Taking the pulse

20 Feb 2008

Long promising a safer and more efficient healthcare sector, is IT delivering the benefits its supporters claim?

The nation’s health has never been more under the media microscope. You can’t turn a page or tune in without being exposed to the latest health concerns such as obesity, alcohol consumption, depression or cancer. This is coupled with the increasing pressure on our health system and the daily battles the Health Service Executive (HSE) seems to find itself in as it tries to tighten its financial belt and keep the system running. Despite the near €17bn budget the health service receives from the Minister of Finance, an estimated 75pc of this figure goes on staff pay.

In times of financial prudence, the budget for infrastructure such as IT is often cut to the quick in an attempt to rein in costs. Conversely, industry observers say now is the time to spend because IT has been proven to save money and drive efficiencies. Despite past technology projects going very publicly awry, the HSE is proceeding with smaller projects that it hopes will improve patient care and increase efficiencies.

ID technology integrator Zetes is involved in a project for patient wristbands with two-dimensional (data matrix) barcodes. The wristband contains key demographic information that includes the patient’s name, surname, date of birth, sex and hospital number. The information is now electronically transferable for use by a PDA-type device, mobile computer or any electronic interface.

“We did this for a hospital in Roscommon that wanted to improve its phlebotomy practices. It previously had to print labels and it now uses electronic wristbands,” explains Barry Long, sales manager with Zetes. “This has two advantages: electronic transfer of information and the details on the wristband is consistent and the same as on the hospital’s system.” Barcoding is a fundamental building block in the installation of wireless networks in hospitals and many hospitals throughout the country are either putting in or piloting the technology, according to Long.

Like Zetes, VisionID has gained significant exposure to Ireland’s healthcare sector through the supply of track-and-trace barcode solutions as well as providing identification and security applications on an ad-hoc basis. Recent media reports relating to misdiagnosis and loss of files have highlighted the need for a more secure and reliable process that needs to be incorporated into the Irish health system, processes that already exist and are readily available. “We currently supply equipment to the medical devices sector that allows for two-dimensional barcodes to be applied to devices that will ultimately be transplanted into the patient, items such as pacemakers and artificial joints,” says Victor Donnelly, marketing manager of VisionID.

He claims the barcode is proving very effective in tracking individual patients within the hospital walls and VisionID has been working with a major UK software vendor with a view to introducing a cheap, effective and workable solution. “By placing a simple barcode on the patient’s wristband when being admitted to the hospital, it will be possible to track, in real-time, all activities relating to this patient and to store this information for retrieval at any time,” adds Donnelly. “For example, by using a simple handheld device a doctor can scan the patient’s wristband and view his or her complete medical history. Should drugs need to be administered, the doctor can scan the barcode on the side of the drug vial and indicate the quantity being administered. This information is uploaded immediately and a full record of the event is available when the wristband barcode is scanned again. This process also allows for the instantaneous stocktake of the pharmacy, which results in better management of supplies and eliminates human error.”

Donnelly believes the health service still has a long way to go, however. “We can track the medical and motion history of an animal within an Irish slaughterhouse, yet it is almost impossible to do the same within our hospitals. The problem within the health service, as I see it, is the lack of any one person or department to take the decision to commit and invest.”

Helix Healthcare, a merger of two software firms – Systems Solutions and Medicom – that claim to be the largest suppliers of IT to the healthcare and GP sectors respectively, has been working on an electronic prescription transfer (EPT) system. While countries in the EU and elsewhere are further down this IT path in relation to connectivity between different strands of the health service, Crevan O’Malley, EPT sales and marketing manager, says Helix Healthcare is driving the product forward to “get Ireland on the map”.

As one of the largest healthcare technology suppliers in Ireland, Helix brings a lot of patient information from the primary care systems and a huge amount from the pharmacy sector. “If we can get the two systems communicating with each other and have each patient as a unique identifier in the databases, the bones of an electronic patient record are there through what EPT can bring, when the two databases communicate with each other,” says O’Malley.

With EPT, the prescription is printed with a two-dimensional barcode that contains all the patient and drug information and this script is then taken to the pharmacy.

If the patient chooses or happens to go to a pharmacist that employs Helix’s software the whole process is speeded up because the pharmacist or technician doesn’t have to manually enter the data – they just scan it with a barcode reader. The name and details of the patient come up immediately and the medication they require is given without any fear of misinterpretation. O’Malley says the benefits are numerous, including patient safety such as the reduction in risk of dispensing incorrect drugs or dosages.

“I’d say a significant amount of primary care centres rely on computers to manage the whole administration side of their business and that’s ultimately the value we offer all our customers in either pharmacy or primary care – to make their jobs easier and let them deal with patients.”

With so much personal information flying around, data loss and privacy issues are an obvious concern. “We’re registered with the Data Protection Commissioner and there’s an element of encryption in the product,” O’Malley responds. “You can’t just log on and view a person’s details; you need password access, user rights and so on. Even within the applications themselves there are areas whereby staff members may or may not have access to the information depending on where they work. So that’s critical to give the patients and users confidence.”

But can IT projects thrive in the health sector when so much of its budget goes elsewhere? O’Malley doesn’t think a case needs to be made for IT, because it’s known to drive efficiencies. He argues that the benefit from computer applications to reduce time-consuming work meant the health service was no different from any other business. He warns, however, that the handling of these projects was the crux of the matter. “You do need to bring all the stakeholders with you and perhaps that’s what was lacking in the past, coupled with not enough clarity on what the projects could deliver,” he concludes.

Heart of the Mater

The Mater Hospital has developed a new intranet that has led to increased staff efficiency, better patient care and more accurate communications.

While the hospital had previously used an intranet, its needs and expectations had outgrown the former system which couldn’t sustain the amount of content that was requested to be put on the site and its turnaround. The hospital then decided to buy a content management system and set about working with a group of pilot users.

Because of the experience with the previous intranet the hospital’s IT department targeted the key users so it would have the right level and quality of content in place for going live so it targeted HR, finance for salaries info, medical postgraduate diaries, nursing care plans and policies.

Brid Moran, internet services manager at the Mater, says the project took 12 months to complete, covering the look and feel of the site and the content such as latest news, events, forms and so on. “We even went down the route of looking for killer applications,” says Moran. “So we developed the postgrad diary for the doctors, which tells them about the different training sessions going on and various tutorials. Often the doctors might not see the notices, so this online diary keeps them abreast of the training available.” Staff search was a particularly useful application created by the hospital that allows users to find any of the 3,000 employees working there.

The initial pilot has grown from 12 to 93 users and, according to Moran, the level of content has grown by almost 50pc from the launch date. “The key thing that helped was the default homepage with the latest news, lunch menu, links to other initiatives in the hospital and information such as staff changes, union business and so on.”

Moran says one of the key things in the project was the training of the users to write good content for the web. “The IT department doesn’t create the content; we just train the users, though we still do the publishing. Once the content is created and approved it moves into a publishing cycle where it is reviewed, then published either automatically or manually.”

Moran believes that the new intranet has improved the hospital. She points to the online care plans that chart the individual methodology of care for each patient. “The only place these plans are held is in the intranet, so it ensures that each ward is working from the correct plan and it’s not changed.”

Moran says the intranet has been very useful for the dissemination of policies, communications and notices. “Patient care and efficiencies in the hospital have improved and the system takes care of itself – it’s been a wonderful success,” she adds.

By Eamon McGrane