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Thu 9 Oct 2008 04:00 AM

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Paper cut

KSA's King Fahad Medical City (KFMC) is working on transforming itself into a paperless organisation

KSA's King Fahad Medical City (KFMC) is working on transforming itself into a paperless organisation using the best that technology has to offer. In the process, it is set to revolutionise the way all healthcare providers in the country serve their patients.

It is not often that one comes across an organisation like the King Fahad Medical City (KFMC) in KSA.

One of the biggest medical complexes in the region, the more than 1100-bed institution boasts a world-class record in patient care and health services.

We are constantly trying to utilise technology in serving our patients, and we would like KFMC to be a leading organisation in this regard.

"KFMC is a relatively newly established organisation. It is only around four years old. It provides tertiary services in the country and has four main hospitals along with four competency centres," says Jumah Farhan AlAnazi, associate executive director of patient affairs at KFMC.

From the beginning, according to AlAnazi, senior management at KFMC wanted to use the best that technology could provide to offer improved patient care services.

"We are constantly trying to utilise technology in serving our patients, and we would like KFMC to be a leading organisation in this regard. We are in the digital era, and there is no way but to go for better technology and utilise the same. From day one, our CEO provided us the guidance to adopt technology, establish it properly in the organisation, and use advances for the hospital's good," states AlAnazi.

This is one of the major reasons that the institution decided to have a full-fledged IP network from the start.

"KFMC was built more than 15 years ago, and it was dormant for 12 years without starting operations. The institution only started functioning four years back. This history affected us because when we came to start KFMC, we found it without much of the cabling that was necessary and almost without any networking systems. We started the infrastructure investments from the beginning, so we literally only started working on equipment around three years back. At first we used wireless to provide connectivity, but within one year all the hospitals were completed and the entire system along with the facilities were connected through IP. From that day we have been on an IP network," proudly states AlAnazi.

All of the staff, which is around 5000, have an account on the network. Every employee gets an account, and can use it for viewing the DMS (document management system), for Outlook e-mail, and also use the same account to access other systems of the hospital.

Ambitious and far-reaching as KFMC's technology aspirations are, the management wanted to make the institution a truly paperless organisation. With this in mind, the IP network has been evolved over the years, and is used for various services, including the critical hospital information system (HIS).

"We believe that any hospital will fall behind if it keeps using the paper system, and it was with this thought guiding us that we looked for an efficient, comprehensive HIS. We selected Cortex, after reviewing several others, and we have done our own customisation on top of that. We are in the last phase of the development connected to it," states AlAnazi.

The HIS and the IP network together help deliver many applications, including the HR system, to the institution's staff.

According to AlAnazi, almost everything connected to HR is conducted digitally, with very minimal paper usage. Moreover, the entire clinical information system, along with the administrative system is also run on the network via the HIS.

We do billing, items chasing and several other activities through the network. All the pathology, radiology reports and all the diagnoses are available on the HIS.

Admission requests, pharmacy and out-patient diagnosis, dietician requests and even the dictation system are all automated. We have taken care to ensure that backend systems here are suitably advanced and one of the better things is the integration we have achieved with these systems.

Some of us have worked in different hospitals and almost all of them have separate systems, working as individual small islands and they cannot really talk to each other. This increased the difficulty in dealing with data in an effective manner.

At KFMC, the network actually helps to integrate several of the disparate systems in the institution, and aids them in talking to each other. This is actually a stage towards a completely paperless environment," explains AlAnazi.

The paperless cause has been taken to not just the internal records, but also how the hospital deals with the outside world, be it patients seeking care or other hospitals.

"Our patients come to us from all over the Kingdom actually, and we are using an automated referral system to help them. And this is one of the main systems we use, instead of using the hard copies of medical reports or sending information via other methods such as faxes. This automated referral system is entirely web-enabled. We designed it here actually and we use it with our partner hospitals, as well as the main centre in the Kingdom, from where the patients are referred. Those are the major systems at KFMC," says AlAnazi.KFMC's advanced web service benefits the physicians who work at the institution as well, since they can access the service, update themselves or provide information as is necessary from wherever they are located at the time.

"Physicians can access the service from their homes, and even if they are travelling outside the Kingdom. This is especially useful when we need to consult them or need their advice for certain specialities or specific cases," says AlAnazi.

"They can provide the relevant information through the service. Other healthcare providers, who can also access the system with an account number and password provided by us, can fill out data about the patient, scan and save medical records online and send us information real-time. They can also track the acceptance of the case online," he adds.

As a hospital, we have suffered from having duplicate files and multiple records for patients. But now we are able to capture the right information.

"Inside the institution, we will refer these cases automatically. We have an automatic escalation process. If a doctor does not respond, it will be forwarded automatically to the next level," states AlAnazi.

Driving force

Tying together more efficient patient care, with lesser use of paper, has been the driving force for KFMC.

This is the major reason that the institution continues to take efforts to link its work with the larger citizen-based initiatives of the Saudi Arabian government.

"We have a really good registration system and we are one of the first hospitals here to connect to the Ministry of the Interior, through the Yakeen services. All the citizens and expatriates in Saudi Arabia have a unique number. A patient's unique identifier and minimum demographic data is checked with the information in the national health information centre. This allows us to achieve great accuracy with patient data," says AlAnazi.

"As a hospital, we have suffered from having duplicate files and multiple records for patients. But now we are able to capture the right information. The patient has only one medical file, and this can be constantly verified against the national registry. This verification does cost us something but the accuracy rate jumps to 100%, which is better than any previous situation," says AlAnazi.

Along with this, in order to increase patient interaction, KFMC recently implemented a state-of-the-art call centre, with an advanced IVR system, to make it easier for patients to reach the institution.

"We established an initial call centre to serve our patients better over the phone. Since we are a tertiary hospital, we play host to a lot of visiting doctors. These doctors visit and serve at the insititution at varying periods of time and they might need to make sudden changes or cancellations to their clinic hours. This creates a problem, since our patients had to be reached to inform them about the changes in the doctor's schedule. Around 60% of our patients are from outside Riyadh, so it is not just a case of a local call," explains AlAnazi.

The initial call centre implemented by KFMC enabled agents to call out to patients to inform them of any changes or cancellations, along with helping them with any other requests, including sourcing information from medical records.

Recently, the institution felt the need to provide patients the ability to call them back as well. In order to enable patients to access the information they need with minimal human intervention or possibility of human error, the company has put in place the IVR system.

"The call centre was done with Nortel technology. We visited some of our partners and other hospitals, and found theirs to be superior equipment. Moreover, we found BTC, Nortel's partner in KSA, to be a comfortable partner to work with.

Following this we ran an initial pilot within KFMC and it was an enormous success from the beginning. Any problems that we did have were taken care of by our IT and communications staff, working along with BTC personnel, who we found efficient and knowledgeable to work with. With the success of the pilot, we tested the system, and then went ahead with full implementation. Now, the patients are using the system," states AlAnazi.

The call centre, which was finished in March this year, has around 12 agents covering it 24 hours of the day. KFMC plans on expanding its services and increasing the centre's strength to between 20 to 30 agents by next year.

Infrastructure at KFMCCabling - R&M

Core switches - Cisco

Edge switches - Cisco

Routers - Cisco

Servers- HP

Storage - N/A

Voice systems - Nortel

Security - N/A

WAN optimization - N/A

Remote access - N/A

Network operating systems - N/A

Network management systems - N/A

The paperless route

Taking the idea of becoming completely paperless even further, KFMC is starting work on an electronic medical records (EMR) project. This is where existing medical records of patients will be made completely digital.

"Our vision is to convert all the records we have in the hospitals. This is primarily to serve our patients better, to have information available in a timely manner and to be accurate when interacting with the healthcare provider. By that I am refering to the doctor, the nurse, and all those responsible for taking care of the patient's well-being," explains AlAnazi.

At KFMC, the network works to integrate the disparate systems in the institution, and assists them in talking to each other. This is a step towards a completely paperless environment.

According to him, the institution has well in excess of 200,000 medical records and all of these will be scanned and subsequently made available on the HIS. KFMC aims to complete the project by the end of the next year.

"With the HIS, KFMC is almost 60% of a paperless organisation. In the next 10 to 12 months, we will work to complete our EMR project, which will hopefully take us closer to around 80%," states AlAnazi.

Apart from this trend-setting project, KFMC is trying to use its records to create a unified patient file across the country, and therefore improve the state of healthcare across KSA.

"I am a member of the National Electronic Medical Records Committee. We are trying to establish a connection between KFMC and other major healthcare institutions including King Faisal Specialist Hospital, the Military Hosptial, and King Khalid University hospital. We are working on sharing necessary critical information among us to serve our patients better," says AlAnazi.

"This is part of a huge project, where in the future we will be working with the Ministry of Health and across other members of the healthcare sector to have national electronic health records, using unified identifiers, providers and facility identifiers. Our patients are visiting several hospitals, and we need to capture all their information that is floating across various institutions, and use it to create a unified medical record," he explains.

The future beckons

"We believe that the patient's information is the property of the patient, while the medical record belongs to the hospital. We use this guideline of the joint application commission," says AlAnazi.

In order to facilitate better information flow to patients, one of KFMC's future projects will include providing additional information on the patient's page via a newly formed website.

"It is our plan to have more information accessible. We are trying to have an account for each patient to access our website and then use the webpage. We can upload the majority of the information they need, with the permission of the doctor.

This means that the patient does not need to get in touch or visit the hospital when he needs any information. He can retrieve this from his own page on the web.

For example, if the patient wants to visit another hospital and needs a pathology report, he can download it straight from the site," says AlAnazi.

KFMC is already working on the website and is aiming at the first quarter of 2009 for the launch of the site.

By using technology smartly, the 60-member IT staff at KFMC is enabling not just internal staff, but also the environment it touches, including healthcare personnel, patients and other providers, to shift increasingly to a paperless environment.

Backed by the Ministry of Health in KSA, KFMC has the guiding vision, the girth and the ambition to take the entire healthcare sector by storm not only in its country, but also across the Middle East.

They are set to do just that, focused as they are on patient care and technology, and driven by the senior management.

All about KFMCKing Fahad Medical City (KFMC) is one of the largest medical complexes in the Middle East, built at a cost of SR2.3 billion. KFMC is situated in Riyadh and consists of a main hospital, maternity hospital, paediatric hospital, rehabilitation centre and primary care clinics.

In addition to the hospitals, there are a burns treatment unit, kidney centre, intensive care facilities and spinal cord treatment unit. KFMC's yearly budget is estimated at around SR300 million for medical and non-medical maintenance and catering contracts.

KFMC is a more than 1100-bed multi-hospital healthcare complex, and is one of the Kingdom's largest healthcare providers. It is recognised as a technical innovator in the region for its ability to use information systems to communicate seamlessly, which has been identified as a key priority by the executive management.

It provides a comprehensive range of inpatient and outpatient care, including a specialist Women's Hospital, a Children's Hospital, the 132-bed Prince Sultan Hematology and Oncology Centre, and the 42-bed Prince Salman Heart Center . KFMC now treats more than 50,000 inpatients and more than 600,000 outpatients annually.

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