A hospital with no need for mounds of hardcopy case notes or files. A hospital where a patient's information can be accessed and documented anytime, anywhere. A hospital where a patient's vital signs are automatically captured via intelligent devices and transmitted directly to central computer systems. That is SingHealth's vision of a hospital of the future.
SingHealth is the largest public healthcare group in Singapore. Under its umbrella are three hospitals -- Singapore General Hospital (SGH), Changi General Hospital (CGH) and KK Women's and Children's Hospital (KKH); five national specialty centers -- National Cancer Centre Singapore, National Dental Centre of Singapore, National Heart Centre Singapore, National Neuroscience Institute and Singapore National Eye Centre; and a network of primary healthcare clinics -- nine polyclinics.
With such a large scale of operation, SingHealth is investing heavily in IT to achieve its goals to build a Digital Hospital by 2010. Digital Ward is one of the three pillars of its Digital Hospital foundation. The other two pillars are Digital Clinic; and TeleCare, TeleMedicine and Homecare.
Transforming the way clinical information is captured and accessed; improving staff productivity and operational efficiency; and improving patient safety are the key drivers behind its journey.
The rationale behind the Digital Ward project is to achieve a ‘wow' factor in a hospital environment, said SingHealth Group CIO Dr Chong Yoke Sin.
"We wanted to help patients feel better by taking away the fear factor. We also wanted to enable clinicians to work more efficiently; make the bedside attention more palatable [for the patients]," said Dr Chong.
When SingHealth observed that its patients were getting more IT savvy, it decided to bet on providing a higher level of automation and improve the bedside experience with technology.
The Digital Ward
In 2005, when SingHealth's IT team did a study with potential users such as clinicians, nurses and operations colleagues of various SingHealth institutions, it found out that some issues impacting productivity included too much time spent on tedious menial tasks; no access to critical information at patients' bedside; and slow retrieval or loss of critical information.
When the Digital Ward is fully deployed across all its member institutions, Dr Chong expects productivity improvement in SingHealth, including the ability to have access to critical information at the patients' bedside; faster retrieval of critical information; and less disruption to patients' rest, resulting in overall improvement for inpatient stay experience.
"Nursing staff time to retrieve and collate clinical information for review by clinicians has been reduced. That time savings allow nurses to focus on better nursing care management."
Since the start of the project, various wireless technologies and devices have been trialed in a SGH ward including Computer on Wheels (COWs), Mobile Electronic X-Ray Computing (MERC), VEGA system and Patient Bedside Terminal (PBT).
"COWs are WiFi-enabled notebooks on ergonomically designed mobile trolleys, which enable clinicians to access patients' medical records and digital radiology images as well as document patients' progress electronically anywhere, any time in the ward," Dr Chong explained.
MERC, on the hand, is a motorized WiFi-enabled system with multiple panel display screens, which enable patients' electronic medical records and digital radiology images to be displayed across different screens. Clinicians can access these records and images wirelessly at the patients' bedside to explain various therapies and clinical options to them. This system enriches the face-to-face communication with patients and their family members, said Dr Chong.
On top of that, the integrated wireless VEGA system enables remote automated monitoring of patients' vital signs, such as blood pressure; pulse rate; electrocardiogram (ECG); pulse oximetry (SPO2); temperature; and respiration rate. The system also provides proximity contact tracing and location tracking.
"The patients' vital signs are captured automatically via customized monitoring devices (using WiFi and Active RFID technologies) and clinicians can view the vital signs charts online."
That reduces potential human errors and increases patient safety, Dr Chong pointed out.
SingHealth has also enabled proximity contact tracing by issuing wearable tags (using both WiFi and Active RFID technologies) to patients and hospital staff in the ward for the purpose of automatically and wirelessly recording and tracking people with whom they have come into contact within the ward.
The contact data captured in the tag is then automatically and periodically uploaded into the server using industry standard WiFi access points. Hospital staff can search, view and print records of the contact tracing details online.
"This system is especially useful in handling infectious disease outbreaks such as SARS and Bird Flu as it helps to ring-fence the spread of contagious diseases," said Dr Chong.
Another innovation is the PBT, which is a touch screen integrated information system that provides both the clinicians and patients an efficient and convenient means to access information within the hospital and globally.
With PBT, clinicians can retrieve and display patients' medical records and digital radiology images, as well as discuss their medical conditions at patients' bedside. Through the terminals, patients can speak to the nurses on duty using a video nurse-call function, while nurses can order meals for patients electronically instead of ordering manually. In addition, patients can also access a wide variety of entertainment and Internet services.
Change of mindset
With these IT initiatives, Dr Chong's hopes patients associate cutting edge service dynamic technology with the SingHealth landscape.
Dynamic IT, to her, is having the appropriate infrastructure in place to support the organization.
"We are still laying the foundation. I don't think we have achieved the ultimate Digital Ward yet. In the next phase, we will be taking Electronic Medical Records (EMR) one step further and deploying Computerized Physician Order Entry (CPOE) system."
Dr Chong explained that in Phase two of EMR, physicians would be able to key in the tests ordered and medicine prescribed.
"This will eliminate written prescriptions and allow nurses to retrieve medication orders for administering to patients accurately. The COWs and other mobile devices will be used extensively in wards to facilitate medical orders and retrieval of information in the wards.
"[As for hospital-wide deployment,] we decided to start with CGH as it was smaller in scale compared to the other hospitals. Project success is also about risk management!"
According to Dr Chong, the go-live date for CGH is end of this year. By April next year, KKH will have Closed Loop Medication Management. And by June next year, the SGH will enjoy the benefits of CPOE as well.
The improved IT system is essential for team-based collaboration and an integrated care environment, she stressed.
"We need electronic medical records at all points of collaboration and are working towards having adequate number of work stations everywhere."
People, processes and technology
Three basic principles of IT management have guided Dr Chong in her 25 years in the business technology industry.
One, intimate knowledge of the work environment must not be underestimated.
"In SingHealth, it is about understanding how clinicians work and their particular needs. It is important to have the appropriate representation of user input so IT can serve them effectively."
Two, streamlining work processes is a part of the wider scheme to success.
"Understand what we are trying to solve. Learn to identify and do away with processes that are not adding value. Having the ability to know and stop something that is not efficient is important."
Three, hunt down the best technology to fulfill the business needs instead of applying the most convenient solution at hand.
Although the Digital Ward started on a small scale in a designated ward, this formed the springboard for a wider implementation across all the hospitals in the cluster.