Hospital Information Systems




Information Technology is
critical in 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 delivery of 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 productivity and 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 sensitive 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 resources.

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 strategies.
 

Mafraq Hospital begins using new EMR system

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 Mafraq Hospital.

Some of the benefits of the EMR include: adverse drug interaction alerts, generic medication alternatives, dosage recommendations and the ability to generate health checkup reminders.

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?

Decision-making

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 delivery[1].

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 reducing risk.

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[2].

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[3]. 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 settings[4].

Customisation

Information-system users most value systems that deliver information at the time that it is needed and guide users by 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[5]. 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[6]; too high and safety benefits are reduced[7]. Additional work is required to explore the optimal alerting for each different user and care setting combination.

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[8]. 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[9]. 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[10]. 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.

Engaging staff

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 decision making.

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 for patients.

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 further.

References

1. Sintchenko V, Westbrook J, Tipper S, et al. Electronic Decision Support Activities in Different Healthcare Settings in Australia. Appendix A in: National Electronic Decision Support Taskforce. Electronic Decision Support for Australia's Health Sector. Canberra, Department of Health and Aging, November 2002. www.health.gov.au/internet/hconnect/publishing.nsf/Content/ 7746B10691FA666CCA257128007B7EAF/$File/nedsrept.pdf Accessed 18 August 2009.

2. Kuperman GJ, Bobb A, Payne TH, et al. Medication-related clinical decision support in computerized provider order entry systems: A review. J Am Med Inform Assoc 2007; 14: 29-40.

3. Teich JM, Osheroff JA, Pifer EA, et al. Clinical decision support in electronic prescribing; Recommendations and an action plan. J AM Med Inform Assoc 2005; 12:365-376.

4. Miller RA, Gardner RM, Johnson KB, et al. Clinical decision support and electronic prescribing systems: A time for responsible thought and action. J Am Med Inform Assoc 2005; 12: 403-409.

5. Slee A, Farrar K, Hughes D, et al. Electronic prescribing – implications for hospital pharmacy. Hospital Pharmacist 2007; 14:217–220.

6. Weingart SN, Toth M, Sands DZ, et al. Physicians’ Decision to Override. Computerized Drug Alerts in Primary Care. Arch Intern Med 2003; 163:2625-31.

7. Shah NR, Seger AC, Seger DL, et al. Improving acceptance of computerized alerts in ambulatory care. J Am Med Inform Assoc 2006; 13:5-11.

8. Barber N. Designing information technology to support prescribing decision making. Qual and Safety in Health Care 2004; 13:450-454.

9. Kawamoto K, Houlihan CA, Balas EA, et al. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330:765-768.

10. Handler JA, Feied CF, Coonan K, et al.Computerized physician order entry and online decision support. Acad Emerg Med 2004; 11:1135-1141.

11. Barber N. Designing information technology to support prescribing decision making. Qual and Safety in Health Care 2004; 13:450-454.

12. Barker A, Kay J. Electronic Prescribing Improves Patient Safety — An Audit. Pharm J 2007; 14:225.

 

First DataBank

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 all levels.

- To book an appointment with Mazen please email: liz_pugh@first databank.co.uk or call Liz Pugh on +44 (0)1392 440127.


First DataBank www.firstdatabank.co.uk 
HIMSS 2011 www.himssme.org/11

 Date of upload: 10th Jul 2011

 

                                  
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