Taking care of business

27 Nov 2006

A system installed by Ergo is helping Tallaght Hospital keep track of patient and financial records.

Tallaght Hospital, also known as the Adelaide and Meath Hospital Dublin, provides children’s healthcare, adult, psychiatric and age-related healthcare on one site. There are 600 beds in the hospital and almost 3,000 staff.

In 2003, it had 20,000 in-patient discharges, 20,000 day cases and 170,000 out-patient appointments. It completed 624,000 lab tests and 200,000 X-rays. The hospital provides specialised local, regional and national services. It is a national urology centre, a regional dialysis centre and a regional orthopedic trauma centre. It is one of the two main teaching hospitals used by Trinity College Dublin.

Ergo recently completed a project in conjunction with Tallaght Hospital and the Department of Surgery in Trinity College making this a true public/private partnership project.

The hospital turned to Ergo to help with an imminent problem that would have serious implications for the way it operated and the manner in which patients were treated.

Initially the hospital was concerned about impending EU legislation regarding the European work time directive where a person could only work so many hours legally per day, per week and so on. To ensure the directive was adhered to there needed to be an audit trail to say that if “Dr Smith” started at 7am on Tuesday morning that he worked his hours and no more than he should have.

The second objective it was going to handle was an audit system imposed on them by the Department of Health. Essentially, the Department would classify the hospital as, for example, an orthopedic hospital and therefore specify the type of work it should be doing. It would then pay the hospital the percentages of its grant based on its ability to prove that it has been able to hit budgetary targets.

“The hospitals have struggled enormously to be able to prove this with the Department of Health,” says John Purdy, managing director of Ergo. “And there are very substantial amounts of money involved. The system we implemented will allow them to prove far more accurately their case mix and allow them to gain much more allocation of their budget.”

The third objective Ergo’s solution covered was concerning the amount of time wastage caused by shift handovers. “If you could imagine one doctor is going home and another coming on and they’re dealing with 20-30 patients, they’ve got to go through the progress their patients have made and what has been applied to that patient in terms of procedures chart by chart,” explains Purdy.

“So not only are we losing an hour of the doctor’s time that’s going off duty but we’re also losing an hour for the doctor that’s coming on duty in terms of time spent attending to these issues. The technology now gives them accurate up-to-date real time feed of what medications have been administered and what procedures have been applied. So it gives the clinician the ability, at the bedside, to interface with all of the hospital’s systems from pharmacy to bed management to theatre management where they can book procedures on the fly in real time. It’s synchronised (using a ruggedised wireless tablet PC) and it also ensures there’s no handwritten notes.”

The system that Ergo created is a Java-based web application which uses Oracle at the back-end. Once captured on the system, inputted data is then immediately classified into ICD910 code. The solution gives clinicians access to all of the hospitals applications at the patient’s bedside, allowing them to order required services, including labs and x-ray, for patients more quickly and more conveniently than they could otherwise do so.

“We developed a middleware solution; essentially it’s a piece of glue that’s taking the data from the existing hospital systems and presenting in to the clinician at the bedside in a wireless format. From the clinicians’ point of view, and this was one of the requirements, it’s as simple as using an ATM or a mobile phone. So it had to be very user friendly and easy to operate,” said Purdy

Purdy said the benefits to the hospital and patients were numerous. “From the point of view of the clinician and the patient they have more access to information and there’s better decision making going on because the doctor has the information at hand and is not wasting time looking for charts. The hospital itself is getting more efficiency from its medical teams because they’re not tied up in administration work. Additional benefits include the reduction of duty doctor workload, allowing the hospital to move towards compliance with the recently introduced European Working Time directive. And more importantly it is now in a position to be able to prove the work they’ve done and be able to get paid by the Department of Health based on an audit trail that shows this work has been done.”

By Neil Dillon

Pictured — Ergo managing director John Purdy with the Minister for Health Mary Harney TD