Going digital in the era of constant change

Quick access to reliable and accurate information, Dr Han Boon Oh observes, is key to more efficient care and fewer medication errors.

What we know ten years ago is obsolete knowledge. Change is inevitable, and thus, uncomfortable. But the healthcare industry need not flinch, especially at a time when patients have increasingly complex medical needs.

Dr Han Boon Oh, Deputy Chief Medical Informatics Officer and Associate Consultant of General Surgery (Breast and Endocrine Surgery) at Ng Teng Fong General Hospital, National University Health System in Singapore, navigates through these complexities with fast access to medical information. In an interview with Hospital Insights Asia, he shares how updated information is critical in providing care and preventing medication errors.

Better care and higher physician confidence

“Information is crucial in providing care,” Dr Oh emphasises, “since I was a student, I have been enjoying the convenience of UpToDate® and now I am using the app on my smartphone to have quick access to medical information I need.”

For doctors to come up with the best clinical decisions at the point of care, the information they must have at their fingertips have to be accurate and credible. Links to referenced publications, peer-reviewed journals, and recently published discoveries help care providers evaluate the available information, thereby allowing them to make quick but precise decisions for patients.

Relying on evidence-based medicine practices

Medical breakthroughs, new drugs, new clinical trials, and newly debunked healthcare myths are important information that has to be readily available. A doctor cannot rely on “what he knows” just because “it has worked before and for other patients” because, like drugs, information changes over time, too. Otherwise, patients are at risk of serious harm, additional cost, and longer treatment. In the long run, hospitals and physicians carry the burden of an inefficient and inferior quality of care.

But with easy access to up-to-date information, physicians at Ng Teng Fong General Hospital, Dr Oh believes, will be more confident about their clinical practice knowing they are able to give the best treatment for patients.

Dr Oh, for instance, gets to know what’s new in surgery as well as the latest recommendations for surgical topics like groin hernia repairs. UpToDate®, he shares, provides the most recent landmark publications divided into various subspecialties, The “Practice Changing Updates” section in UpToDate highlights selected specific new recommendations that may have a significant and broad impact on practice,  and “this is one of the main things [he] like[s] about using this resource.”

Likewise, in the time of COVID-19, doctors know what to do because they have the updated research and guidelines for appropriate care.

Reducing medication errors

Errors are not an option in healthcare. Hospitals cannot afford to lose patients because these mistakes are generally preventable. Hospitals likewise do not want to lose revenue; these errors already cost the industry more than $42 billion.

There is an overwhelming number of available medications, and this is both good and bad news for physicians, especially when treating an ageing population. This group of patients has increasingly complex medical needs, therefore, multiple medications that need to work concomitantly and safely are prescribed.

Again, solutions proven to have worked several years ago may no longer work today. Physicians, therefore, benefit from having accurate drug information at their fingertips to prevent medication errors and help patients avoid long hospital stays, serious harm, and unnecessary cost.

This is where Ng Teng Fong Hospital sees the advantage of using Lexicomp®, which provides evidence-based referential drug information. With a few quick taps, pharmacists, nurses, and physicians can search for drug information for common medications. The tool also proves useful in making the best and safest drug decisions for each patient.

While there are other factors associated with medication errors, it cannot be taken for granted how quick access to credible and evidence-based information can elevate the standards of care expected from care providers.


About UpToDate® and Lexicomp®

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Lessons and realisations on EMR since 2018

A look at how Bumrungrad International Hospital transformed patients’ hospital experience to an EMR-enabled journey with Dr Adjhaporn Khunlertkit, Division Director for Health Information Management and Operation Analytics and Transformation

How many times have your patients complained about their hospital journey: a one-hour hospital visit extending to a half-day; laboratory tests to be scheduled for another day?

Bumrungrad International Hospital understands the value of a patient’s hospital experience. Thus, the Thailand hospital started its EMR-enabled journey in 2018. If you’re a patient, your appointment prior to the visit is booked with EMR. Once inside the facility, you’ll be registered through EMR. Your doctor will access your patient record through EMR. Your diagnosis, treatment plan, medication, and bills are generated from EMR.

“One EMR system connects all departments,” describes Dr Adjhaporn Khunlertkit, Division Director for Health Information Management and Operation Analytics and Transformation at Bumrungrad, as she tells Hospital Insights Asia about how the whole patient journey is transformed with the implementation of EMR and urges hospitals to push for a well-functioning hospital information system.

Source of truth

“We use EMR as the source of truth,” Dr Khunlertkit says. Bumrungrad’s vision is to “provide world-class holistic care with innovation” by 2022. “To enable care with innovation, we need to start digitising core processes. We, thus, start implementing a unified digital information platform.”

Information is necessary for providing care. “Complete, accurate, concise, and timely” information, for her, is key to enhancing the quality of patient care.

Physicians use information to diagnose and treat patients. Nurses monitor patients and provide information to physicians for optimal treatment decisions. Pharmacists rely on information to assess prescriptions. All other disciplines are, more or less, the same.

A seamless flow of all these necessary information is possible with electronic medical records. This, in turn, allows clinicians to make more informed decisions.

Best system design

Maintaining a health information system like EMR is never simple, just as with other technologies today. Dr Khunlertkit advises hospitals to start with a clean set of data: “Start your maintenance from the get-go. Make sure your system always contains a clean set of data.” The key is to use user-centred design to encourage users to use the system as they’re intended to.

“The platform has to be efficient because care providers don’t have the luxury of time,” Dr Khunlertkit recommends. It should also be simple and flexible: simple enough to enforce documentation standards for more concise and complete data input, and flexible enough for users to customise.

“Equally important is to equip the system with advanced technology,” she underscores. Up-to-date literature aids clinical decisions. Medical and diagnostic errors can be prevented when data is presented in a logical format, and cutting-edge technology alerts clinicians for potential errors.

Change management

Dr Khunlertkit knows that transitioning to digital is never easy. “My responsibility as a team lead is to set and align the vision, strategy, and roadmap towards Bumrungrad’s digitisation.” Implementing EMR, and other digital platforms, means adjusting both practices and processes, she says. “Adjusting only one of these two always leads to a failed implementation.”

Both hospitals and vendors have to find balance. “It should be a top priority as there is no such thing as a ‘one size fits all’. A change agent is responsible for understanding users’ perceptions, and being knowledgeable of EMR design’s purpose. This way, you’ll have a win-win situation.”

But changing people’s mindsets are always the hardest. For the change management expert, the strategy of starting with open-minded users works. The others then follow. 

“I communicate thoroughly and regularly with those who are not too keen to get on board with the new system,” Dr Khunlertkit reveals, “but I barely find pure resistors; sometimes, they are yet to see the benefits of the system, thus, the reluctance.”

Trust justifies cost

Several hospitals are hesitant to adopt EMR because of the cost. Bumrungrad focuses on what it can provide rather than its return on investment (ROI). “You will never get to implement EMR if you use ROI to justify for such investment.”

Instead, the justification should be the “trust that the system could bring to both care providers and patients,” emphasises Dr Khunlertkit. “There is definitely more to the EMR than just monetary value. Numerous literature has proven how a well-designed health information system improves patient safety and the quality of patient care.”

For Bumrungrad, EMR is a significant step forward to achieving its vision by 2022. A smooth patient journey and topnotch quality of care are the wins from all hiccups with implementing the system. After all, Dr Khunlertkit believes that “if there is a will, there is a way.”

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Aligning expectations on EMR adoption

A Malaysian hospital that has recently implemented EMR tells us what to expect

Before the 31st of May 2020, Assunta Hospital had patients complaining about the long wait to see their clinicians. Since June, complaints like this became fewer, all thanks to Assunta’s move to use electronic medical records (EMR).

Rachel Lee, Chief Business Officer at Assunta, sat down with Hospital Insights Asia to discuss their hospital’s EMR journey, together with the decisive factors, the challenges, and the opportunities that come with it.

Centralised documents

“We want to centralise all hospital documents into one single system,” says Lee. Like a one-stop-shop for care providers and hospital staff, the EMR caters to all ward levels, all clinical services, the wellness centre, and specialist clinics or the outpatient department.

Because digital documents are easier to store and access, EMR is helpful in reducing workload, tracking folder movement, and uploading information to the existing Health Information System (HIS) at Assunta.

“Specialist clinics and the wellness centre use EMR for booking appointments. Medical reports are easily inputted into the system so consultants can easily record and retrieve patient information. Wards, including intensive care and high dependency units, use EMR for notes clerking. Clinical services, like radiology, heart centre, pharmacy, laboratory, and physiology, use the system to upload reports and make them easy to access by care providers,” Lee explains.

The flow of documents, when they are digital, becomes smoother and faster. Patients at Assunta appreciate this, just as the staff, nurses, and doctors do.

Changing the workflow

“The purpose of EMR is to accommodate data exchange. At a practical level, EMR information consists of a mix of digital and non-digital,” Lee notes. Users from different hospital units can easily send and receive patient information they need.

For healthcare professionals or care providers at Assunta, EMR provides decision support. Because consultants can easily record information, review a patient’s medical history, drug allergies, and the like, they become more productive and see more patients in a day.

But there is always the struggle on staff acceptability for the new system. In the past months, though, they are finding EMR useful in doing daily tasks, especially with audits and medical reports, folder tracking, and lesser occurrence of misfiling. “Our staff finds that medical report applications are now easier to process because digital documentation is in place. Laboratory results, too, are easier to access,” shares Lee.

Looking forward

The system is not perfect, or at least not yet, says Lee. Users find that documentation can still be improved to enable faster processing of reports. The months prior to May 2020 were dedicated to preparing the system, but still, the work does not end with getting it up and running.

“When the EMR system is down, the rather smooth flow of information is disrupted,” reveals Lee. When this happens, Assunta turns to its Business Continuity Plan which includes going back to paper-based as back-up until the system is running again.

Considerations on protecting patient data and confidentiality, too, are significant inclusions. Currently, “the use of data in the EMR is controlled by the IT department hand in hand with the Medical Records Manager.”

Improvements for the EMR at Assunta are underway. Now that Malaysia is gearing up towards a digital health ecosystem, digitalising patient records seems to be the next automatic thing for hospitals and clinics in the country. Assunta understands how constant audit of the system increases staff acceptability and eases change management.

It’s true that COVID-19 accelerated digitalisation in healthcare. For Lee, hospitals without EMR should consider using one today to reduce patient complaints, and more importantly, to help ease the workload of healthcare providers.

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Getting ready for EMR

Perspective from a hospital that’s still looking to implement an electronic medical records system

Patient volume increases every year. If hospitals stick to paper-based records, this volume also requires a larger space for storage and longer waiting time for patients.

This is where electronic medical records (EMR) come in. “It will be a game-changer in the healthcare industry,” underlines Dato Dr Hjh Selasawati Bt Hj Ghazali, CEO at Hospital Raja Perempuan Zainab II (Kota Bharu).

For a hospital that is yet to implement EMR, the system is a welcome solution to reduce the burden of manual records storage. In an interview with Hospital Insights Asia, Dr Selasawati talks about how she sees EMR to benefit hospitals and how hospitals can prepare to adopt this technology, especially in a setting like Malaysia.

Ease of data transfer

Malaysia’s Ministry of Health’s announcement of going for full EMR for all public hospitals and clinics is a top-down project. The government chooses the first hospitals to implement it.

In lieu of EMR, Hospital Raja Perempuan Zainab II uses a patient management system called Sistem Pengurusan Pesakit (SPP). “It is basically for internal data management and is available in other selected government hospitals in Malaysia,” says Dr Selasawati. SPP has basic patient data information. It is used by doctors to request further tests from the laboratory, check patient records, and generate statistics like the number of inpatients and outpatients for the past year.

But SPP is not the same as EMR. “SPP is just intra-hospital, thus, can be used only within the hospital,” Dr Selasawati explains. “EMR will enable us to exchange patient data with other hospitals especially when the nationwide implementation is completed. I consider it a single tip technology that allows us to save time, and have more efficient and speedy transactions.”

“Patients are transferable from one hospital to another,” she adds. “And for this to happen, there should be a continuity of information.”

If a patient is transferred to another hospital, for example, it’s just not practical to have the patient fill out new forms and repeat a laboratory or radiology test. “Our hospital is a tertiary state hospital so we receive patients from step up and step down cases. When we transfer patients to other hospitals, the patient data should follow with the patient.” This can only be efficiently done when medical records can be transferred electronically.

Preparations along the way

There are certain criteria before a hospital is selected to implement EMR in the earlier stages. Dr Selasawati has high hopes for Hospital Raja Perempuan Zainab II to be one of the first hospitals in the country to adopt this. But she also knows there are challenges that need to be overcome.

First is the infrastructure. This is why Dr Selasawati understands why EMR implementation is done in phases. “We shall start with something that is most doable and then proceed with upgrades as time goes by.”

Second is system stability, a huge concern for the hospital. “I want the EMR to offer safety and security. We cannot afford the system to be down for a long period of time as we want to do away with patients waiting for hours for consultation.”

If the system is unstable, the hospital has no choice but turn back to a business contingency plan using a manual system, as is the case at Hospital Raja Perempuan Zainab II. “We have to be prepared in case of technical failures, especially the instability of internet connection, electricity breakdown, and inadequate hardware,” the CEO remarks.

Growing as a team

For EMR to be a successful venture, “we have to grow as a team”, this is what Dr Selasawati reminds her employees. Staff’s acceptance is not much of a problem, she argues, because there is always the initial stage which is the adjustment stage. But after a time, they become used to it and find out it’s helpful in doing their tasks in a more convenient, fast, and efficient way.

What matters more is the continuous training of staff and rationalising the importance of integrating EMR into their workflow. “When we install the system, we have a scope of the process, but after some time, there’s always a dynamic where we need to add more and more processes in the working modules.” Hence, users must be kept aware of how the system works.

Hospital administrators play a significant role in keeping the process going. “We need to inculcate to customise the behavioural changes and the mindset towards embracing this technology in our employees’ practice. We have to have everybody embrace it.”

Dr Selasawati believes that Malaysia’s health ecosystem is already moving toward the full EMR direction. There are some things that need to be tackled and addressed, but for her, these shouldn’t stop the movement towards EMR.

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The next Frontier of Digital Healthcare: exclusive interview with Kerry Stratton, Global Director, Healthcare of InterSystems

A new appetite for innovation

The pandemic has set the pulse racing on digital healthcare innovation. Healthcare providers are turning to new software that can help to transform care processes, but underpinning this transition is the demand for reliable, accessible, usable data that is ready for action, so better decisions can be made.

For the savvy solutions provider in this era of rapid change, to stand still is to fall behind. One company is taking the fast route to the next frontier of digital health with EMR and unified care record solutions and a data platform specifically engineered to extract value from healthcare data. Kerry Stratton, Global Director, Healthcare Solutions for InterSystems, speaks with Hospital Insights Asia on staying agile to stay ahead, helping governments and hospitals to make smart decisions, and adding real life value to virtual healthcare.

Trends of a changing time

“I think the whole COVID experience has been a real test for healthcare IT providers”, says Stratton. From diagnosis to discharge, the crisis has driven digital disruption across the healthcare sector.

Asia especially has picked up the pace. A recent survey put the region at the forefront, with 78% of Asian hospitals ‘excited’ by digital health compared to 66% globally and 91% willing to try new healthcare innovations compared to a worldwide figure of 84%.

In Southeast Asia, Malaysia is at the start of an ambitious pilot plan to roll out electronic medical record (EMR) systems across all hospitals nationwide. In Vietnam, 14 major public hospitals recently announced the implementation of EMR systems. And with an ageing population, Singapore has embraced the need for greater agility and a more effective, accessible healthcare service.

“Everything is changing so rapidly”,  says Stratton. “We’re seeing exponential growth in both technology capabilities and the volume of healthcare data”. But speed is only part of the solution.

“It’s not just about doing business for the sake of it, quickly”, he says firmly. “It’s about how you extract value from digital platforms”. For InterSystems, this value depends on the quality of digital assets – the healthcare data itself – not just the quantity.

Healthy data in the key to digital health success

InterSystems sees “healthy data” as the foundation of digital health success. “Healthy data is clean, accurate data available anytime and anywhere”, Stratton explains. “It is ready for action, enabling better decisions.”

Data sources include EMR systems, specialist applications, biomedical devices, healthcare portals, national health records, and others. The challenge is not just connecting these data sources, but translating them using appropriate standards and aggregating information “cleanly” for safe, reliable and immediate use.

“The hard part is ensuring the integrity of data and extracting value from it”, says Stratton. “If clinicians cannot trust it 100%, they will not use it. That’s equally true of a clinical decision support system designed to improve patient safety, or an artificial intelligence app promising to assist clinicians in identifying an accurate diagnosis”.

Healthy data also drives innovation outside hospitals. “With COVID-19, it has been proven how important it is to have key demographic and clinical information quickly to hand for contact tracing”, he says. “The next step will be more accessible and reliable vaccination records”.

Post COVID, the innovation will continue. “Artificial intelligence and machine learning can predict the likelihood of patients being re-admitted into hospitals”, Stratton suggests. “And precision medicine combines individual records with population research to offer the best treatment for each patient.”

Driving digital change at national level

Innovations in the private sector often coincide with wider government initiatives.  Technology decision making can be very challenging.

“Governments can take a long time to make decisions about digital transformation,” cautions Stratton. “It can be difficult to make decisions without solid business cases but quantitative measures are not always easy to pin down due to the complexities of health and care and are often hampered by a lack of baseline data.

InterSystems also works with governments with a vision for sharing data across the health and care system to drive service improvements and the best possible outcomes. While their journeys may look different, the goals and challenges of various governments are very similar. InterSystems, and Stratton, have built a strong instinct for their digital needs, working closely with progressive customers like the NHS in the United Kingdom and Western Australia Health, South Australia Health and Northern Territory Health in Australia.

The Northern Territory government in Australia has standardized on a single system for all of its public hospitals and primary care clinics, “bringing all information together in a trusted record that allows clinicians to make responsive decisions”, says Stratton. South Australia has chosen a different path, using a state-wide health information exchange that connects different healthcare systems, normalizing data into the same HL7 format and performing integrity checks.

Decisions made now will impact agility in the future so governments must solve short term needs while building a technology foundation for the future.  Interoperability initiatives are a foundation for value; once data is brought together you can start to mine that data and unlock its potential. Governments must adapt to massive increases in data volume, complexity and sources if they are to meet increasing expectations of how data will drive improved workflows and better care decisions. Working with governments to “assess technology and understand the benefits of data platforms”, InterSystems is helping them to thrive in this era where agility is critical.

Digital safety for a digital age

In a sector where cyberattacks account for more than half of data breaches, virtual incidents can have real world consequences. “If a banking system goes down for half an hour, it doesn’t usually hurt anyone”, explains Stratton. “But if a healthcare system goes down lives can be at risk”.

While digital innovation can help governments and hospitals improve healthcare services, no-one wants to suffer the reputational damage of a digital lapse. “Patients are very concerned about how their information is being used and shared… who’s looking at it, what’s being done with it, and can they trust the organisation that has got that information”, says Stratton.

“We’ve been making Internet-based healthcare information systems for many years and the reality is that our customers must constantly deal with the threat of cyberattacks”, he says. “But in healthcare, ensuring data safety is not just about cybersecurity. It is also about being able to maintain the information in a clinically safe way”.

InterSystems helps organisations and governments protect data and maintain trust with their patients and citizens through strong, military strength encryption. The company also has a dedicated information security department and clinical safety officers in each region to support customers.

“People are always comparing and asking why isn’t healthcare the same as other industries? They don’t always understand that healthcare is far more complex and has many additional requirements”, says Stratton.

Kickstarting change for a connected future

The present era of change is setting the pace for the future.

“COVID has created a sense of urgency and I think there will be an ongoing expectation for technology companies to provide a rapid turnaround”, observes Stratton. “In China, we had customers set up hospitals for critical care with full digital systems within two to three weeks”. InterSystems was also able to deploy systems remotely during the pandemic using teleconferencing and other digital collaboration tools at MercyAscot Hospital in New Zealand and Tzu Chi Hospital in Indonesia.

This potential kickstarted by the current climate has unlocked opportunities for the future. “We’ve seen many customers shift to providing virtual care overnight”, says Stratton. “That has spurred innovation around how we work with them to deliver more proactive, virtual care that can pre-empt serious problems, alert doctors and patients, and integrate artificial intelligence for better decisions”.

“Overall there’s been a high degree of success and satisfaction”, Stratton confirms confidently, adding that InterSystems will remain highly responsive to its customers’ needs in this changing environment. And with their help, and a commitment to healthy data, hospitals and healthcare systems are thriving.

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Exclusive interview with Malaysia Ministry of Health’s Director General of Health, Datuk Dr Noor Hisham Abdullah

Paper-based patient data is a thing of the past. Hospitals are driving the digitalisation of patient records, in a bid to streamline both patient care and business. The global electronic medical record (EMR) market is expected to hit US$20.7B in the next 5 years

In Malaysia, when the Ministry of Health announced it’s to roll out EMR systems across all hospitals and clinics nationwide last year, the message was clear: the country would not be left behind in the global digitalisation wave. The nation is on the brink of the next step of their digital trajectory, the 12th Malaysia Plan (2021-2025), which will focus on priorities, such as “quality and safety of care” and “inclusive innovations and smart solutions”. 

As the nation makes its quantum leap towards Malaysia 5.0, the Ministry’s Director General of Health, Datuk Dr Noor Hisham Abdullah, tells Hospital Insights Asia about how the COVID-19 pandemic has increased the pace of innovation, why partnerships are key for interoperability success, and what the “next normal” will look like for patient care.  

Malaysia’s digitalisation journey

Malaysia’s healthcare is at a critical junction. With an ageing population expected to jump by 40% in the next 30 years, growing demand for treatment is putting increasing pressure on the system. And governments and hospitals are turning to technology for support and innovative solutions to streamline operations without spending excessively. 

The pandemic has accelerated this demand for digital evolution, and the Ministry is stepping up to embrace the new challenges of a socially distanced era. “COVID-19 has altered attitudes and accelerated adoption of policies that enable the business of work”, says the Director General. “This crisis offered a unique opportunity to accelerate digital transformation”.

Where “virtual engagements have become a norm”, the Ministry has rapidly improved connectivity and bandwidth across the nation to meet the need for virtual clinics and highly tele-networked operations, with “system implementation and solutions for COVID-19 going live in a short period of time”. 

An integrated future, and past 

Telemedicine may be the future, but when it comes to Malaysia, it is also a key part of its past. Since its Telemedicine Blueprint 1997, the Ministry’s key focus has been a “people and services focused… wellness through an integrated healthcare”. Today, that mission has received fresh impetus from the coronavirus pandemic.

In February this year, the MoH partnered with DoctorOnCall, a medical video consultation start-up to create a customised virtual health consultancy platform that would address public concerns about Covid-19, a “first-of-its-kind solution initiated by a government in the region”.

Today, Datuk Dr Noor Hisham speaks of the Ministry’s vision of “nationwide system implementation”, and missions such as the “Lifetime Health Record for individuals”: an e-health initiative set to provide a “one record, one person, accessibility to data and patient engagement”.

“The MOH has been strengthening its digital health strategy and technology adoption…with a goal towards achieving Universal Health Coverage”, Datuk Dr Noor Hisham shares. 

Centrally accessible data: at the heart of the new normal?

For hospitals which have already embarked on their EMR journey, interoperability might seem like a natural next step: linking hospitals across the nation’s healthcare system by carrying information through an interconnected network, like veins connecting vital organs. 

Interoperability can improve the patient experience, co-ordinating administration, and providing greater visibility of possible treatments and prescriptions. It allows for hospitals to track, trace, and protect their sensitive data. And it is good for business: a white paper from American research organisation West Health, estimated that interoperability could save the health sector $35 billion annually through streamlined production and reduced costs.

The Director General is quick to confirm that “a robust interoperability platform” is critical. While there is no announced timeframe, the Malaysia Health Information Exchange, a patient record interoperability platform launched in 2009 as a precursor for public-private integration in health, remains a “significant digital health initiative” the MoH is “actively pursuing” to shape the future of Malaysia’s health system. 

But making a health system interoperable, especially on a national level, is not always a smooth journey. EHR systems from different hospitals using different vendors, don’t always mesh together, meaning communication can be lost. And without established industry-wide standards and policies to send, receive and manage data, hospitals meet challenges in identifying patients and their healthcare needs. Pricing of integration can also be a barrier to entry for smaller hospitals. 

When man and machine interact, the human factor can sometimes be the weakest link. Describing her EMR journey at the first hospital to embark on a fully automated early warning scoring system in the APAC region, Dr Tan Hui Ling, Managing Director, Bagan Specialist Centre and Oriental Melaka Straits Medical Centre admitted earlier this year that “the biggest challenge is in the mindset, expectations and the ability to visualize how to… use technology to improve our work process or quality of care” across medical professionals and hospital managers. 

“Many health sectors across the globe have embarked on interoperability with many challenges” Datuk Dr Noor Hisham ventures. For him, success lies in involvement from both public and private sector, and taking lessons from other countries’ interoperability journeys. In the USA, a pioneer in healthcare operability, one issue has been a disconnect between government and industry. “Federal reporting and administrative requirements” were cited earlier this year as a roadblock to operators in implementing efficient electronic exchange. 

“An interoperability layer is crucial”, confirms Datuk Dr Noor Hisham, “(but only) with agreed standards and policies”. 

Partnerships for the next normal 

“4IR with telecommunication advances, and the dawn of 5G technology, are presenting multiple strategies and challenges ahead”, says Datuk Dr Noor Hisham. To plan for this connected future, the Ministry is reviewing and developing regulatory strategies and policies to foster digital health technologies, spur innovations and boost the digital economy. 

But the success of digital health also requires partnerships and strategic collaborations at regional and global levels. And to build the required competencies, policies and frameworks for a Smart future, the right partnership with the right solutions provider is critical. 

The overall increase in global demand for information exchange and connection enabling solutions has resulted in a “market explosion of vendor offerings” and a search amongst hospitals and governments for an elusive “golden standard” of interoperability solutions. 

For Malaysia and its Ministry of Health, these “collaborative partnerships” and “public-private integration” are key components to the country.

“Sharing of medical information is important to ensure continuity of care, improved outcome and population health”, asserts Datuk Dr Noor Hisham. Connectivity is more than just electronic information. It is the network of relationships that help build, not just data, but also expertise for the future. 

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Healthcare from the heart

Exclusive interview with Nilai Medical Centre’s CEO on the real-life benefits of digital data

With a global predicted value of USD $20 million by 2025, digital data is pumping growth through the heart of the healthcare market. In Malaysia, leading EMR solutions providers are expected to expand by over 100% within the next two years

But for Jasmine Lau, CEO of Nilai Medical Centre, there is a greater value to hospital’s digitalisation journey: the intangible ROI of quality patient care. 

She shares with Hospital Insights Asia the real value of hospital experience, how to protect your patients and their data, and why connectivity is a critical part of Malaysia’s healthcare future. 

For patients, not for profit 

Malaysia’s RM80 billion healthcare industry holds healthy commercial opportunities. But for Lau, the impetus behind Nilai Medical’s EMR journey was not for profit.

“The main reasons we wanted to have electronic medical records are…the efficiency, the workload, and (reducing the) number of medication errors” she confirms. “We don’t make profit out of it, but it does give you a sense of a return of investment, like providing value-added services to the patient”. 

As the pandemic pushes demand for efficient patient care, the reduction in patient waiting time is one of the greatest benefits Lau has seen since implementing EMR throughout Nilai Medical. 

“(Patients) used to wait for a long while… for the records”, she explains. Now, the automatic flow improves the patient journey by significantly reducing waiting time. Patients who used to spend half a day in hospital now wait for less than an hour. 

“It’s really good news for the nurses, doctors, as well as pharmacies”, says Lau proudly. “And of course, patients benefit”.

Aligning man and machine 

Yet, for a sector notoriously “slow to embrace technology”, the road to digitalisation hasn’t always run smooth. Last year, Dr. Prathaban Raju – a co-Chair of Digital Health Malaysia’s special interest group, and joint founder of Health-tech platform Door2Door Doctor –  cited better “training for healthcare providers, who may not be comfortable with technology” as a key factor that needed to change if Malaysia’s healthcare sector is to survive and thrive in the digital future. Lau agrees. 

“Some of the doctors, nurses, and staff have been here for almost 10 to 15 years, and you want them to switch from handwritten to electronic”, she shrugs. “Our biggest challenge is to get buy-in”. Nilai Medical ensured that there was support for medical staff from the very start of the digitalisation journey. As productivity increased, their reticence disappeared. 

“Eventually, when I talked to the doctors, I noticed they started to like…the system”, she confirms. “It’s very useful and beneficial to them as well”.

Protecting patients: protecting their data 

For Malaysia, cybersecurity concerns have grown alongside digitalisation. In 2016, 20,000 Malaysian patient data records, and 1.2 million scans from three different systems, were made accessible following a leak from a private organisation

Since then, EMR evolution means that it is not just patients’ physical, but also their digital wellbeing that is at stake.

“We were quite worried in the beginning”, admits Lau. “How do I preserve the patient’s confidentiality? How do I ensure that patients data isn’t leaked out, how do I ensure people don’t just hack on my system?”. 

The solution to these concerns lay in a “strong IT system to ensure data security” and regular free training, not just for healthcare professionals, but across the board. 

“We audit the system regularly. We also develop a lot of policy and procedures”, explains Lau. “(and) we actually restrict access for personnel…  which means that doctors only can access their own patient information”. 

Interoperability: small steps towards great ambitions 

If EMR sophistication is Nilai Medical’s latest landmark on the digitalisation journey, interoperability – the seamless exchange of electronic health records across different hospitals –  seems like a natural next step. A standardised system and fast exchange of data can enable greater accessibility for healthcare professionals, and more efficient care for patients, especially those transferred across institutions. 

Yet while data-sharing across hospitals is “doable”, Lau notes that “it has not actualized for Malaysia… yet”.

For the careful CEO in a critical climate, security of patients’ data, the stabilisation of systems and the cost of integration are just some potential hurdles on a hospital’s interoperability journey. 

 “It doesn’t stop us”, she is quick to stress. “But it’s giving us more time to think about and consider about whether this is the right timing to go for digitization strategies at this moment”.

Taking it slow in an era of rapid digitalisation means Lau has a clear idea of what resources – and partnerships – are needed to achieve her ultimate interoperability goals. 

“What I hope to see is actually another Public Private Partnership, which is for government patient information to transfer to the private sector”, she reveals. “Instead of reordering all tests from government hospitals, patient information like lab tests can just be transferred or shared”. 

Digital goals giving new strength to the industry 

These clear visions give Lau confidence in navigating an era of uncertainty. For Nilai Medical, and for Malaysia’s healthcare as a whole, digitalisation of data is not just an asset, it is an inevitability. 

“Moving forward, every private hospital in Malaysia, whether you’re big or small, we are going for full EMR”, she says confidently. 

The healthcare sector is already among the fastest growing industries in the country. Now whether spurred on by patients, profits, or practitioners themselves, its progress has new power.

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Will interoperability in Malaysia remain a dream?

Hospital interoperability definitely helps patients, hospitals, governments, and insurers. But is it doable for Malaysia? Gaurav Rekhi, Managing Director and CEO at Manipal Hospitals Klang, shares his perspective.

Quality of care depends on having the right information at the right time, so that whenever or wherever patients are, they are able to access proper care. This is what interoperability does, still a goal for most hospitals in Asia but something that’s in every organisation’s wish list.

One factor why interoperability seems a far-flung dream for Malaysia is the lack of digital efforts from hospitals. However, in recent years, steps are being taken to adapt to the changing times, particularly during the ongoing pandemic.

Telehealth suddenly became a new way to reach patients. And with this, electronic access to patient data was urgently needed. Manipal Hospitals Klang, a private hospital in Malaysia, says that this had been possible through their Electronic Medical Records (EMR), which allowed their consultants remote and quick access to patient records from their registered devices.

Manipal Hospitals Klang adopted EMR in 2018 primarily to realise a paperless retrieval of patient records, allowing them to save time and save lives, says Gaurav Rekhi, Managing Director and CEO. It is integrated with Lab Information Systems, Radiology Information System, clinical notes, and prescriptions, among others. Most private hospitals in the country use a similar EMR system.

Government hospitals, too, are slowly embracing this data management technology. Last year, the Ministry of Health (MoH) in Malaysia announced its goal to implement EMRs within three to five years in all public clinics and hospitals, allocating up to RM1.5 billion for the project, hoping that a fully established EMR system across all hospitals in the country will make room for interoperability.

However, there is always the difficulty of getting buy-in from stakeholders, especially healthcare providers and users of the system. A survey from the Centre for Connected Medicine finds that less than 40 percent of hospital executives approve of data sharing between hospitals, although the majority of respondents assert their move to using EMR as part of their plans to be interoperable.

While Rekhi understands that there are challenges, including data privacy issues, insurance participation, high cost, and universal patient identification, he believes that hospital interoperability in Malaysia will “increase patient trust in the hospital” since patients can receive care anywhere and anytime they need it, thereby, helping to “enhance services and doctor-patient relationships across hospitals.” Thus, it can be a huge advantage for patients, hospitals, the government, and even insurance companies.

Still another issue is the scalability of the solutions used by hospitals. The American Hospital Association finds that the main barriers to exchange and interoperability are usually the lack of compatible technology for receiving providers, exchange challenges across different vendor platforms, and difficulty in matching and identifying the correct patient between systems.

It isn’t enough that every hospital has an EMR. The problem lies on whether the technology or the EMR is interoperable with other applications and can be scaled up to a full and large distributed system, such as the entire Malaysian healthcare ecosystem. In other words, the technology should be able to “talk” with other systems so as not to cause a break in the otherwise smooth intercommunication of patient information.

Should there be increasing support from both the government and private sector for an interoperable healthcare system and a required scalability feature for data management solutions by vendors, it is only a matter of time that patients in Malaysia can enjoy a more seamless patient journey and access higher quality of care wherever and whenever they seek treatment.

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Tips from a digital trendsetter

Bagan Specialist Centre and Oriental Melaka Straits Medical Centre’s Managing Director on empowering your practice and your people for the next era of healthcare

The global health crisis has hit Malaysia’s private healthcare hard. As travel restrictions send shocks through the lucrative 1.5 billion Ringit medical tourism market, and public hospitals bear the bulk of the country’s coronavirus care, the nation has seen 50% revenue drops across private hospitals.  

As the industry slowly moves towards recovery, new technologies are critical for these hospitals to heal.

Dr. Tan Hui Ling, Managing Director of Bagan Specialist Centre and Oriental Melaka Straits Medical Centre, talks with Hospital Insights Asia on being a digital trendsetter, choosing the right time – and the right partner – for your hospital’s EMR journey, and why the will of your workforce is the most important asset in your digital toolbox.

Digital – the lifeblood of the business

The COVID-19 crisis has accelerated Healthcare’s digitalisation journey, with a recent survey of Malaysian telehealth providers and hospitals noting the pandemic has strengthened the foundation of digital health care services in the country. And in a market full of healthy competition, it’s important for private hospitals to keep their finger on the pulse. 

“The world is transforming to be digitally driven and as a healthcare provider, we have no choice but to transform and adapt to IT innovation in order to be competitive”, Dr. Tan states candidly. “For me it is better to be leading it and be (a) trend-setter, rather than be left behind and become outdated and inefficient”.

Part of staying ahead of the game is implementation throughout the lifeblood of the hospital’s infrastructure. 

“Almost 70% of our hospital operational needs are dependent on IT now, 90% of the clinical process and 50% of the administrative process”, explains Tan. This holistic hyper-connectivity not only streamlines business operations, but can also gain life-saving moments in patient treatment, an asset that will remain critical post-COVID.

“There is no time to lose when we have patients in emergency situations…. operation theatres or ICU, and every minute is time gained when we have immediate access to patient medical info”, says Tan. “This happens every day and not just during COVID – 19”.

Revitalising your workforce 

In an interview earlier this year, Tan broached the challenges of a workforce unfamiliar with a digital healthcare system and “resistant to change”. With time, she has found a balanced dose of providing new training opportunities, and restricting access to familiar but outdated practices, is an effective method to reinvigorate, and re-motivate the workforce. 

“To learn a new skill or new system, in this case the electronic version of medical records, was time-consuming and difficult in the initial stage”, she acknowledges. “People generally find it easy to use what they have been familiar with… Providing training and preparing the team mentally for the need to change, we had to be draconian, and limit the access to paper medical records after a period of transition was allowed. Otherwise there is always a reason not to adopt EMR”.

Prescribing the right partner for business success 

Yet, as with all aspects with healthcare, digitalisation is not a one size cures all solution. 

“EMR is not a magic pill, and definitely not perfect”, Tan says firmly. “We are very selective in which IT solution we invest in. It has to be effective and affordable, balancing quality and cost. We start with the basics and slowly build upon it as our team becomes more experienced in healthcare IT needs and solutions”. 

For her, choosing the right EMR system involves a careful diagnosis of your hospital and workforce’s capabilities to prescribe the right partner for your specific business needs. 

“I think it is important to know the stage of your hospital’s IT infrastructure capability and staff’s healthcare IT knowledge level”, explains Tan. “With that choose a system that is easy for your hospital to start implementing it, in terms of cost and capability wise.” 

For hospitals at the start of their EMR journey, she suggests starting slow, “choosing a basic system first, then build upon it progressively, rather than jump into a sophisticated system”. 

A hyper-connected vision 

Bagan and Oriental are just one of the vital organs in a wider national body. The centre’s current projects coincide with the Government’s announcement of the pilot phase of a nation-wide EMR initiative, implementing electronic health records across all public health institutions in the Negri Sembilan state. 

Equally when discussing the future of interoperability – the smooth electronic exchange of data across different hospitals – Tan reflects on the wider context of Malaysia’s healthcare industry. 

“It will be beneficial if it exists nationwide in all public and private hospitals where patients frequently visit”, she muses. “(But) at the moment there is no government will to enable hospital interoperability for health information exchange nationwide across both public and private sector. As a country we do not have industry standards…. be it standard interoperability format for data sharing … or standard requirements for data security”.

While the backbone of a realistic interoperable healthcare sector may be yet to come, for Tan the vision of a hyper-connected future is already clear: and it stretches past the (virtual) walls of hospitals. 

“Ideally it will be instantaneous access to patient data including previous treatment record, investigation results, prescription history, everything medically related”, she says enthusiastically. “not just from another hospital, but also community pharmacy, general practitioner clinics, traditional or alternative medicine practitioner clinics, independent laboratories, community dialysis centres and even nursing homes”.

A certain future for uncertain times  

There are a number of factors that help nurture a healthy EMR infrastructure. A clear understanding of your hospital’s capabilities and a solutions provider that balances quality and cost are just a few things Tan hopes will help Bagan and Oriental work towards her ultimate goal “to improve our workflow and clinical care, at an affordable cost… (to) track, monitor and be alerted of clinical outcomes individually and as a hospital.

But the most important asset for patient, commercial and EMR success, lies not within the hospital infrastructure, but those who run it.

“Most important is the will to employ it”, Tan states firmly. “Once it is there, we will find the resources to get it done and to overcome the challenges”.

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All of Dubai in one command centre

Dubai’s COVID-19 Command and Control Centre does not function as a single unit but as a collaboration among several hospitals, agencies, departments, and individual volunteers, igniting a cohesive approach to conquer the pandemic.

Although fiction books might have hinted on it, no one was essentially prepared for a pandemic in the 21st century. Good thing for Dubai, they always have a disaster management and readiness plan, an overarching plan for all types of emergencies.

Within this plan, they activated the Dubai COVID-19 Command and Control Centre, with operational and strategic functions central to their winning fight against the outbreak.

It’s operational and strategic

Crucial to each country’s pandemic response is the availability of hospital beds and supplies, such as protective equipment like N95 masks for staff. Dubai’s command centre fulfils the bed management and supply chain management roles, on top of other roles like the coordination of patient COVID-19 testing and finances.

The command centre coordinates four public hospitals, the Primary Healthcare Centres (PHCs), and the private facilities in Dubai, all working collaboratively with a common purpose, describes Dr Younis Mohammed Amin Kazim, Chief Executive Officer, Dubai Healthcare Corporation, Dubai Health Authority (DHA).

Multiple entities working together proved beneficial to easily facilitate patient movement and effective virus containment. With near real-time update on bed capacity from hospitals, the DHA efficiently transfers and assigns patients according to clinical nature.

Apart from addressing COVID-19 related issues, the command centre strengthens the relationship among stakeholders, particularly the hospitals as they hold daily meetings and coordinate patient movement. Dr Karen Barbara Carbone, Advisor to the CEO for Dubai Healthcare Corporation, DHA, observes a “very positive experience” on the relationship between the centre and external agencies such as the ambulance agency and the police, among others.

The emirate’s COVID-19 Command Centre likewise plays a strategic role as it liaises between various organisations, including the federal entity (National Crisis Committee), the Ministry of Health, the authorities in Abu Dhabi and other emirates. Serving as a focal point, the command centre can make informed strategic decisions. Hence, it functions similar to an airport control tower, which relies on data from air traffic control and ground personnel to protect thousands of lives each day, as it manages Dubai’s pandemic response based on data gathered from different units.

High-quality data is the first step

A command centre is only as efficient as its data management, this is what Dr Carbone finds from the Dubai COVID-19 Command and Control Centre’s activation, asserting that “high-quality data from relevant sectors is central in decision-making.” Without accurate data shared across the system, a coordinated approach is not possible. 

Recognising the importance of data systems, the DHA is looking at utilising data in a real-time manner to support the command centre’s everyday operations. The DHA Command and Control will exist, even after the pandemic ends, “to manage the ebb and flow of healthcare in Dubai.”

It goes without saying, then, that having electronic data is one step for hospitals looking to build their own command centres. But they also need to use this data to identify areas of opportunity and determine bottlenecks.

For instance, hospitals dealing with issues on overnight stays in emergency rooms can make use of high-quality data to get estimates of patients’ length of stay, current patient volume, inpatient bed availability, and staff availability.

Electronic systems using real-time data can now trigger if a patient is deteriorating, hence, can help hospitals take proper and immediate action to resolve issues on sepsis and mortality, Dr Carbone shares.

Beyond data, healthcare organisations should work on improving the culture of collaboration among disparate entities. Rather than working as separate teams, working in “one line”, as Dr Kazim describes, better takes care of the bottlenecks.

Manpower remains the toughest challenge

Filling in these teams, however, is not at all easy. In fact, Dr Carbone shares that manpower was one of the biggest challenges they encountered in its activation. Skilled labour was required to manage the command centre and healthcare labour to care for the increasing number of critically ill patients. 

Working through the resources, the DHA utilised the availability of internal staff and took in new personnel. Because elective surgeries were stopped, nurses and doctors were re-trained and re-assigned to areas related to their specialities. Volunteer physicians, nurses, and administrative personnel, who signed up through a website DHA has created, also came in.

Gaps were then filled in a more efficient but less costly means, supporting the premise that the command centre actually made everyone work together “for the sake of the patient, and for the sake of the country,” as Dr Kazim emphasises.