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Applying IT skills in the ICU

Tech matters: Dr Sharil Azlan (third from left) explaining the limitations of the current patient information gathering system to (from left) Michael, Tony and Brian.

Tech matters: Dr Sharil Azlan (third from left) explaining the limitations of the current patient information gathering system to (from left) Michael, Tony and Brian.

Technology is at the heart of healthcare and a group of undergraduates were happy to provide input on system improvements.

Bleep ... Bleep ... Bleep, that’s the sound of the monitor as the cardiac specialist examines a patient. He’s surrounded by nurses and a group of IT (information technology) students.

One student is scribbling on his notepad as he monitors the heart patient’s medical statistics on a computer screen.

Another relates the information that’s constantly popping up on the screen to the doctor.

The other two observe how the doctor and his medical team attend to the patient who’s hooked on to a machine that immediately translates information to a computer.

The Monash University Malaysia students were in the intensive care unit (ICU) of the National Heart Institute (IJN) to come up with a sytem that would allow doctors to have vital medical information of their patients at their fingertips, in order to make critical decisions..

Such information is very important, says IJN consultant anaesthesiologist Datuk Dr Sharil Azlan Ariffin.

App-solute task: Brian was asked to come up with an application that consultant doctors could use on their ward rounds.
App-solute task: Brian was asked to come up with an application that consultant doctors could use on their ward rounds.

“It is vital for doctors to ‘see’ all available data before making any medical decision on a patient. This is especially so in the operating theatre or the ICU.

“Technology is at the core of healthcare these days,” adds Datuk Dr Sharil.

Computer science student Brian Cheng Ze Lim, one of the students in the group says he wanted to be in the project to do his bit for society.

For a start, he was involved in “mobilising” the existing programme used in monitoring patients’ statistics. By doing so, doctors can retrieve the information on their mobile devices.

“I had to create a mobile application (app) version of the system,” he says of his project.

“It is basically to transfer data from a complex system into a smaller mobile device like a tablet,” shares Brian.

Viewing data

“The problem with using tablets is that not all data can be viewed with the limited screen space,” he adds.

In any case such data need not be viewed at the same time, he explains.

Brian was tasked with creating an app that allows a consultant doctor to have his patients’ medical information on his mobile device during his ward rounds. This was to make it easier for the doctor to access a patient’s data “quickly, efficiently, intuitively and with ease”, says Brian.

He adds that he also had to take into consideration that doctors have different requirements depending on their areas of expertise.

For the project, the 24-year-old came up with graphs that were scrollable. By just clicking on any point on the graph, he says the relevant information will pop up.

“If this becomes a properly implemented system, this will all be ‘live’ data,” he says, adding that his work currently is still a prototype.

He applied the same methods when he came up with the information tables in the system.

“Pulling up different data one at a time can take about 40 seconds, but with the improvements I’ve made, doctors or nurses can view everything in just 10 seconds,” he says adding that he spent countless hours just observing and collecting notes at the hospital for the project.

Technology helps: Dr Sharil Azlan says doctors must be able to see all available data before making a decision
Technology helps: Dr Sharil Azlan says doctors must be able to see all available data before making a decision.

He believes that having a mobile app will definitely increase efficiency levels for any healthcare system.

Brian says he’s thankful for the exposure at IJN, and adds that while the hospital’s current system was good, it could be more user-friendly.

Bachelor of Information Technology students Tony Moy Seng Leong, 23, and Michael Gunawan, 22, worked on a completely different project.

After following the doctors on their rounds and observing how they used IJN’s computer system, they came up with a proposal to simplify the usage of the software by doing some minor adjustments to the interface.

One modification they suggested was hiding the toolbar.

“If you hide the toolbar, there is a bigger and wider view of the data, and it’s not so cluttered,” Tony explains.

He says they noticed that doctors did not need to access all the options in the toolbar when browsing through the data. So, it made sense to hide some of it.

“This way, they can digest the information better,” Michael adds.

Currently doctors are able to view only one chart at a time.

So, the duo suggested that doctors could view two charts at the same time by using a pop-up window.

“This way, a new window will open with a separate chart so you can place both charts side by side,” adds Tony.

Before the actual development of the prototype, the students had a participatory design session with the doctors where they discussed ways on improving the current system.

Brian says they first allowed the doctors to use their prototypes, then posed questions to the doctors during the exercise.

In other words, even more feedback was gathered before development could actually take place.

“We needed input from the end users themselves,” says Tony.

“Sometimes, the end user, being a non-IT person will not be able to effectively voice their needs or requirements,” Tony says, adding that this is where their IT knowledge becomes crucial.

“It’s a very creative process,” adds Monash University Malaysia School of IT lecturer and industry-based learning coordinator Dr Nik Nailah Abdullah.

She says the methods applied by the students and what she teaches in her classes such as the participatory design session, are widely adopted in the IT industry in the United States (US).

Sharing software

“Thanks to technology, we’ve been able to send our ideas and feedback to each other using a sharing software,” says Dr Sharil.

Tony says that this software has been beneficial as doctors and nurses have very busy schedules. Arranging meetings will take up too much time. By doing so, he adds that end users and students do not have to meet face-to-face every time.

The students had to meet deadlines based on a timeline as well.

“We had to give progress reports just as if we were doing this for real clients,” Michael says.

Timely upgrade: Using the skills he learnt at university, Michael helped automate his family’s business in Indonesia.
Timely upgrade: The programming skills he learnt so far, helped Michael upgrade and automate his family business.

At the end of it, the vendors who created the original software were invited to hear the suggestions from the IT students and the design was handed over to IJN.

Tony says that the three of them took an ethnographic approach to carrying out their projects in IJN.

He explains that this is a systematic study method where people and the way they behave in their environment is observed.

“In this case, we’re observing the doctors and how they work with the computer system,” he adds.

“It really helps the research and analysis portion when we were designing the system.”

“It’s important to know the processes and workflow from start to finish of the users,” adds Tony.

“Ultimately, my time spent in IJN was for me to understand the doctors’ needs.

“In some tech companies, a system is designed and built in the office based on research obtained from someone else.

“I guess ethnography is important for an industry like healthcare where the speed of understanding data and how it affects your decision is critical,” shares Tony .

Dr Nik Nailah says there is a science involved in designing the user interface.

“People assume that creating the layout is easy and the notion of entropies is taken for granted.

In reality, it is not that simple, she says.

“We need to think of the way human minds perceive and process information.” She explains that the placing of certain information or objects on the screen affects how easy it is to process that little bit of data.

In the world of computer science, entropy means the lack of order or predictability.

For good human-interface interaction, the application has to have a certain a degree of predictability so that users know where to find things they want without difficulty.

All three undergraduates agreed that their IJN stint allowed them to see things from the medical practitioner’s’ perspective. They were also the first batch of IT students to be stationed at the institute.

Michael says the communication skills he picked at IJN has helped him connect better with people from different backgrounds and educational levels.

Using his IT skills, Michael helped upgrade and automate his family business, during a recent holiday back home in Indonesia.

“Previously, everything was recorded in books. I designed a system which is a lot more efficient and time-consuming,” he shares.

For Tony who was bent on doing engineering, things changed when he took up a programming course in college. It was “intriguing and interesting,” he says of the course. As for Michael and Tony, they had no choices and were literally “thrown” into the project. But, they have no regrets and are glad for the experience and exposure.

“Interacting with the doctors – people from a completely different field – made things more exciting and challenging.

“They often used medical terms and we had to learn fast so that we could understand what they wanted from us,” says Michael.

The students were unanimous that the growing dependence on technology is inevitable especially in the medical, business and engineering fields.

As Brian summed up, those pursuing a career in IT should look into how they can apply their knowledge and create an impact in people’s lives.

Monash University , IT students