Computerised Patient Management in Malaysia.
*This is a personal note and is open for discussion.
I have worked in both IT and non IT hospital in Malaysia. The spectrum is from a typical manual computerised system in a Public Hospital to a Private GP system. I have seen the pro and cons of each system and I can compare and suggest the best system to use. After all, I am the one who is entering the notes in the computer, tracing the results, running the procedures, summarize the case notes and orders multiple blood investigations and radiological investigations. I have done it all.
For this post I would like to explain what are the needs with using the IT system Hospital and GP.
1. The Basics
In Malaysia, there are two main systems, a fully-integrated system and partially-integrated system. Fully integrated system are of the newer hospitals that are built in 2008 and beyond, the partially integrated system are the old hospitals. Apart from that, some of the fully/partially integrated-system includes the administration, clerical, financial and of course the clinical aspects of the system. Despite the fully/partially integrated system, the system can exclude other services such as lab (blood bank system, blood investigation, radiological, pathology, and subspeciality investigations e.g ECG/COROS/ Lung function test/ 6 MWD/ X rays). These can be overcome by of course typing into the system, or creating another ‘manual folder for patient’ but this has not always been the case Most of the time these results are left and is not attainable. As a conclusion, there is no one system that can fit all. So, a solution is needed to overcome this.
2. ‘Tweaking’ the system
- The design of the system can be a tough one. But I think the best way to look at it, is at the level of end user. User friendliness should be the most important criterion to take into consideration. This is due to the fact that, the turn over of user is high. You can have 20 housemens, 10 medical officers, 5 specialists and 3 consultants using the same system. And to topple that up, the number of user is also dynamic, there can be 10 new housemen and 10 senior housemen, and 5 new medical officers and 5 senior medical officer, so as you can see the system should be designed in such a way user friendliness is the utmost priority. Sometimes, the consultant need a HO to key in the data, thus making the HO the official clerk in the Hospital. At times the consultant also is having difficulty to use the new system, as the system revolutionized the working style. (from paper- abundant to paper-less) The system should be design in a way that, an hour of training is enough to learn the system. It should not be design in a difficult way. (just to get the result of investigation, you need to click multiple times to search through the system). The system should also be created for non clinical work such as accountants, ward manager, pharmacy and so on. It is very difficult to attain a system that is integrated and also standard.
- Light weight – the system should be design as lightest as possible. I noticed that, patient case note can be typed in however results such as radiology, pathology and manual results such as lung function test, angiogram results and all high graphic dependent data are not possible to attain within the same computer. This also goes that, if one wants to see the result of ultrasound and radiology, one need to go to another set of computer with better resolution which I think is absurd, because the time going to look for the computer is wasted by not seeing patients. It is also important to note that, sometimes these high data results need to be seen as it is, such as full blood pictures and trephine results, certain specific radiological views, and histopathology results. These results has a qualitative meaning rather than quantitative results.
- Difficulty in data mining and data interpretation- A haphazard system design also makes life difficult. For example, in ability to retrieve qualitative data contributes to difficulties in data interpretation. Another example is, the ICU and wards system are not integrated, certain parameters for example, changes in diastolic pressure to changes of appropriate haemoconcentration is difficult to see with different sets of data.
- Security of the system should also be noted. I don’t want to dwell on this, but just like banks and stock exchanges, the security of patients’ confidential data should be wary off.
- Inter hospital hybrid integration – the system should be able to include, an integration into a different system. These is important but I wonder how it can be done. These should be those of *.csv style of data, with exporting the data, the same data can be used on a different system. Maybe jpg or png data for high graphic burden patient’s clinical case.
- Cost effective- the system should encompass the general idea that, IT hospital with its computer should be cost effective. Cost effective, in a sense that, you do not need someone to fetch and trace results, easily managing the inventory in and outs which can avoid the expiration of drugs, and uptodate bed status. I wonder having a computer related system is really cost effective.
- Integration with telecommunication system- I think a closed system of clinical patient management is still inadequate. The system should be able to directly email, sms, or sending an invitation or reminder instead of different platform. We are talking about patient care, therefore you need that advantage of calling up and reminding patients. A system that can send infoblast and reminder personal gadget should be wonderful.