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Sun 13 Dec 2009 04:00 AM

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Health matters

The healthcare industry has seen dramatic changes over the past year as technology mandates have revolutionised the industry. Imthishan Giado checks into Oasis Hospital, which is midway through the process of renewing its decades-old infrastructure.

Health matters
PERFETTI: Vendors responded with several files full of documentation, from which we extracted the responses.
Health matters
With the new infrastructure, Oasis Hospital doctors will be able to eliminate paper usage from their daily routine.
Health matters
Doctors were part of the evaluation process for the new system, giving their ratings on the vendors vying for the project.

The healthcare industry has seen dramatic changes over the past year as technology mandates have revolutionised the industry. Imthishan Giado checks into Oasis Hospital, which is midway through the process of renewing its decades-old infrastructure.

Over the last year, CIOs have had to swallow one very hard pill. It’s been a lesson washed down with the sour taste of brutal budget cuts and scalpel-precise reductions to staff. It is quite simply; to innovate and never get left behind in the mad race for progress.

While the former titans of banking and real estate are now grappling with vast projects that face innumerable delays, the companies that are climbing out of the recession successfully are the ones that are proceeding down every dark and dangerous path they can find, looking for a technological solution that isn’t simply business as usual.

Healthcare is one vertical that has prospered, particularly in the last 12 months; after all, morbid though it sounds, there will always be a surfeit of ill people and an aging population is equally a guarantee of future business. To that end, hospitals across the region have been shaking off their lethargy and rapidly adopting technology, moving to paperless systems that promote a freer flow of information and, with greater access to medical histories, can potentially cut down on misdiagnosis.

One such organisation is Oasis Hospital based in Al Ain, in the UAE. With a history that stretches back nearly half a century, the privately-funded institution has begun the difficult process of revamping its infrastructure to bring itself to the forefront of the region’s healthcare providers.

Luis Perfetti, director of information systems, explains the firm’s old infrastructure: “Our main application is the hospital information system application. It was built by ourselves in the last six years. We have other applications like Great Plains from Microsoft for finance and HR. Most of our users and our operations go on the hospital information systems (HIS) – I would say 70% of our users work on the system, which has a lot of administrational operations and workflow. Then we have a lot of other minor software for the different areas like service desks, quality and so on which integrate into the main system.”

His team consists of five full-time staff, supplemented by a continuous stream of interns from local higher education outfits such as the Higher Colleges of Technology and the UAE university. A team of consultants is also available for the new project, which is nothing less than a complete replacement of all the hospital IT systems.

This drastic step includes replacing the Great Plains modules with Oracle applications and a brand new hospital information system from French medical specialists MAIDIS. The system also necessitated the requisitioning of 20 physical servers from Dell, which will operate in a virtualised VMware environment.

He explains that planning for the project started back in 2006: “We started deciding that our current system which we had been using needed to be expanded. Vendors were invited in June 2007, we got the responses back by September. We did the demos by December 2007. Final decision was taken somewhere in June 2008 but the contracting part took much longer than what we expected. We ended up signing the contract at the end of December 2008.”

It’s certainly an ambitious plan – but then, as Perfetti puts it, the hospital had no choice if it wanted to continue providing a high standard of care.

Where art thou, Cerner?

As one of the biggest names in healthcare IT. no one was surprised when Cerner submitted a proposal for the infrastructure renewal project. But as Perfetti relates, they priced themselves out of the running.

“They did bid in our project, but their price range was way up from what we needed. They are bringing all their experts from the US and putting them up to live in Dubai, with high expenses. That automatically runs up the price of the product by several millions. Of course, the government can afford to spend in a project millions of dollars but we cannot afford that – we are a not-for-profit organisation so we have to be very careful,” he warns.

‘You go in to see a doctor about a cough. One gives you syrup, the other one gives you five antibiotics. That’s a problem – what is the standard of care? You need to set some guidance and protocols that the organisation agrees that these are best practices so that everybody will follow the same thing. With the hospital information system that we have been using, as you get more into patient care, you really need a lot of development. We realised that we couldn’t keep up with the development that we needed with our current team. So we decided to get a solution that has been proven and really incorporate best practices from different hospitals,” he explains.

“There are hospital information systems that manage the administration of the hospital like billing and in/out patient management, but very few that go into the doctor’s work, that really help the doctor to make decisions that guide the treatment of the patient according to certain protocols. If you ask in the market, there are many that do the administrative part. After one year of research on different products, we analysed 11 offers and proposals, shortlisted four of them, did demos, site visits, reference checks of those four. We came down to two and finally committed to MAIDIS. It took us quite a while; we found a lot of vendors that promised a lot of things but not many could deliver,” he adds.

As mentioned earlier, the old system had been in place for six years, but with the arrival of electronic claims for all hospitals in the UAE, Perfetti knew he had to modernise Oasis’s IT infrastructure. However, the decision was complicated by the fact that the old system actually managed the task of e-claims reasonably well when put to the test.

“We’re a private hospital but of course we are under the regulations of Healthcare Authority Abu Dhabi. We were basically the test case for the system and actually, they told us we wouldn’t have made it. In a way, the whole project of going to electronic claims for the whole of the Emirates may not have succeeded; they were pushing very hard, all the hospitals needed to get systems. We had all those things in place so for us, it was just a matter of building the interface with insurance. We didn’t have to start from scratch, getting a new system or starting to train our doctors,” he says.

“But we want to go bigger. This new system is at a higher level and has a full electronic medical record so that the doctors don’t need to use paper records. They get the full information including images to make a decision for the patient. The main driver was to get a better patient care, if you would, by eliminating paper work, giving the doctors immediate results on the screen, by guiding their decisions, preventing errors and saving costs in different workflows,” continues Perfetti.

Normally, in a situation of this nature the CIO turns to a ready stack of available best practice papers, but Perfetti notes that it is not widely available for the regional healthcare industry. Major providers like Cerner have begun projects of this nature with the UAE government, but systems are not widely in use and he does not believe that any hospital has completed electronic medical records, which can have all information available at the bedside or the operating table.

But his one year of research stood him in good stead, as Perfetti explains: “The request for proposal document had about 500-600 specific questions that the vendors needed to respond with a yes or no and a comment. It took them a couple of months to respond, even for the big companies that have many people. Plus, they needed to provide a full project plan and they needed to provide warranties and details of the SLAs they proposed.

“Most of the vendors responded with two or three files full of documentation. From that we extracted the responses, discerned what we needed and came up with a shortlist of software. We actually had a big range from software built in India, the Middle East, the America and Europe. 11 vendors responded on the first call within two months. Five more came afterward who wanted to participate but were after the cut-off date,” he elaborates.

Among these contenders were names like Cerner, Misys, TrakCare, IVA, and Infinite Dimensions from India. Next, he set up a three-day scripted demo which each vendor had to run through with a number of Oasis departments including administration, doctors and laboratories.

Perfetti explains why demos made more sense than inviting the vendors to pitch their wares: “The scripted demos allowed us to rate them. When you do a scripted demo, you don’t allow them to do their marketing speech that they do normally – they need to do what you request them to do. Two of them couldn’t follow the script; they just didn’t know how to do it. It was something new, so they ended up doing a demo on their own and their marks were bad, so we discarded them.

Doctoring technology

The ultimate endusers for any hospital information system are the doctors themselves, yet they are not always the most receptive to new technology, as Perfetti relates.

“Doctors tend to be resistant. Some are more tech-savvy than others. It depends also on the personality and how young they are. Every time a new doctor comes here, part of their orientation involves learning how to use the system. They don’t get an assistant that types for them. In other places, each doctor has a secretary. We save money by getting our doctors to do it and think getting the information from the doctor itself is much better. They are responsible for the medications they order and the lab tests they request, what diagnosis they think the patient has. They have to enter all these things and the orders get triggered to each department,” he says.

“We had someone from IT and someone from the user side marking them. For the laboratory, we had representatives from the IT team, the lab team and the head present to rate them. We marked them all this way for each module of the demo and then came together for a numerical result and got the ratings for that,” Perfetti adds.

In the end, it came to a head-to- head contest between MAIDIS and Australian vendor TrakCare. While the products were very similar, the differences between the two came down to the number of modules they integrated, with TrakCare requiring Oasis to persist with its earlier Great Plains systems for finance, for example. On the other hand, MAIDIS pushed the hospital to move to a bigger and more advanced ERP from Oracle, and eventually, Perfetti selected the French vendor.

Work has begun on the new system and is projected to take 15 months to complete, with the MAIDIS HIS set to go live on March 1. In addition to servers from Dell and a new storage area network from EMC, Oasis is also replacing much of its imaging equipment with newer models that can connect to the infrastructure being built. The MAIDIS system alone is expected to cost in the region of $7.6 million, which includes implementation, software licences, new hardware and networking systems. The hospital has also signed SLAs with Dell, EMC and MAIDIS to ensure that its systems remain operational.

With such a long implementation period, most would advocate caution, but Perfetti says that because of the way the hospital is structured, it is very difficult to split the system in separate modules. As a result, all the new changes are being done in one fell swoop.

“We’ll do almost a rip and replace, a big bang implementation in March. We are already training for that, sitting with heads of departments, training doctors and analysing changes that will happen. On top of that we will have lots of refinement projects. We will go live probably with not a full implementation. We’ll have at least a minimum to replace our current system. Then we will go on mostly internally with our own team refining the way the processes in each department work,” he explains.

As any glance at the calendar will reveal, March 1 is not that far away, yet Perfetti and his team are confident that they can meet the challenging deadline. That is not to say however, that everything has been completely smooth sailing.

“There are always challenges and problems here and there and delays with the deliveries and so on. Equipment didn’t always reach on time, but nothing that serious, basically. When we went live in July with Oracle, the virtual environment was not ready. We had to go live with alternative servers and then migrate later on,” he says.

He continues that virtualisation has been a particular pain point for the team: “The Oracle system is running in a cluster, but not virtual servers. Oracle told us that they don’t support virtual environments with VMware, which is funny because now Oracle purchased a virtualisation company of their own. They officially said that they won’t support the installation if it is in a virtual environment, so we had to put it on bare metal for that reason. But the rest of the environment is running for testing and training.”

For Oasis Hospital, it’s an exciting time with new systems coming online and a new work paradigm set to come into effect next year. But as Perfetti concludes, there’s still a great deal more changes to come, and a very good reason why his team can’t rest on their laurels.

“The hospital has a new building coming up which we expect to be ready at the end of 2011. We broke ground this summer. When we move there, the operations will certainly change. That will require a lot of information to be in place, and why we needed this project to be finalised before we move, so that when we move to the new place, not everything is new!” he ends.

Status update

As of December, progress continues to tick over smoothly on the implementation. In a follow-up interview, Perfetti describes the current state of the project.

“We finished the hardware setup. That means our full environment with about 40 virtual servers installed and our storage area network is running. We have started our Oracle installation; Great Plains was replaced for all administrative purposes. HR modules, financials, accounts payable and receivable and purchasing inventory – it’s all migrated to Oracle.We have installed our picture and archiving system (PACS ) for all X-rays and ultrasounds. That’s already installed and running,” he explains.

“We’re in the middle of our implementation of our hospital information management system, the MAIDIS software. We are in the training phase and going live on March 1, replacing our current HIS. We have more dates along next year for different modules that will come live. Mainly a big chunk will be done on March 1 which has many modules already there,” confirms Perfetti.

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