LOH FOON FONG focuses on the problems encountered at Selangor’s Selayang Hospital which was touted to be the world’s first fully wired-up and paperless hospital when it opened four years ago.
WHEN Selayang Hospital, the first fully integrated computerised hospital system was established in Malaysia, it impressed everybody by being the first hospital in the world to operate without paper or film.
Costing RM530mil, the hospital which covers an area of 15.8ha has 960 beds and is staffed by 2,300 specialists, nurses, paramedics and support personnel. There are cyber links between the clinical services, management, financial and human resource sections of the hospital.
Since there was no single computer software that could connect all the departments, several types of software were combined to create the Total Hospital Information System (THIS). The hospital’s core software that stores medical records of patients is linked to other medical sections of the hospital such as the laboratories and pathology departments.
A patient checks in and gives his particulars to the reception desk and the doctor retrieves the information from the computer before he examines the patient. There is no need for a nurse to take the patient’s medical documents to the doctor. After examining the patient, the doctor makes a prescription online and the patient goes to the pharmacy and collects his medication and makes his payment.
The hospital information system was supposed to speed up processes and shorten patients’ waiting time. However, a recent visit to the hospital showed that the waiting time was just as long as in other public hospitals. Coincidentally, the computer system was down. Patients said it was a quite common occurrence. Said one woman who had taken her mother to the hospital: “It’s a matter of luck. There were times we were in the hospital for four hours when the system was slow or down.”
Another patient said she had waited for almost two hours and was told that the computer system was down. “Now, I have difficulty getting a medical certificate because they could not retrieve my medical records,” said the patient who was suffering from severe rheumatoid arthritis.
“The last time I came here, the system was down too and I had to wait for three hours before I got to see the doctor and another two hours before I got my medicine,” she said.
Currently, nurses still have to write down patients’ temperatures and other particulars and key them into the computer at the counter, which mean additional work.
One doctor, who declined to be named, said that while THIS is good as it stores the data well, the network could not cope when the number of patients increased by leaps and bounds.
“Doctors run into intermittent network problems. It is difficult for doctors to get into the system after 9am each day when most people are using the computers,” he said.
“Patients sometimes shout at us when the system is down or when it hangs. What can I do? Daily, we get stressed over whether the system is going to work and not,” he said.
When the system is down, he would examine the patient and write down the information on a piece of paper and key in the information later in the evening when the system is up .
He said he could not place prescriptions online because he could not read the blood test results or other laboratory results.
There is concern that the inefficient computer system could put patients’ lives at risk when information retrieval is delayed for patients whose conditions need urgent treatment or when information is left to memory.
The THIS at the hospital runs on a single server. It is not broadband connected and computers are run on outdated computers.
A source said the Selayang Hospital could not do anything because the project was given to a company which was the general contractor of the THIS system at the hospital.
He said the company was supposed to handle the turnkey project for five years until early next year but the work was outsourced. He said a lot of experienced staff had left the company.
The Health Ministry had awarded the Selayang Hospital project to the Public Works Department (PWD). The PWD then subcontracted to Radicare (M) Sdn Bhd, a company known for clinical waste management, to handle the IT set up of the hospital. Radicare then set up Team Vantage to implement the project.
When contacted, a spokesperson for Team Vantage said Datuk Azmi Jaafar, chairman of Team Vantage and executive chairman of Radicare, declined comment and told The Star to speak with the PWD.
Datuk Dr Mohd Ismail Merican, deputy director general of health, said the failure of the computerised system at Selayang Hospital “occurs more often than necessary,” and a few frustrated doctors have left the hospital.
“When we mooted this idea of a paperless hospital, it was to provide greater efficiency of services to the public as well as health care providers. It safes time and is user friendly. It is supposed to be based on high-tech and high-touch philosophy,” he said.
“The systems were disturbed (sic) and patients have to wait for long hours, but to be fair to us, it was the first time for us to have THIS in government hospitals and when we say THIS, we are talking about the total system framework in which clinical, imaging and administrative functions are being linked in one function,” he said.
Was there a test run before the computerised system was implemented?
“Well, they tested it. When the Selayang Hospital was opened to the public, we didn’t open 60% but we started with 10% and 20% and it was okay then. But when it got bigger, the problems surfaced,” he said.
“We didn’t realise the amount of time, human resource and money required to sustain the operability and sustainability of the system at Selayang Hospital,” he said.
He said the single server capacity is not the only problem. The current IT contracts are not comprehensive in coverage and quite ambiguous when it comes to the maintenance, upgrading and operation of systems.
“There are certain loopholes that we have overlooked and we are addressing them,” he said.
Declining to elaborate on the details of the weaknesses in the project, Dr Mohd Ismail said the Health Ministry hopes to resolve the problems at the Selayang Hospital by February 2004 once the old contract expires.
He said the Health Ministry plans to inject some capital to upgrade the whole system while reviewing contract agreements.
“We have asked for RM10mil and it’s up to the Government how much they want to give. We know where the problems are but some of the problems are tied to the contract. We don’t want to get embroiled in legal issues. That’s why it’s easier for us to start cracking after the contract expires,” he said.
Dr Mohd Ismail said for future projects, IT contractors with good track records and experience in hospital information systems are required.
Was the IT contractor for the Selayang Hospital not good?
“All I can say is that maybe the modus operandi was slightly different. Maybe there was a lot of subcontracting. Nobody takes responsibility. That may be the issue that we learned.
“We didn’t have an example to follow when we put up Selayang. It was the first of its kind in the world. So when some body said they could do it, we didn’t realise that they subcontracted and subcontracted.
“To them that was the efficient way of doing it but now we realised that it was not so efficient,” he said.
If too much subcontracting is the issue, will it be stated in future contracts that no subcontracting will be allowed?
“No, you cannot say that. It’s how you subcontract it, what kind of responsibility you have on the vendor and if there is a problem that is brought up by a subcontractor, who will address it,” he said.
He also said that upgrading of the system should be in the contract since technology goes obsolete very quickly.
Prof Datuk Dr Hamdan Adnan, president of the Federation of Malaysian Consumers Associations, said a lot of money has been spent on making Selayang Hospital IT based but it is not working out as well as it should be.
“They (the authorities) must sort it out. There should be some kind of audit. The authorities should check so that if there is negligence or misused of funds, they have to be responsible. Someone must be responsible for it,” he said.
He said the authorities should know in the first place what to expect and not give the excuse that they did not know what to expect until later.
Hamdan said the project should be given to a company that has a proven track record in integrated hospital system.
“If they don't have the expertise and they start looking for the expertise when they start on the project, that's like putting the cart before the horse,” he said.
The Government is also wiring up 13 other hospitals throughout the country in stages. Will that be on hold until the problems at the Selayang Hospital are resolved?
“It’s going to go on. We’ve learned from Selayang. We know what the problems and solutions are now,” he said.
Can all of the problems be resolved?
“Yes, but you need IT contractor with good track records,” he said.
The Health Ministry is currently evaluating six proposals from IT companies vying for the 13 projects, he said.
The total or most comprehensive computerised system (THIS) will be set up in five hospitals. The intermediate system will be set up in two hospitals while the basic system will be set up in six hospitals. The THIS system is for hospitals with more than 450 beds, intermediate 200-250 beds, and the basic fewer than 200 beds.
The first of the THIS projects will be set up in Ampang Hospital later this month. The basic hospital information system will be tested at the hospital in Kepala Batas, Penang, while the intermediate in Lahad Datu, Sabah.
Different companies or groups will set up the systems, said Dr Mohd Ismail.
If many parties are involved in the set up, how are hospitals with various systems going to link up with each other in future?
“We raised that question with Selayang and Putrajaya. Our people are working on it to see that they are linked up to one another,” he said.
The Putrajaya Hospital was launched as a wireless hospital just after the Selayang Hospital was launched. It has a bed capacity one-third that of the Selayang Hospital and hence it faces fewer problems with its computerised system compared with the Selayang Hospital.
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