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Macau's digital hospital

Carol Ko | July 10, 2008
This year, Macau will have one of the first digital hospitals in the region. Carol Ko reports the upgraded facility will use some of the latest technology including enhanced mobility and security, plus real-time access to data applications.

The digital hospital initiative for Kiang Wu, one of only two hospitals in Macau, includes the implementation of a comprehensive set of unified communications solutions across its new Specialist Medical Centre.

Expected to be in service in October 2008, the new Dr. Henry Y. T. Fok Specialist Medical Center aims to set new standards for high quality medical services for Macau, Hong Kong, and the region.

Cardiologist Dr Zhang Xuming, Kiang Wu Hospital's director, says the project will deploy Cisco's IP networking technologies. A wide array of applications will be developed via a unified communications solution and a unified wireless network.

While reluctant to provide a precise budget figure, Dr Zhang says the development will take place in two phases. Phase one lays the foundation, with the construction of an IP network and wireless network infrastructure. As patient intake is expected in phase one, the new centre will house an IP Nurse Call System, Hospital Information System (HIS) and Picture Archive and Communication System (PACS).

The director does not specify the date for phase two, but expects the next time frame to incorporate Barcode Point of Care (BPOC), Patient Panel (a patient entertainment and information panel), and Telemedicine.

Incorporating technology

"Although we don't really face keen competition, as a medical institute, however, we bear the responsibility of providing our patients with high quality, safe medical services," he says.
"With this project, we have an ideal opportunity to incorporate the latest technologies to help elevate our ability to provide patients with the highest quality of services and equip our medical practitioners with the tools they need."

Dr Zhang expects to employ specialists from Hong Kong and mainland China to take charge of medical treatments, and to co-ordinate with existing specialists at Kiang Wu Hospital.

"Several specialist medical centres will be established in the new facility," he says. "These include endoscopic, minimally invasive surgery, medical beauty and plastic surgery, advanced body examination and women's health, an in-vitro fertilisation centre, oncology, vision correction and exciplex laser surgery, urinary and men's health centre." The project will also purchase advanced medical facilities including positron emission tomography/computed tomography (PET/CT). PET is a non-invasive scanning technique used to analyse the brain anatomy and functions.

Manual data

Dr Zhang recognises the potential risks of handling patient data manually. "It is hoped that the implementation of IT can be extended to the bedside, to aid healthcare workers in conducting the final procedures of verification," he says. For instance, clinicians need to observe the Five Rights Upon the Issuance of Medication: the right patient's name, the right name of drug, the right dosage of medication, the right method of medication, and the right time to take medication. "We can achieve this real-time if we adopt the BPOC solution," Dr Zhang says.

"When nurses conduct treatment and operations at bedside, they will input patients' data into their PDAs while verifying and confirming procedures simultaneously. "With increased work efficiency, healthcare workers can allocate more time in patient visits, strengthen mutual communication, and raise patients' satisfaction level.

Entertainment info

"With the bedside Patient Panel, patients can browse various entertainment information and medical education programmes, surf the Internet, or connect to Telemedicine."

According to Dr Zhang, the sharing of patient records not only helps reduce medical resources, but is crucial to patient's safety. At present, the database of pre-natal examination health records is being shared between Macau's two hospitals. The plan is for the Hospital Information System to be extended, to enable shared computerised tomography (CT) scan images of patients.

When the Specialist Medical Center enters service later this year, Kiang Wu Hospital will consider broadening the IP network to other medical premises to cater for the region's increasing demands for quality healthcare.

Data security dominates

Dr York Chow, the secretary for food and health of the HK government, was quick to raise the health records issue in his keynote address, which opened the second Asia-Pacific Healthcare Information and Management Systems Society Conference. Some 1,500 professionals attended the conference in Hong Kong recently from the medical industry, of which 49 per cent came from Hong Kong, 11 per cent from Singapore, 8 per cent from mainland China, and another 8 per cent from Australia.

Dr Chow advocates providing clinicians instant access to medical records, anytime and anywhere within the healthcare system. "An electronic health system encompassing medical records of the whole population will provide a basis for real-time disease surveillance, especially for infectious disease," Dr Chow says. "This would allow governments to take much more timely and targeted measures in response."

Computerised system

In the past 15 years, the Hong Kong Hospital Authority-the public healthcare sector in Hong Kong-has invested about US$256 million in developing a computerised clinical management system (CMS).

"With the exception of in-patient medication ordering," Dr Chow says, "the system effectively covers the full range of clinical services offered in all public hospitals and clinics run by the Hospital Authority, which takes care of more than 90 per cent of inpatients and about 30 per cent of outpatients, in the whole territory.

"The system contains more than eight million patient records and is used daily by more than 30,000 healthcare workers. It is inter-operable in all hospitals, specialist and general out-patient clinics under the Hospital Authority."

Dr NT Cheung, chief medical information officer of the Hong Kong Hospital Authority, shares his views on the CMS.

"It's not that hard just to write a system for a particular doctor," he says. "What is hard is writing a system that can be applied across the board for lots of different settings, without writing lots of different programmes for each need.

"The key thing about a clinical record system, is that you have one electronic record for one patient." According to Dr Cheung, the challenge lies in the integration of the data, "which is captured in a way which we can always bring together in one single patient record".

Developing the CMS

At present, the Hospital Authority has begun phase three of the development of the CMS. "What we are doing now is to redevelop the CMS using a more modern technology platform. We are moving everything into SOA and a web-based front end," says Dr Cheung.

He says the phase three CMS system will comprise "a lot more intelligence" with the implementation of Clinical Decision Support. The system will be able to evaluate information and rules, and to take appropriate actions. In the case of alerting nurses, the system will be able to monitor and evaluate incoming information, and issue messages to pagers.

He named the three clinical needs that require the most IT support. The first need is to reduce medical errors. "The IT system [procedures and workflow] can help reduce errors. You need IT in certain places to check certain things like barcode scanning of patients, making sure people are getting the right medication," says Dr Cheung.

The second need is to ensure doctors take the best care of patients. "There is a whole movement called Evidence-based Medicine, or standardised care. The CMS serves as a reminder to doctors and nurses about "what they should be doing", he says. The third need is to share patient records between public and private hospitals and doctors. "Now, if private hospitals and doctors join our pilot scheme, their private hospitals can actually access the HA record electronically, through the Internet."


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