Hospital Information Systems
Information Technology is
driving the growth and modernisation
of the Middle East healthcare sector
What do healthcare professionals require
from networking technologies and
from the Information and Communication Technology people who design,
implement and support them? Ali Ahmar, provides an insight.
The GCC healthcare
sector is forecast to
triple in value over the next decade from
$18bn to $55bn by 2020, according to a
recent report by Kuwait Finance House
Research Limited. An estimated $10bn
worth of healthcare projects are planned
or underway in the GCC. More than 200
new hospitals have been announced or are
under construction, with a cumulative
capacity of 27,000 beds, most of which are
due to be delivered in 2015.
Effective hospital information systems
(HIS) are critical
to the successful
patient care. For healthcare workers focused on healthcare
delivery, the availability and integrity
of information can literally be a matter of
life or death.
As HIS evolve many healthcare facilities
are confronted with the challenge of
trying to deploy modern applications and
systems over older networking equipment
and obsolete technologies.
For the ICT (Information and
Communication Technology) teams that
support healthcare workers, the pressure to
provide technologies that help to make
them more mobile, reduce
waiting times, improve
reduce operational costs, is immense.
If healthcare workers are to meet new
targets and identify better ways of
working, with a view to improving the
patient experience, it’s clear that network
upgrades support next-generation wired
and wireless healthcare applications.
However, it’s clear that few healthcare ICT teams are provided the resources to
design an optimal HIS from the ground
up, so the priority for many will be
tactical enhancements, supporting selective
deployments that make a real difference
to healthcare outcomes.
For a start, there’s the widespread migration
from paper- and film-based data to
electronic medical records. It’s no secret
that paper is a major factor in spiralling costs, inefficiencies and
errors in the healthcare sector,
but the transition to electronic
medical records not only places an
additional (and often multimedia)
burden on existing data networks, but
also increases staff reliance on them. For
that reason, healthcare workers need a
network that can guarantee continuous
high performance, unhampered by the
slowdowns in data transmission that result
from lack of bandwidth.
High performance needs to be matched
with powerful security. Confidential patient information is among the most
data that exists, and, in most jurisdictions, is
subject to a host of legislative and regulatory
controls. In 2009, the UK’s
Information Commissioner’s Office (ICO)
issued public warnings to at least 10 NHS
Trusts, after finding them in breach of the
Data Protection Act. According to the
ICO, NHS organisations were responsible
for 30% of the security breaches that were
reported to the body in 2008 and 2009.
While performance and security are
paramount, new trends in medical practice
are fuelling demand for better
networks. Healthcare workers increasingly
need to be able to work seamlessly
across both wired and wireless networks,
equipped with mobile PC carts, tablet
PCs, PDAs and other wireless equipment.
These devices free them from wired
terminals, giving them ready access to
patient information and the ability to
diagnose and treat patients more quickly,
regardless of their physical location in the
hospital complex: wards, clinics, specialcare
units and so on.
At the same time, they’re looking to
newer applications, such as wireless
patient monitoring, to relieve them of the
burden of conducting regular patient
observations and to alert them immediately
if a patient’s condition deteriorates.
By providing an uninterrupted record of
patients’ vital signs, held in a central location,
wireless patient monitoring eliminates
the need for medical staff to disconnect
and reconnect leads to devices as
patients are moved around the hospital.
Increased mobility of both staff and
patients, however, demands better levels of
wireless network coverage and performance
– as do less critical, but still valuable,
services such as medical equipment
tracking using Radio Frequency ID (RFID)
tags and the provision of Internet access to
long-term patients and hospital visitors.
For modern healthcare professionals,
better network-enabled communication
and collaboration is essential. They want
to be able to share expertise and information
more widely and more easily. Web
conferencing and patient video monitoring
are the kinds of unified communications
services that promise great
advances in patient care and cost benefits,
but these applications don’t work where audio and visual quality is compromised
by network problems.
As medical facilities make the move
from physical data, such as film-based Xrays
and scans, to digital alternatives based
on technologies such as PACS and
DICOM, the capacity of these new
hospital networks is coming under
increasing strain. For example, while new,
high-speed, high resolution CT scans
allow doctors to take ever-more accurate,
fine-grained views of a patient’s body,
these medical imaging technologies are
consuming increasingly vast network
It's no wonder then that Information
technology spending in the UAE is
expected to grow from around $3.1 billion
in 2008 to nearly $4.7 billion by 2013,
according to a report in 2009 by Business
Monitor International and this is indicative
of the trend in the Middle East as a
whole. The modernisation of healthcare
systems is seen as a hub for growth and a
condition for the long-term sustainability
of public health systems. IT investments
are a fundamental part of these modernisation
begins using new
Mafraq Hospital in Abu Dhabi has
officially said ‘goodbye’ to paper
records and started its new, completely
electronic, system for keeping
patients’ medical records. The new
system has been introduced as part of
the renovation of the whole
Information System for business and
patient care activities at the hospital.
The Cerner Electronic Medical
Record System (EMR) allows Mafraq
Hospital staff to create a unique record
holding all of a patient’s medical and
critical information, such as medical
history, future appointments, current
medications, allergies, etc. The
records are accessible across all SEHA
facilities. SEHA is the Abu Dhabi
Health Services Company responsible
for all the curative activities of
public hospitals and clinics in the
Emirate of Abu Dhabi.
“The implementation of this new EMR system allows us to become an
even more patient-centric hospital,
and both our patients and staff
benefit,” said John Nickens, CEO of
Some of the benefits of the EMR
include: adverse drug interaction
alerts, generic medication alternatives,
dosage recommendations and
the ability to generate health checkup
The integrated system facilitates
the immediate sharing of information
between doctors from different
departments. It will also enable the
collation of data for epidemiological
and research purposes.
Mafraq Hospital was established in
1983 is one of the largest tertiary
referral treatment hospitals in the
United Arab Emirates, with 451
licensed beds. Mafraq Hospital operates
the largest burn unit in the
country and is a Center of Excellence
for ENT and Thoracic surgery.
How e-prescribing and
clinical decision support
improves patient care
Neill Jones, clinical director at
First DataBank highlights the
major factors for ensuring that
technology for e-prescribing and
clinical decision support (CDS) is
implemented in a way that
supports improvements in the
provision of healthcare, by
streamlining and integrating data
sources, engaging staff in the
change process and providing the
appropriate tools to improve
workflow and patient outcomes.
Experience of electronic prescribing in
hospitals (secondary care) in the UK and
the US is evidence that the appropriate
application of IT (including e-prescribing
and clinical decision support with realtime
alerting) can reduce the risk of
medical error and support the improvement
of patient care.
But e-prescribing and CDS can only be
effective in improving patient care to its
full potential with a multidisciplinary
approach and proactive leadership to drive
positive change. So how can healthcare
leaders ensure that these tools are used to
their full effect? And how can CDS and eprescribing
be made to work effectively?
Technology’s role in assisting decisionmaking
in healthcare is ever evolving.
CDS has repeatedly demonstrated its
worth when evaluated. The claims fall into
three broad categories: improved patient safety; improved quality of care; and
improved efficiencies in healthcare
In order for e-prescribing and CDS
applications to be utilised successfully,
they must be implemented well, with thorough
system integration prioritised.
Equally, staff must be willing and able to
ensure supportive technology can reach its
full potential in streamlining processes and
A successful implementation of eprescribing
and CDS should facilitate
and support change, creating an environment
in which healthcare professionals can transform the benefits provided by
technology into tangible improvements
to patient care and organisational efficiencies.
Healthcare organisations implementing
e-prescribing and CDS technology must
understand what class of decision support
their e-prescribing systems can support,
ensure that the clinical knowledge underlying
the CDS is reasonable and must represent
individual patient data appropriately, to
enhance the CDS. These factors will determine
to what extent an institution will
succeed with its e-prescribing implementation
and achieve its set targets.
Streamlining data sources
The impact of CDS increases as more types
of data and workflow are combined in a
single system or interoperable set of
systems. Increasingly, time and effort is
being expended in secondary care to
ensure that an understanding of patients’
medicine occurs as soon as possible,
following admission to hospital.
This requires an up-to-date record of the
drugs that the patient is taking or should
be taking. This can be a very timeconsuming
process that requires information
from a number of different sources and
systems where a patient record is held
(both electronic and paper-based); from
the GP system, previous hospital records,
emergency department, nursing homes
records and the patient.
Furthermore, an otherwise excellent eprescribing
and CDS system that contains
incorrect, unclear or incomplete patient
information is unlikely to produce good
results. After 'passing' simulation testing,
extensive clinical testing (involving real
patients) should occur in carefully monitored
Information-system users most value
systems that deliver information at the time that it is needed and guide users
offering alternatives, rather than simply
stopping them from doing something. The
use and value of the system should be
monitored to improve the alerts and identify
areas for further training.
The clinical significance of active
alerts, such as drug interactions, drug
duplications or contraindications, at the
point of prescribing, need to be interpreted
for individual patients. By
capturing the reasons for any overrides at
the point of use, further analysis will
reveal if the override was justified on an
individual patient basis or whether
further improvements or customisation of
the CDS are required.
In addition, it will flag up user training
needs. By researching where and when
clinicians accept alerts or where they
need to be customised, more of a balance
between over and under-alerting can be
established. Having the flexibility to
manage the threshold for alerting is critical
to deriving the most benefit from
CDS; too low and the clinician is overwhelmed
with alerts; too high and safety
benefits are reduced. Additional work is
required to explore the optimal alerting
for each different user and care setting
Integration into clinician workflow
The benefits of an IT system may differ
across different human settings of work;
the application of any given computerised
system in the Middle East may be different
from its effectiveness in the US. In order
to derive the most benefit from CDS it
must be provided automatically as part of
the normal clinician workflow and at the
time and place of decision making.
When clinicians have to actively
search for decision-support tools and then
enter (or re-enter) the clinical data
required to generate output, the utility
and efficiency, as well as the use of decision support, decrease. As most
prescribers do not know that they have
made an error, it follows that software
must run constantly in the background to
highlight mistakes or gaps.
The effectiveness of CDS depends not just
on the way it handles patient data, but also
on who uses it and under what conditions[
11]. Users need to understand and
participate in implementation and development.
In addition, clinical leaders need
to engage users in the process, to enthuse
their team and ensure that users across the
board understand and buy into the benefits
of using these technologies.
The amount of training required should
not be underestimated and should go on
well beyond the implementation phase
and become a permanent fixture, given the
turnover and transient nature of staff in
the Middle East coupled with the system
developments that are likely to take place.
Electronic CDS should never be designed to replace human knowledge and judgement but to provide up-to-date information
to support clinicians in their own
Where such systems are already in use,
users are required to have a solid working
knowledge about what is, and is not, available
and receive regular training and
support in order to optimise the benefits
Developing an electronic patient record
as a means of accessing and sharing patient
data across the hospital and clinic network
will be a gradual process. Wholly digital
healthcare may be an aspiration but there
are real patients, with real health problems
who need to be cared for in the meantime.
Electronic CDS is available now and is
already providing invaluable support to
clinicians in the Middle East in delivering
healthcare outcomes. By optimising its use
and increasing its distribution, healthcare
organisations can enhance the quality of
care and improve patient safety even
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First DataBank is a leading provider of
drug databases and clinical decision
support with a reputation that attracts
healthcare organisations worldwide.
First DataBank is a Diamond Sponsor
at this year’s HIMSS Middle East on
29-31 May in Riyadh, Saudi Arabia.
This event will play host to many of
the region’s senior healthcare clinicians
and executives. Product demonstrations
will take place at booth 101
at this event.
Mazen Sobh is First DataBank’s
newly appointed regional sales
manager for Middle East and Africa.
He has extensive IT healthcare experience
gained from working across the
Middle East. As a Registered Nurse
who also holds an MBA, he is able to
communicate with professionals on
- To book an appointment with Mazen please email:
or call Liz Pugh on +44 (0)1392
First DataBank www.firstdatabank.co.uk
of upload: 10th Jul 2011