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Thu 1 Feb 2007 12:00 AM

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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.

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 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 to 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 been proven 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 modern technology running alongside computer 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.

KSA 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.

“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.

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.“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.

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.”

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.”

However, it is up to suppliers to justify the investment, particularly to hospitals that may have less money available. 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 1000 to 1200 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 healthcare industry in the Middle East is reinventing itself.”

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