Tech supplements
By Lai Ee Na, C|Level Asia
Friday, August 6 2004 10:25 AM
By the end of the year, all seven public hospitals, 17 polyclinics and six specialist centers in Singapore will share more than the hospital in-patient discharge summaries, including prescriptions, treatments and allergies.
The Health Ministry intends to have the institutions, grouped under the National Healthcare Group (NHG) and Singapore Health Services (SingHealth), share outpatient records, X-rays and laboratory reports via a centralized platform. The platform in question is the Electronic Medical Records Exchange (EMRX) system, launched in April.
揑t is the crossover point where for example, a patient is discharged from an NHG hospital and follows up at a SingHealth polyclinic, we need to share information. EMRX enables this by allowing SingHealth to draw on information stored in NHG systems, and vice versa,?said NHG chief information officer, Linus Tham.
揟here is no need to create another large database to store all the information to achieve this. That抯 an unnecessary overhead when technology today already allows for information exchange.?
About 240,000 patients are referred between public healthcare institutions each year, with one quarter referred from one cluster to another.
In his report in Singapore Medical Association News, associate professor Goh Lee Gan from the National University of Singapore抯 department of community, occupational & family medicine, listed the additional benefits of the EMRX system:
?Better coordinated care for patients moving across different providers (for example, specialists from different disciplines), and improved levels of healthcare delivery (for instance, from the general practitioner to the hospital to the nursing home);
?Better clinical decisions, with access to complete and legible clinical histories, and updated test results at the providers?fingertips. The risks of transcription errors and missing records are reduced;
?Cost savings through the avoidance of unnecessary repeat tests and investigations;
?Better distribution of care, for example, patients with conditions that can be effectively managed in a community setting can be discharged from the hospital specialist outpatient clinic, and followed up by the general practitioner;
?Facilitation and follow-up of other IT-based applications, such as electronic prescriptions and clinical decision support systems;
?Potential for 24-hour access to realtime data for up-to-date results reporting; and
?Provision for data security and audit features to be built into the system.
Safety precautions
The records in EMRX will not reflect a patient抯 positive HIV status, psychiatric history and previous pregnancy terminations. Checks are in place to ensure that only the right eyes can view the records.
Associate professor Goh highlighted the security measures within the hospitals and across the clusters in his report:
?Computer systems handling medical records will allow access only to staff with the right level of clearance. For example, a nurse will have different access rights from a consultant;
?All staff are informed of legitimate uses of the system, as well as their responsibilities for ensuring the security of the system. All staff are legally bound by the Computer Misuse Act and professional codes of conduct;
?All access histories are tracked in an audit log. Active monitoring systems detect illegitimate access to patient records;
?Electronic medical records are digitally signed to ensure that they are not tampered with during transmission;
?Electronic medical records are transmitted over a secure network and only authorized computers are connected to it; and
?Requests for electronic medical records from legitimate computers only will be processed.
Within the clusters?own Electronic Medical Records (EMR) systems, doctors have been able to access information on patients?medical records since the first quarter of this year.
揙ur systems today automatically verify if a drug order may cause an adverse reaction to the patient and warns the doctor of such a possibility,?Tham said.
He also said the EMR saves time for doctors when they need to retrieve pertinent information about a patient抯 medical history.
Additionally, electronic orders from doctors?PCs to the laboratories or pharmacies mean that preparatory work can start immediately. Laboratory staff and pharmacists need not wait for patients to present the prescription and related forms.
揂lerts are in place to notify doctors of a laboratory result that requires his or her immediate attention in order to treat the patient quickly,?said Tham. 揟hese IT support capabilities serve to enhance the care of our patients.?
For patients, NHG抯 standardized processes, such as patient registration, appointment booking and billing, should also result in quicker service.
揥hen completed end of this year, (the process harmonization and IT consolidation programme) positions us to provide better service to the patients. For example, one registration anywhere in NHG will allow for appointments to be coordinated and arranged between several clinics so the patient can avoid making multiple trips,?Tham said.
Better care
Said Tham: 揥e expect the investments (in IT) to enable us to enhance the quality of care for our patients and also improve the productivity of our staff. Enhancements to patient safety is also a very important area, and one where it is not possible to put a justification using time or cost savings approaches.?
Online records aside, another healthcare institution in Singapore has been using an Intensive Care Unit (ICU) data integration analysis solution since June. The decision for the implementation came after a nine-month trial that ended in May.
Hewlett-Packard Singapore抯 director/general manager (customer solutions group), Leong Say Haur, said the National Neuroscience Institute (NNI) has implemented the solution to reduce medical error, improve workflow and manual workload of ICU staff.
揘NI was looking for a cost-effective, simple and stable solution which enables them to integrate data from a multitude of ICU machines on a single interface,?said Leong. Looking ahead, with the leaps in technology, the patient might well be able to store his own medical record in a credit card-sized device or in a USB memory stick in future, said associate professor Goh in his report.
揥hat is more important is that readers of such devices are now standard hardware, so the infrastructure needed to implement a patient-held portable computer record is eminently possible.
揟he development of the ability to scan documents in readable formats?such as XML (Extensible Markup Language)?means that a truly paperless record is possible. If you want an ECG report to be part of the medical records, just digitalize it in XML and it can go into the medical records. Photographs can be treated the same way. Heart and lung sounds be digitalized too and stored in EMR. It is truly amazing,?he added. |
发表于 2004-8-11 10:52:51
发表于 2004-8-11 15:04:23