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The problem of delivering good healthcare at a reasonable
price is taxing governments around the world. With rising education
and income levels, people everywhere are demanding better health
services; at the same time the healthcare providers, doctors, nurses,
pathologists, and a myriad of other healthcare workers, face a
rising tide of paper-work increasing costs and resulting in less
time to attend to patients.
Computer systems have been used in hospitals and
clinics for many years, in particular for patient billing and accounting.
Larger and more progressive hospitals have also developed systems
to support specialised areas within the hospital such as laboratory
testing or radiology, but hitherto there has been little or no
integration between these different systems; data is often printed
on one system only to be typed into another; mistakes are frequent.
The key to the effective use of information technology in healthcare
is integration whereby the various subsystems are connected and
make use of a common database. The health service then, not only
keeps better records, but medical personnel have more time to devote
to their patients.
Strangely enough the lead in developing comprehensive
integrated hospital information systems has been taken by small
start-up companies; not by the industry giants like IBM and Microsoft.
One of these is novaHEALTH, a Singapore-based subsidiary of the
Malaysian Nova MSC Berhad, which develops software for hospitals
and clinics. novaHEALTH's flagship product VESALIUS is a complete
solution which can be deployed in a single hospital or clinic,
or used by a group of hospitals or clinics.
What are the features which make VESALIUS so powerful?
Firstly, it is a web-based system. It can be accessed
from any PC which has a web browser and an internet connection,
provided
that the user has the correct credentials and the security
settings permit it. This introduces a new level of convenience
and flexibility.
A doctor can review his patient's condition from home, or prescribe
medicine on his ward round using a tablet PC connected to a
wireless network. Because the only software needed on the client
is a
web-browser, all system administration is focused on the server;
consequently
the system can be managed by a much smaller team than would
otherwise be the case.
Secondly, the system is modular. A core module
is built around the patient database. It does what many older hospital
information systems do, registers patients and manages billing
and payment, - the typical administrative side of the hospital
or clinic. Unlike older systems however, other modules can be added
according to the customer's requirements. Additional modules all
require the core module to be present.
The core module itself can be enhanced to support the booking of
appointments, the rostering of staff and the allocation of patients
to doctors. SMS's or e-mails can be sent out automatically to remind
patients of appointments.
Other modules include clinical management, pharmacy (including purchasing
and stock control), laboratory, radiology, and nursing.
The clinical management module allows the doctor to view patient
records and to make new notes directly into the system. During the
change over period from old to new it will often be necessary to
refer to old hand-written records. These records can be scanned and
stored as image files; there is then no longer any need to refer
to paper records. The clinical module comes in different flavours
to support the needs of different specialities. The general practice
module captures the typical data noted by a General Practitioner.
The ophthalmology module has interactive diagrams and forms to support
the recording of eye conditions. There are also other specialist modules
in the planning stage. Other modules are planned
to meet specific requirements.
Providing that the pharmacy module is also present, the doctor can
prescribe drugs from the clinical management module. He can select
drugs from the pharmacy stock and can view the quantity of stock
on hand. He can also see the cost to the patient of the prescription
and offer the patient generic alternatives. He may use his normal
shorthand to specify dosage, frequency and duration.
At the pharmacy the prescription immediately appears in the task
list. When the pharmacist has picked the drugs the system will print
labels for each packet with directions for use. When drugs are dispensed
the stock level is automatically reduced and if this falls below
a pre-set limit, a purchase order will be generated.
The third important feature of the system is that it is process-oriented,
it follows the progress of the patient through the hospital. For
example, if the doctor orders an X-ray, the patient's electronic
file with the doctor's order will be waiting in the radiologist's
task list when the patient arrives. Similarly, when a patient is
allocated to a particular doctor, the patient's details will appear
in the doctor's queue. The doctor knows who is waiting to see him
and can refresh his mind about the case before seeing the patient.
Some workflow systems suffer from being too rigid but VESALIUS has
avoided this problem. Because workflow is not the same in every hospital,
workflow can be customised and changed when processes change. The
exchange of messages between users if supported, and ad-hoc tasks
can be carried out.
VESALIUS can handle a single hospital or clinic, a single organisation
with a number of hospitals at different locations, or a number of
organisations each with its own group of hospitals and clinic. When
an organisation has more than one establishment, this feature brings
a dramatic reduction in the cost of system management. The system
also supports multiple pharmacies and stores at each location. The
system set-up is sufficiently flexible to meet the needs of the vast
majority of hospitals without any customisation of the source code.
Costs are captured at each stage on the patient's journey through
the hospital so that by the time the patient has had his tests and
X-rays and reached the pharmacy, his final bill will be ready for
settlement.
novaHEALTH realises that finance systems are specialised and that
most hospitals already have one. They have therefore preferred to
build interfaces between VESALIUS and the most common finance systems
such as Oracle Financials, SAP and others. Bills and payments, purchase
orders and invoices are generated and managed in VESALIUS and transferred
to the finance system on a regular basis.
VESALIUS is in use in a number of hospitals and clinics in Singapore,
Malaysia, Indonesia and Hong Kong. The National Skin Centre in
Singapore was the first to adopt VESALIUS and
the first "paperless" hospital
in Singapore. When a patient registers, at the counter or a kiosk,
he is given a chit with a queue number. He will not handle another
piece of paper until he gets his bill and receipt at the end of
his visit. The multi-organisational feature is one that is well-received in
Indonesia. Hospitals in Jakarta and Pekanbaru 1,500 km to the north
share the same system on a common server. In Hong Kong 15 clinics
from two organisations use a single system. This system includes
a clinical management module and pharmacy module for traditional
Chinese medicine (TCM). It also highlights another feature of VESALIUS,
its multi-language capability, - the user interface can be switched
between English and traditional Chinese characters.
VESALIUS has proved itself stable in operation and has won compliments
from its users. With a solid base of reference sites in its home
territory, Nova is well placed to take VESALIUS further afield, to
the Middle East, America and Europe.
It is obviously only possible in an article like this to scrape the
surface of the rich functionality of this software. For further information
visit http://www.novamsc.com/pdts_health_main.htm
Contributor of this article, Dr. Stephen Price is one of the founders
of the Nova Group where he served as the Chief Technical Officer
until his retirement in early 2009. He remains a non-executive
director of the company and divides his time between South
Africa and Singapore, indulging in his favourite pastime - writing.
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