Doc: Tech must meet the needs of patients and staff

Like technologies deployed in a corporate environment, those used in healthcare are meant to improve services and productivity. On its new clinical management system (CMS 3), the Hospital Authority aims to create new modules to meet patient needs and reduce risk in patient care.

According to the HA's chief medical informatics officer Dr Cheung NgaiTseung, the organization is set to complete the remaining development work of CMS 3 in 2013, while roll-out of various modules on the system has been underway since a year ago.

Many of the modules were there before CMS 3--a tech-refresh initiative to move from the previous client-server model to an SOA model. The six-year project, budgeted at HK$556 million, will also see a total move to browser-based applications.

Cheung said 40,000 HA staffers will access CMS 3--which includes many applications including some for front-line clinicians and others for functions like reporting and query, dispensary, and medical images--for their daily work.

"There are so many [modules] that I won't be able to explain how each one helps us transform processes and health care," said Cheung. "But there are some--like drug-checking, the Hospital Admission Risk Reduction Program for the Elderly (HARRPE), and In-patient Medication Order Entry (IPMOE)--that helps us reduce risk and improve services in a far-reaching manner.""

Avoiding potential drug problems

According to Cheung, the drug-checking module helps identify potential problems such as those arising from interactions between various types of drugs for each patient.

The module sends alerts to doctors when there are potential problems with their prescriptions, he said.

According to HA figures, the module sent 210,000 alerts while 90,000 changes in prescriptions were made as a result from 2007 to 2010. The other 12,000 alerts weren't followed by doctors, but patients weren't affected as a result, Cheung noted.

"Tech helps, but a doctor's judgment is important when it comes to something as complex as drugs," he said. "So I can't quantify the benefit and say we got rid of 90,000 drug incidents because we have no idea if those patients would be affected if they had the original prescriptions," he said. "It'd be more accurate to say the module helps us avoid potential problems."

Reducing elderly re-admission cases

HA also aims to reduce the risk of an elderly patient being readmitted to a hospital due to an emergency within 90 seconds after he or she's discharged.

The HARRPE helps determine that risk based on a statistical model, Cheung said. Nurses call each of these high-risk patients, making sure they understand how to take the prescribed drugs, according to him. "This module helps us cut the number of readmitted elderlies by 20%," Cheung noted. "Reducing the risk also helps the HA reduce costs."

Delivering the right drugs to in-patients

The HA is also working to extend electronic medication order--already used to manage outpatients' medication--to in-patients.

Instead of relying on manually written prescriptions, doctors and employees in dispensaries will be able to use the In-patient Medication Order Entry module for their work while nurses will scan hospital patients' wristbands with 2D barcodes to make sure each patient gets the right drugs, Cheung said.

The Princess Margaret Hospital in Kwai Chung is intensively testing the system, he said, adding that the HA will finish the test next April. Cheung said the HA chose Princess Margaret Hospital because it has relatively more resources and provides a large number of general and specialty medical services.

"The HA will also test the module in some other hospitals," said Cheung. "But we want to make sure the module works well in a hospital as large as Princess Margaret [before it goes live]."

Other transformations brought by CMS 3

Modules aside, CMS 3 has also brought about the use of other technologies that optimize procedures and reduce medical risks.

For instance, the deployment of 2D barcodes helps reduce errors in phlebotomy procedures and blood transfusion, Cheung said. Previously staff could only rely on paper-based orders for these procedures and manually checked if the right patients were there, he explained.

"That resulted in errors and on average several incidents every month, he said. "Now we [have] sharply cut the number of errors when staffers can scan those 2D barcodes on patients' wristbands to view on computers what needs to be done for them."

With additional storage and higher quality monitors, now HA clinicians can access and view patient records and medical images like X-ray records on computers. "This helps doctors come up with more accurate diagnoses and treatments," said Cheung.

Hospitals' electronic patient records on the CMS help the HA quickly identify affected patients whenever manufacturers report problematic drugs. Doctors can also input prescriptions directly into the CMS without the need for handwritten or repetitive prescriptions for regular patients each time they visit.

In addition, the CMS--together with electronic patient records and a telephony system--enables the HA to take care of outpatients through its community health call center.

Staff needs

"Technologies help us meet many objectives and goals," said Cheung. "But we must also make sure that the technologies deployed aren't a burden to our staff."

"The ward environment is complicated," he explained. "There could be situations where a system can't get the work done. So modules or applications deployed must be flexible enough to allow staffers to work in different ward situations."

Technologies must also be easy to use, so that busy front-line clinicians can easily integrate them into their workflow, he added.

Next step

Besides the plan to add more modules incrementally, the HA is already testing the use of tablets by front-line staffers in wards, according to Cheung.

With use of technologies from Citrix and tablets, nurses can complete patient-assessment forms while doctors can view X-ray films easily in wards, he said, adding that tablets are better devices than notebook PCs as they are much lighter and require fewer battery re-charges.

"But there are patient data security and privacy concerns when it comes to the use of mobile devices, so we must be cautious," Cheung concluded.

This story, "Doc: Tech must meet the needs of patients and staff" was originally published by Computerworld Hong Kong.

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