For Healthway, care is about information

case study Singapore's Healthway Medical Group believes having an electronic medical record system in place for its clinics goes a long way in enhancing healthcare for its patients.

Jong Hee Sen, president of the outpatient medical care provider, explained that the ability to link and share information between hospitals, labs and its clinics, enables the group to provide better patient care.

"Our vision is to provide better personal care, and a lot of it can be driven through IT connectivity," Jong said in an interview. "Having IT and an electronic medical record system in place makes a lot of difference."

Healthway was established in Singapore in the 1990s as a general practitioner (GP) chain. After new investors got onboard three years ago, the organization expanded rapidly and now includes specialist and dental chains, as well as health wellness centers. It currently operates about 90 clinics and medical centers in the country, employing some 150 full-time GPs and specialists.

The group's network of clinics receive some 3,000 patient visits a day. To meet the demands this puts on its operations, Healthway implemented the CrimsonLogic ClinicWeaver clinic management system suite, Jong said.

Initial rollout of the software suite started over a year ago at the group's largest chain, Healthway GP Clinics, which has about 50 clinics. Implementation of the suite across Healthway's other facilities is still ongoing.

ClinicWeaver provides Healthway with a basic workflow system for activities such as drug procurement, billing and the setting of doctors' rosters. It also provides the platform for the central database of Healthway's electronic medical records, enabling its GPs to view lab results and patient records electronically.

Jong said: "Healthcare is about information. Better healthcare comes from better availability of information linkages, and this can be life-saving."

Enabling medical records to be accessible electronically lets the healthcare provider expand the scope of its patient care. For example, in the event that a patient needs to see a specialist, medical records can be shared electronically between the GP and specialists.

Michael Lie, vice president for healthcare at CrimsonLogic, said the IT vendor presented a product demo to Healthway over the healthcare group's busiest network.

"They took along a stopwatch and said, 'teach the clinical assistants to use the system'. It was about 15 minutes later when we finished teaching and the clinical assistants started to use the system," Lie told ZDNet Asia in the interview with Healthway. The clinic operator then recorded the time it took for each patient to be processed, which was "about 40 seconds", he said.

Jong noted that "speed is important" because some Healthway clinics each attend to about 200 patients a day.

He added that another issue the group wanted resolved was the need to gain the support of the clinical assistants.

Lie added: "Without their buy-in, no system can be adopted."

Jong concurred: "The nurses must see that the system improves [their ability to do their job]. If you bring in a system that cannot work, they will throw it back at you."

The medical group employs a hybrid model for its medical records system. This comprises Microsoft SQL Server-based servers located at each clinic, and a central Sun server and Oracle database hosted by CrimsonLogic, which the clinics access over the Web.

For most part, data between the local and central servers is synced in real time, Lie said. This way, the central system, which contains copies of all data, provides redundancy so a switchover can be easily done if the servers in the clinics experience a failure, he added.

Graphical data such as x-rays, are stored only in a clinic's local database, but are still accessible on-demand by other clinics in the group.

Clinical tablet trial
Healthway will soon implement ClinicWeaver Suite's latest module, ClinicWeaver Consult, across its clinics and specialist centers.

GPs will pilot the module on tablet PCs during consultation, using the device to take notes and prescribe medicine.

Jong said capturing information directly via the Consult software and tablet PCs means the clinics need not store physical cards containing such information.

"This seems a very mundane thing, but if you go to a GP clinic you will find that the cards take up two-thirds or half of the clinic space because [under Singapore] law, you have to store them for seven years--and you may have a patient that sees you only once in those seven years," he explained.

In addition, as this information is now stored electronically, it can be accessed by other clinics in the chain, he added.

Furthermore, in the traditional practice, the doctor sees the patient and writes a prescription that he will pass on to the nurse who then needs to decipher the doctor's writing, Jong said. But, with the tablets, because the prescription is created based on input directly provided by the doctor into the system, the chances of errors are much lower.

It also improves the consultation process by automating key clinical procedures.

According to Jong, the system is designed to be intuitive and easy to learn, such that the process of capturing data using the tablet PC has proved to be much faster than writing it down. For example, he said, when a chronically-ill patient sees the doctor, his name is displayed on the screen and his medical record is automatically pulled for viewing, including medication prescribed during the last three visits.

"The doctor can, of course, adjust the medicine dosage on the tablet," he said.

Another key benefit would be to have the ability to have alerts on patients' drug allergies show up on the tablet, lowering the chances of a doctor missing the warning. Jong said: "If it's written on the card, [even if] it's written in red, it may not be [obvious as it may not be] on the same page," he said.