Differences in Hospital Computerised Systems

With less than 2 months before the final MBBS, final year students are thinking about what order they want to do their HO rotations and in which hospitals. And when it comes to hospitals, all aspects come into play: location, teaching, people to work with, how good it looks on a resume, so on and so forth. One surprising factor that came in are the computerised systems.

It’s now the IT age. Accordingly, the hospitals have moved with the times. The ol’ whiteboard with patients’ info (for staff) in TTSH had given way to two large flat screen panels at the nurses’ counter. The X-ray, CT, MRI films no longer need to be printed out. They can be viewed on the computer monitor with real-life adjustment of views/contrast/brightness. Discharge summaries no longer need to be written out by hand. Patient lab results can be pulled out easily.

With this convenience comes problems, however. Things that are more complicated tend to break down more easily, and the IT upgrades don’t stretch to all areas. For instance, the computers in some of the TTSH MO rooms look (and work) like it’d be an act of mercy to put them down. In some wards in NUH, over half the COWS (Computers on Wheels) are non-functioning. On the whole, however, things have improved.

One thing that stood out in the contrast between hospitals is which system they used for patient information. In the SingHealth cluster (SGH, CGH, KKWCH) it’s from iSoft. For National Healthcare Group (AH, TTSH, NUH), it’s the self-developed Computerised Patient Support System (CPSS). A quick survey of his classmates as well as the members of the current batch of house officers that J. knows revealed that in general, it’s not much of a fight. The vast majority support iSoft. It’s supposedly faster, better designed, easier to use and more pleasing on the eye.

Thinking about it, it’s actually true. One pet peeve of CPSS is that it leaves a tiny slit for entering components of the discharge summary. Whereas iSoft provides a “+” button to “full-screen” the text entry area, users of CPSS end up opening Notepad to type their discharge summaries before cutting and pasting into the text entry area. Similar things go for laboratory investigations, it’s definitely more easily seen on iSoft. That’s not to say that CPSS isn’t useful or doesn’t work, but it’s like the difference between Windows Vista and Mac OS: CPSS does the same things with less user-friendliness, is less intuitive and takes more time.

In the past few months, J. has heard that if there’s one thing HOs hate, it’s the investigation ordering program in NHG: Aurora. Here’s J.’s experience. The phlebotomist usually comes around 9-10’ish, while rounds can sometimes go to 11-12’ish. While the HO follows the round, he/she’d ask the SIP students to quickly run to a COW (as mentioned above, frequently broken) and order investigations using the software. It often takes some time to find a free computer.

And once one is found, there’s the problem of loading Aurora. It is slow. Then there’s the entering of details, ordering of investigations, waiting for confirmation and then printing it. It doesn’t take absolutely a lot of time, but it definitely takes time that one can’t spare on the round. Now, SIP students are only around for a couple of months each year… so the HOs without the benefit of such runners would suffer, and so would the patients that can’t get their bloods done in time for the consultants to review in the afternoon round. In December this year, one person commented:

“This horrible system takes eons to load and they are now forcing me to print aurora stickers. when will this madness end?”

Anyway, here’s what J.’s wondering.

  • Should we stick to one computerised patient support system throughout all public hospitals?
  • Did it cost more to license iSoft than it did to develop CPSS?
  • What are the benefits of spending money and time on Aurora? Does it cut down on mistaken investigations? We’ve heard the bad, what’s the good?
  • How does the IT department keep everything running smoothly?
  • Does this, an essential part of everyday hospital work, affect one’s functioning and choice of healthcare clusters?

The answer to the last question is a resounding Yes.

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5 responses to this post.

  1. Posted by James Yip on February 19, 2008 at 10:44 pm

    Yes. IT has truly changed the landscape of practicing medicine. The pen and paper system like all traditional media has its pros. Simple, fast, flexible and low cost . However, we all know the problems, bad handwriting, multiple systems of coding disease processes, not efficient to store long term, data not mineable for research and so forth. At its worst it may compromise patient safety due to poor record keeping. IT itself has its own set of problems. Expensive to develope, expensive to implement, impossible to keep up with long need for more speed and computing power, unrealistic expectations of people who want IT to make things better, faster , cheaper and safer. The current EMRX/CPRS system is a testimony that sharing of electronic data is important in the co-ordination of patient care. Then comes the difficult decision to buy a commercial system or build a home grown system. Both again with its pros and cons. As a physician who spends most of his other life helping build IT systems that make sense, it is difficult to please everyone. Every commercial system locks you in to its proprietry code and hence cannot expand beyong a certain time. Building your own takes a lot time and effort. iSoft is at the end of its lifespan and may soon be replaced. CPSS may also soon move to another platform. The pressure is on to make reports safer and more accountable by having Clinician Order Entry Systems, hence ‘Aurora like’ interfaces will start appearing for everything. Soon electronic IMR will become a reality as would decision support systems. I welcome any who would step forward who will take on the mantle to lead your colleagues forward to the exciting and sometimes scary world of medical IT.

    Reply

  2. Many of the people on the wards don’t know about the difficulties of IT systems that you’ve pointed out.

    At the moment, it’s still a pain to work on Aurora. That said, everyone sees the final result, and few see the effort that goes on behind the scene. Thank you, Dr Yip, for commenting and ofr your work on medical IT systems.

    Looking forward to seeing the new systems in both NHG and SingHealth!

    Reply

  3. Technology innovates the health care system is also into most convenient and empirical state of services that brings better service to humanity.

    Reply

  4. msot computer monitors these days are already using LCD technology and some are LED-LCD .:.

    Reply

  5. Wow, fantastic blog layout! How lengthy have you ever been running a blog for?
    Vsevolod http://test-page.ru/

    Reply

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