Healthcare, Technology

Accessing Chinese patient records on the move

By Jianggan Li | 12 June 2007

Qiao Kai, Chief Technical Officer of Sir Run Run Shaw Hospital, shares his experience in building and managing workflow using mobile devices.

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• INTERVIEW

Information technology has been playing an important role in the management of Sir Run Run Shaw Hospital (SRRSH) since its opening in 1994. Over thirteen years of improvements, we have established a comprehensive computerised management system which is the finest within Zhejiang Province.

In addition to the fixed-line infrastructure, we also have a mobile information system comprising a wireless LAN and handheld mobile devices. The seamless integration of the two systems ensures the real-time information flow in the hospital.

Impetus to deployment The senior management decided to implement the mobile network in 2005.

More data are now stored in the computer system and less in paper form. Things like laboratory test results and temperature measurements are no longer printed. This is very convenient for doctors to access in offices, but not in the ward. When they make the rounds, the doctors have to keep going back to the office to check records, and sometimes print them if they are complicated.

This is a particular challenge for us as we are having a system where each doctor is responsible for more than 10 patients. Nurses are facing similar challenges when they go the rounds of the wards to carry out doctor’s orders.

In December 2006, we became the first and only public hospital which received Joint Control International (JCI) Accreditation for the quality and safety of healthcare services.

We had done a lot of work over three years to prepare for the JCI examination, including the annual simulated inspection by an expert from Loma Linda University, our partner in the United States. It pointed out in 2004 that the communication between doctors and nurses was not adequate. Since both are walking around in the wards, it is hard for doctors to receive nurses’ evaluations and feedback, vice versa.

The lack of fluent information flow breeds hidden danger to patients’ safety, and this is one of the focus areas of JCI accreditation.

Both factors lead to the determination of the Hospital’s management to construct a wireless network, with both doctors and nurses equipped with PDAs and patients wearing barcode wristbands.

The wireless network was not meant to replace, but to complement the cabled infrastructure we already established. It is an extension of the wires connecting all the offices to the wards.

Challenges during implementation The biggest challenge we faced while rolling out the system was the funding. Majority of the public hospitals in China nowadays are constrained. The State authorities have rigorous rules overseeing fees charged to patients, but on the other hand the investment in public hospitals is far from adequate. This leaves the hospitals in a very embarrassing position.

Fortunately the senior management are very supportive of the project. They reviewed the thorough report we produced and decided to invest on the development and all the subsequent renewals.

The second challenge is training and receptiveness of the doctors and nurses. Fortunately SRRSH is relatively young and this is less a problem to us than to other hospitals in China.

We didn’t have any difficult technologically. On the hardware side, we are using the devices provided by Motorola; the software applications were developed by one of Motorola’s partner companies. SRRSH had a team working together with the application developers to provide the workflow and processes specific to our operations.

Wristbands might be common in the US for identification of patients; but in China most of the hospitals are still using bedside cards which disclose patients’ privacy. SRRSH took a different approach by adopting wristbands at the very beginning and the barcode was added in line with the PDA deployment. Patients are very receptive to the practice as this protects their privacy.

Management of the system We have two groups of people for the maintenance of the system: information technology specialists and medical professionals. Together they form the ‘Medical Information Group’ to make sure the system is available and optimised. The group also provides advices on possible improvements of the mobile working solution.

Only text information and reports are available on the handheld devices. We have tested transmitting medical images to the device and found it was not possible to provide the details necessary for doctors to make a well-informed decision. They need to view X-ray images on their desktop workstations whose display unit is optimised for such pictures.

As I mentioned before, the wireless network is only a complement to the current wired infrastructure, not its substitute.

The wireless network is strictly limited to the premises of SRRHS, and no reception propagates out of our perimeter. We have double authentication before allowing access to the data stored in the network. First is hardware recognition, only certified PDAs and other computers are allowed; this is followed by the user’s personal identification. Patient records’ security is one of the biggest concerns for hospitals, so we take effective authentication seriously.

Revolutionary benefits The improvement of efficiency after the deployment is very obvious. Now they can get all the information in real time. Laboratory test reports are transmitted into the system once it’s available, and doctors can view them immediately. Nurses can obtain doctors’ orders instantly after they are given. The whole clinical process has been significantly streamlined.

This shortens patients’ number of days in hospital. The faster turn-over rate helps the hospital receive more patients and thus boost its revenue.

Another more profound benefit is the safety of patients. For instance, if a patient is allergic to penicillin, the system will prompt doctors not to add it to the prescription.

Personally I believe the convenience the mobile network brings to the doctors is immense, but the benefit for the nurses is revolutionary – they rely on the system more than doctors.

Doctors sometimes can make rounds in the wards without their PDAs, but nurses must bring their handheld devices with them. When they perform infusions for patients, they need to start by scanning the barcode on the patient’s wristband to make sure it is the right patient and it is the right time to perform transfusion. Then they will scan the barcode of the liquid drug bag to see if it belongs to the patient and is supposed to be transfused at this time. An infusion can be carried out only if these two factors match. The nurse will be prompted instantly if the match has failed.

In the past nurses, had to transcribe the doctor’s notes and prescriptions in a notebook, a process where errors and misunderstandings could occur. Now nurses will get an alarm when they are supposed to perform something at a specific time.

As a result, the efficiency and safety of nurses’ operations have been dramatically improved. Meanwhile, SRRSH has revamped the workflow and rules of nursing in line with this mobile implementation.

We are aiming at paperless operations. But it doesn’t mean that all the paper will be eliminated. The target is still smooth information flow. In fact, we still need to print all the documents with doctor and nurse’s signatures to hand over to the patients while they leave the hospital, as electronic records are not yet recognised as legal documents in Chinese legislation.

In fact, the potential of this wireless infrastructure is very extensive. Now, we are employing it only for doctors and nurses, but other applications can be developed and added-in, such as internet surfing for patients and administrative tasks. We are also looking at using RFID to manage and track all the assets of the hospital. In addition, future developments also include the direct link between medical equipments and mobile workstations to further improve the efficiency and information flow.

Mobile working is very prevalent in the healthcare sector in the United States, but it has just started in our country. Although we are running the most advanced hospital wireless information system in China, we still need to continue to discover new applications and deepen the current usage of the established mobile infrastructure.

About Sir Run Run Shaw Hospital Established on the donations by the Hong Kong media mogul and philanthropist Sir Run Run Shaw and complementarily the government of Zhejiang Province, Sir Run Run Shaw Hospital (SRRSH) is a fully public-owned comprehensive hospital. The foundation was laid in 1999 and the hospital became fully function in 1994. The hospital was administered by Loma Linda University in the United States during the first five years of its operations. Since 1999, the University assumed adviser’s role to participate in the hospital’s management and personnel exchange is frequent between the two organisations. Currently the hospital has 1589 employees and 33 clinical departments with 833 beds. In 2005 the hospital received 27623 inpatients and 532549 outpatients. SRRSH also runs Sir Run Run Shaw Clinical Research Institute of Zhejiang University.