health information. It also incorporates a security rule which specifies a series of administrative, physical, and technical safeguards for entities to use to assure the confidentiality, integrity and availability of electronic protected health information.)

Zeven pointed out that to support medical records legal requirements – ICIP has a full audit trail built into the system. “You cannot delete any information in the system, you can change it, but the change is recorded with your name, date and time. It also supports versioning, which enables you to go back to previous versions of the record,” he explained.

Zeven said that the system’s data storage supports ‘Microsoft clustering’. This service provides automatic failover, reinstating services and resources in cases where a server in one cluster fails or is taken offline. The benefits of clustering include continuous data availability, centralised data management and strong security. “Customers who have built their IT strategy on VMWare (virtualisation software) will appreciate the support ICIP provides for it.”

Installation

Philips has installed ICIP in several hospitals in the Middle East including King Abdul Aziz Cardiac Centre in Riyadh, Saudi Arabia, and Tawam Hospital in Al Ain in the United Arab Emirates. This hospital also serves as a reference site for Philips.

Other facilities in the region with ICIP include:

In Saudi Arabia:

National Guard – Cardiac Center, Riyadh Prince Sultan Cardiac Center, Riyadh Riyadh Military Hospital

In UAE:
Rashid Trauma Center in Dubai Zayed Military Hospital in Abu Dhabi Um Al Quwain Hospital, Um Al Quwain

Zeven added that ICIP as a PDMS has a large installed base world wide.

He explained that before an installation the company will send in a team of experts to do a pre-assessment to figure out exactly what the healthcare facility does, it’s existing workflows, how it operates and what user requirements it has.

“We need to know their KPIs (Key Performance Indicators). We need to understand what types of data they are collecting, how they benchmark themselves (several hospitals in the Middle East use Joint Commission International standards as benchmarks, for example) and, essentially, what is important to them,” said Zeven.

Philips will also take a full inventory of the facility’s equipment and look at their hospital language system. Is it HL7- compliant or do they operate some system that doesn’t conform to a recognised international standard, for example?

“From this data Philips does a technical and clinical evaluation,” Zeven explained.

“With this information a decision can be made about what system is most suited to their needs – as the ICIP system has multiple components within it.”

Training
After the system is installed Philips will provide end-user training.

“It’s important that we change the relationship from vendor-customer to a partnership relationship,” Zeven pointed out.

Philips provides training at three levels.
1. Train clinical super users to train others in the facility – so-called train the trainer
2. Train IT people to run the system
3. Train super users how to make configuration changes

“We teach customers to own the system.
“We offer several support contract models, from simple telephone support by customer care service centres to full support 7 days a week, 24 hours a day by technical or clinical application specialists,” Zeven said.

“When you invest in an information system, as important as the software is, is the professional service that is delivered with the product – the knowledge, education, advice and consultancy that is brought to the customer,” Zeven emphasised.

 

Soarian MedSuite

Siemens Healthcare’s sophisticated Soarian MedSuite is one of the company’s latest offerings in the competitive Hospital Information Systems market. Middle East Health spoke to Robert Cohen, Siemens Healthcare Vice President for Soarian Medsuite, to delve into a bit detail about the product.

Siemens markets the new Soarian MedSuite (it has only been on the market for the past 2 years) as an ‘innovative, integrative and intuitive’ Hospital Information System (HIS), designed specifically to meet the functional and non-functional needs of the global healthcare market . The system covers the entire hospital environment by integrating information from the clinical, financial and administrative spheres of the facility in a single database. In addition, the system has a built-in clinical decision support application, an electronic patient record, an integrated medication management solution, a laboratory information system and numerous other configurable tools to improve efficiency, productivity, patient safety and decision making in the hospital and wider hospital network.

“Soarian is an overarching brand of Siemens Healthcare and the MedSuite solution is the newest member of the Soarian family,” explained Robert Cohen, Siemens Healthcare Vice President for Soarian MedSuite.

“It is a complete Hospital Information System that is focused across the hospital.” Being built on a single integrated database has many advantages, one of the most important of which is the ease of access to information, as all the information is in one place, so to speak. Physicians, nurses, pharmacists, lab staff and administrative personnel have authorised access, with ‘user rights’, to information at any time and from practically anywhere through a single point of entry, be it a workstation, laptop or other web-enabled device.

Providing an overview of how the HIS works, Cohen explained that MedSuite is a role-based solution as opposed to a solution built around modules – separate databases that are ‘glued’ together.

“For example, when we look at pharmacy, we don’t think of it as a department, but rather we look at the roles of the pharmacist, the context of the pharmacy in the healthcare facility, and the doctors and nurses who need pharmacy functionality as part of their work. And this is the same for all the pieces of the system.

The role-based functionality of the system enables information and workflows to be configured specifically for different users based on their roles and responsibilities.

“The emphasis is on the people in healthcare, rather than the places where they work,” he added.

Architecture

The system is designed for the modern dynamic hospital environment with a webnative, Service-Oriented Architecture (SOA), Rich Internet Application (RIA) technology, a Business Process Manager (BPM), and a built-in integration engine.

So what does this all mean?

“The web-native, SOA supports our ability to provide role-based functionality,” explained Cohen. “For example, if you are a doctor you need to write orders for drugs – for many HIS, that means you have to go into the pharmacy system, and then the pharmacist, after the doctor has written a drug order, has to go into the order system to see the order and then go to the pharmacy system to dispense it and then the nurse, working with this workflow, has to go to another system to record the administration of that drug and so on…

“With a service-orientated system, an order is a service. So the same service of an order that a doctor uses is the same service that the pharmacy uses to look at the order and same service that the nurse uses to know that the order is available.”

The user-interface, or as it is now being called, the user experience, is via a webbased application or RIA. The RIA combines the adaptability and multi-functionality of a desktop application with the vast reach of the Internet through a web browser application. The user experience is interactive and intuitive. The RIA enables workspaces to be tailored to suit the various spheres in the medical facility.

“We don’t use a web-based server to create pages, instead we use architecture running in a browser as a real-time machine to build the pages on the fly on your desktop – so it is really fast and has a low bandwidth requirement because it doesn’t have to serve a webpage over the Internet.”

“The user experience is much more flexible and much richer. You can sort columns, you can search for stuff on the fly...

“This is very cutting edge,” he added. “From a technological perspective – you are looking at technology in MedSuite that didn’t exist four years ago.”

Business Process Management

Siemens created Soarian through a collaborative process with our customers to enable healthcare organisations to quickly and cost-effectively respond to the demanding needs of today’s healthcare environment and to adapt quickly to change. It brings the advantages of business process management — used in other industries to continuously improve processes and evolve with change — to the healthcare industry with tools for designing, organising, tracking, and delivering workflow.

The integration engine

One of the main requirements for medical facilities considering installing an HIS is that it will work with other third-party applications and devices already installed at their facility. Siemens engineers have built an ‘Integration Engine’ into MedSuite to do this as seamlessly and efficiently as possible. The Integration Engine is robust and supports multiple standards and protocols, which enables the system to be rapidly integrated and scaled up across business and geographical boundaries.

“We have integrated into Oracle and SAP at the back office. We have integrated into third-party lab systems when necessary,” Cohen remarked.

Healthcare coding

MedSuite supports the major international healthcare coding systems and standards, such as ICD-9 and ICD-10 as well as HL7, among others. ICD is the International Classification of Diseases, a procedural coding system published by the World Health Organisation. ICD-10 is the most current version. HL7 is Health Level 7, a global standard for the interoperability of health information technology.

Cohen pointed out that Siemens is very proactive in this field and sits on several major international standards committees.

Workflows

MedSuite has a highly configurable workflow, enabling the customer to tailor it to their needs. The system provides commonsense, easy-to-learn tools that help physicians and nurses streamline virtually every aspect of clinical care.

Cohen explained: “In the US, hospitals use a Joint Commission accredited workflow. When a doctor signs a drug order it must next go to the pharmacist who is required to validate it. After it is validated, it then goes to the nurse who is authorised to give that drug to the patient. This is a particular workflow, but it is not hardwired/ coded logic into the MedSuite system. In some hospitals in the Gulf States, for example, when a doctor writes a drug order, the patient is required to go and pay for that drug before the pharmacist can see the drug order. This is another workflow, for example, which can be configured in the system. Almost every other system requires core engineering development to change this business logic and workflow.”

Data security

Data security is an important issue with any digital database system and this is particularly true when it comes to protecting a patient’s medical data. There can be no breach of the system by illicit intrusion and there can be no loss of data in case of disaster or other untoward event.

Cohen explained that Siemens has strong authentication, authorization and audit trail-technology to secure patient data. The system is accessed through logon passwords. In some facilities smartcards are used. There are also ‘user rights’ which puts access limits on individuals depending on their status in the institution.

For example, anybody changing the data has his/her name, date and time recorded with the alteration. This also ensures that all previous versions of the data are accessible.

Cohen said: “Full disaster recovery is part of our consultation. “Storing data offsite is up to the client, however, in some countries there are regulations that require this,” he added.

Multilingual

The system was designed from the beginning to be fully multilingual, Cohen explained.

“We have a complete Arabic-enabled user interface including right-to-left switching. It supports various functionalities, such as people with multiple Arabic names and even Arabic-specific workflows, which can include how Arabs view mother-to-child and father-to-child relationships. The system also supports Hijri and Gregorian calendars.”

“We can enable multiple languages onsite, depending on user preference,” he added.

Implementation

Sales and installation of the product in the Middle East is done by approved valueadded resellers and “although they may have their local nuances when it comes to selling the product, Siemens will take a consultative approach when speaking to potential new clients”, said Cohen.

“We will start with a systems study and analysis of the institution and will work with the institution to identify achievable results and efficiencies.

“Typically, we like to look for measureable outcomes as part of implementing the IT solution. So we will look at things such as number of patients seen in the outpatient environment per day; average revenue recognised for patients; how long it takes to get a charge to a patient to recover bills, and so on. On the clinical side, we look at processes such as how many patients with a drug order got that drug that day, for example.

“We work with the customer throughout the implementation process, so they can help direct what the desired result is that they are looking for.

“At the end of the day it is about setting realistic expectations for the customer and then achieving those expectations and ideally exceeding them,” Cohen said. System support

Cohen explained that system support is provided on three levels.

The first level is customer site-specific support, which is typically done by an inhouse IT team. The second level of support is usually regionally based and done by Siemens resellers where there is a high level of sophistication around the network, the configuration, the system deployment, etc. He said Siemens will always provide the third level of support (whether or not they are providing level one and two support) which takes care of system level code repairs and upgrades that happen from time to time. This level of support is provided through a global 24- hour, year-round global support centre and engineering teams.


Methodist Hospital


 

Advanced technology improves health care for patients and hospitals

Technology might be flashy and fun, but every day, new pieces of health care equipment hit the market, and the choices hospitals make can determine their futures.

At The Methodist Hospital in Houston, the purchase of new technology – both medical equipment and the information technology that helps improve hospital processes – is carefully planned and fully vetted by the major stakeholders, always with the institution’s vision as a guide. Technology’s strategic value, financial impact and return on investment are critical – but not always the driving forces.

“We also have mission reasons – the right thing to do for the patients and pushing the envelope,” explains Roberta Schwartz, senior vice president of operations. “Our physicians who constantly push for the next level of innovation, they change the way medicine is practiced.”

Today, the most money is being spent on imaging technology to give physicians clear, real-time pictures inside the human body. Intraoperative MRIs and CT scans pave the way for minimally invasive surgical procedures across medical disciplines.

But, she cautions, budgets are tight and with an estimated $20 million a year for new medical technology, the decision to purchase is made only after exhaustive investigation and consideration.

“It’s almost a daily deal, because technology changes so quickly,” explains Clare Rose, vice president of operations. “We have really seen the evolution of a kind of medical arms race, on this campus for sure.”

Health care administrators have to be smart enough to know their hospital’s limits. They have to invest with an eye toward the future and the next promising technology that might appear. Like medicine, investing in technology is never an exact science.

“It takes years, a lot of money and an ongoing, sustained commitment to medical technology,” Schwartz says.

Flexible platforms for the future


Around the world, there’s a boom in health care construction. New hospitals, renovations and expansions compete for funds as the industry strains to keep pace with patient demand. The time gap between conceptual design and opening day makes it a challenge to match the rapid technology cycle with the much slower building cycle.

“The goal is to be state-of-the-art when you open, not when you finish preliminary design,” explains Sidney Sanders, vice president of facilities and construction for The Methodist Hospital System. Methodist has more than $2 billion in expansion and construction projects under way across the Houston region. To stay ahead in the competitive health care marketplace, it delays big technology equipment decisions until as late in the project as possible.

Building stakeholders – including clinical staff, physicians, information technology specialists and financial planners – work on setting parameters and determining the infrastructure early on. Planners work out the basics: power needs and distribution, floor-to-floor height, loading, column gridding, cooling capacity and, if necessary shielding, which involves lead for stopping particles. Then, as the building gets closer to operation, different stakeholders are brought in to choose the best, most advanced pieces of medical equipment available.

Sanders says the idea is to build platforms that can be easily and economically transformed to accommodate new technology. A well-designed hospital must also be flexible enough to accommodate new technology for its estimated 30- to 40-year lifespan.

“You lead medicine when you build very robust, very flexible platforms that accommodate the latest thinking and don’t get in the way of changes that evolve five or six years from now,” says Sanders.

Methodist’s Research Institute – a 12- floor, $218 million facility soon to open – is modular in design to support a large spectrum of research specialties. Its imaging and communications technology decisions remain in the investigative stages as stakeholders envision the potential of long-distance surgery consults and other remote match-ups.

“If you build a well-designed hospital or research facility, you can add enhancements after the fact without a lot of time and money,” Sanders says. “Some things have to be accounted for early and specifically. And other things can stay open-ended.”

Revolutionising medical information


Health care is an information-intensive industry like no other. It is its own world.

“We have the information and security requirements of a financial institution; the regulatory requirements of a governmental agency; the supply chain requirements of a high-tech industry; the service requirements of a five-star hotel; and the emotional requirements of a faith based institution,” says Dr Tobias Samo, former medical director of Methodist’s Information Technology Division. “It’s extremely complex.”

That complexity is what took information technology (IT) more than three decades to catch up with health care processes. Today, IT is at the forefront of health care advances. “Hospitals are starting to understand that this has to be part of their core competency,” says Samo.

Proof comes in the fairly new role at Methodist of informatics, the process of translating between the clinical world and the IT world. Paula Hansen, a former vice president of operations with 36 years of nursing experience, says informatics has made great progress in patient access, insurance, billing and employee payroll and scheduling. Informatics also has had a huge impact in the storage of medical records and information. And finally it is reaching into areas that touch patients.

“We’ve got to figure out how to help our physicians and nurses work smarter so they can still do patient care and the parts required on a personal note, yet we’re cutting the time elements on the rote stuff,” says Hansen. “Your ROI (return on investment) comes in error reduction, patient satisfaction, staff satisfaction and comfort in a world where everybody is doing everything they possibly can to ensure the correct diagnosis and the correct treatment.”

Oftentimes, it seems the IT world is fraught with boondoggles – incompatible software, impossible interfaces, hardware that doesn’t live up to the hype. In larger institutions especially, there is the problem of overlapping or conflicting information technology. Methodist cut down on these inconsistencies by limiting its vendors to a handful of major players and aiming for integration rather than interfaces.

At one time, Methodist had 78 different IT vendors. “It was a nightmare,” recalls Hansen. One software update under this multi-vendor, “best of breed” strategy took five years and millions of dollars before it was finally rejected as unworkable. The best thing institutions can do when these impasses are reached is cut their losses and move forward, administrators say..

The ultimate goals for every new information product remain the same: improve the quality of patient care, the efficiency and the research capabilities of each of Methodist’s centers of excellence.

Customised technology


Every hospital has them, and they’re usually expensive. The big mistakes. That piece of equipment or software or hardware that carried big promises and an even bigger price tag but never got off the ground. They’re dubbed dust-collectors and are tucked away in the netherworld of health care technology.

The best way to avoid such technology traps is to customize new technology and make it work for the institution. When Methodist purchased a $10 million Document Imaging System, they made sure it was customized to do what Methodist needed it to do. The hospital is now the vendor’s premiere site because it has done more with the system than any other client.

From the latest medical information storage software to the latest ultra-highslice CT scanner, technology drives physicians and administrators to excel and push the envelope, to be trailblazers and pioneers in health care. Today’s “disruptive” technology may become tomorrow’s standard of care.

And so institutions must commit to the future even as they focus on patient care and safety in the here and now.

Methodist has a solid, working template for new technology investigation, consideration and purchases. Over the years, committees have evolved and are in place to continually review, update and replace the technology that improves patient care and outcomes.

A products committee considers new products from Band-Aids and IV tubing to smart pumps that administer and monitor medication. An informatics committee studies new software and its potential with other technologies. An information technology council has established a standardized process for approving every hospital IT purchase. Physicians rank and vote on all new medical equipment purchases. The processes themselves are subject to refinement from time to time, but they are ongoing.

The technology selection process has become a critical part of Methodist’s mission and a best practice. Because all involved recognize that ensuring the best patient outcomes also means providing the best technology to get there. Institutions that recognize the undeniable link between patients and technology have a clearer focus on the future of health care.


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ate of upload: 15th Aug 2010

                                  
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