Category Archives: bTechno

Streamlining medical records into a centralised system at UMSC Malaysia

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Image credit : CHIP Malaysia

I fist read about – from reading the September issue of CHIP Malaysia, an IT magazine I purchase from time to time, a move to streamline medical records into a centralised system utilising virtualisation technology supplied by VMware, the market leader in virtualisation at the University of Malaya Specialist Centre (UMSC). This article was too short and hard for me to understand about ‘virtualisation’. I decided to find out more, prepare a post on this blog, and here is what I like to share with you readers. In this post I shall focus a little on virtualisation techonlogy – hoping you and I can understand it better, and how UMSC hopes to decentralise medical records, and its benefits.

The UMSC is a private medical centre within a publicly funded, 1,300-bed teaching hospital called the University of Malaya Medical Centre (UMMC), both operated by the University of Malaya. UMSC provides the public access to world-class specialist clinical services with the support from about 200 clinicians and another 250 nursing and support staff.

Image credit : http://sprouti.com/

The VMware website explains that virtualisation is about how “today’s x86 computer hardware was designed to run a single operating system and a single application, leaving most machines vastly underutilized. Virtualization lets you running multiple virtual machines on a single physical machine, with each virtual machine sharing the resources of that one physical computer across multiple environments. Different virtual machines can run different operating systems and multiple applications on the same physical computer. “

You can watch this video and learn how virtualisation works.


Source of the video above : http://www.vmware.com/virtualization/

I am sure many of you readers out there will feel intimidated watching and understanding all the IT jargon in this video.

Allow me to describe a little about virtualisation, and tell you how servers we know about can be transformed into virtual machines, which is what basically virtualisation is all about.

Most of you will know and surely heard of servers and networks. A server is a physical computer dedicated to running one or more services to serve the needs of the users of other computers on the network, the “clients”. Servers usually run a single operating system and a single application. You would have heard the IT guy talking about a database server, file server, mail server, print server, web server, gaming server. Each of these kind of named serves run a single operating system and a single application, depending on the computing service that each of these servers offer. This is the traditional way servers are managed, in a simple way of understanding You would have noticed several servers (computers) all located in a server room. Since servers are designed to run a single operating system and a single application, these leaves most of such computers (machines) vastly underutilised. This is when the virtualisation technology steps in.

Virtualisation converts any one server which is a single physical machine, into mutliple virtual machines inside it, with each virtual machine sharing the resources – including the CPU, RAM, hard disk and network controller of that one physical computer across multiple environments. Different virtual machines inside any one server can run different operating systems including Windows, Linux and more and multiple applications, for example Oracle, Exchange, SQL Server, Sharepoint and SAP, on the same physical computer. Thus, the old “one server, one application” model is eliminated. This frees IT admins from spending so much time managing servers.

Healthcare IT infrastructure in healthcare settings in many places as it was at UMSC, is a very traditional environment of complex, device-centric computing made up of autonomous content factories or “silos” with inherently incompatible technologies, product-specific workflows, uncoordinated content development, efforts resulting in overlapping content, linear workflows to produce multiple deliverables from each product’s content.

Medical records in most hospitals in Malaysia are still not centralised, scattered across departments often keeping their own documents making it diffiucult to collate them. This often leads to long delays in patients getting treatment.

In the pursuit of a new strategy for content ubiquity (that is to say the state or capacity of the contents of medical records being everywhere, especially at the same time), UMSC seeked solutions to change its fragmented, legacy IT systems of a decentralised medical records system into cost-effective, agile computing infrastructure environments. UMSC wanted to concentrate the data and make it readily available for their medical personnel to access.

According to Leon Jackson, Head of IT, UMSC, in the past doctors could end up using as many as three terminals simultaneously to access the necessary information to treat a patient. Jackson was hired in 2009 to help develop UMSC’s IT system for its new premises in 2016. He started the hospital on a journey which would see the digitisation of existing workflow and adopting virtualisation to drive efficiency and making a move toward a unified virtualised IT environment. Jackson believes this is one of the easiest ways to gain a competitive edge in the medical industry.

The solution process faced a specialised set of infrastructure and end-user requirements to support the digitisation of biomedical imaging and other medical information, to enable/ease basic clinical processes via electronic workflows, and to provide personal desktop environments that could be accessed on mobile devices, and via terminals throughout UMSC including in sterile and electronically sensitive areas such as operating theaters which allow for more “sterile” equipment through the deployment of thin-client touchscreens with washable mice and keyboard.

UMSC wanted to deliver a more user-centric (that is to say in which the needs, wants, and limitations of end users of a product are given extensive attention) connected care computing infrastructure environment to boost the availability of systems needed to treat patients effectively, the encouragement of clinicians to embrace digitisation, and meet demand for new medical services applications.

After evaluating options, UMSC decided on VMware. VMware claims that VMware virtualisation solutions have been chosen by over 250,000 customers, including 100% of the Fortune 100.

VMware’s solution to UMSC was for a more user-centric computing infrastructure environment which enables higher quality on-demand experience which allows new ways for clinicians to collaborate across applications and data from any device, where and when they need. In this way, more clinicians and healthcare consumers were expected to leverage hybrid cloud resources, while maintaining a managed, secure environment to use their applications and services, through which healthcare providers will be able to deliver better services at lower costs.

We know for a fact that patient care happens everywhere – bedsides, remote offices, homes, labs and these days in the cloud. These varied locations require providers to manage a variety of unique desktop environments, ranging from workstations on wheels to high-traffic nursing stations to inpatient room computers.

UMSC hopes to benefit from this automated and efficient ubiquitous IT system in the following ways:

  1. speeding up clinicians’ access to various clinical information systems across different devices, including mobile and fixed terminals providing the continuous availability necessary to clinicians delivering tertiary care, and to all delivery units using IT to improve patient management.
  2. provides better decision support to clinicians and increases efficiency that will lead to reduced waiting times and UMSC being able to see more patients
  3. cutting server hardware and infrastructure spending to 60 percent of the cost of an all-physical infrastructure; vendors that could not adapt to its new infrastructure were gradually phased out
  4. a system that responds quickly to clinicians’ requirements and helps provide a better service to patients; minimising unplanned downtime; and redirects IT spending to support new application delivery
  5. deploy new virtual machines in minutes to support staff requirements, rather than waiting weeks or months to procure and implement new physical servers
  6. VMware View desktop virtualisation provides the surgical team with a ”follow-me desktop’ that helps them access the same data from multiple devices within the private network; surgical work is considered to be typically not conducive to carrying mobile devices, so for surgeons a ‘follow me’ desktop accessible from fixed terminals anywhere within the UMSC buildings is ideal
  7. clinicians will be able to consume and contribute information to and from the patients records at the point of care, improving efficiency, reducing errors and the need for clerical support plus time wasted treasure hunting for information; for example, that if a doctor was giving a lecture on campus and received a call from a nurse, he would be able to remotely access his files and provide the required information for a particular patient

For your information, UMSC is currently running about 100 VMware View desktops, and expects to increase this over the following year to 300 concurrent users. Jackson revealed that to support this migration, UMSC had invested up to 4 percent of its revenue each year for the last three years on IT.

Also on the pipeline by the end of Q3 2012, is when all clinicans will use iPads to access a virtual Windows 7 desktop incorporating legacy thick-client (thick-client meaning, “intelligent” regular Windows applications installed on the local machine i.e the client machine, capable to processing more data locally on the client) applications together with new mobile applications for its hospital information systems.

References:
Avanti, K 2012, How VMware is helping to ‘free’ Malaysian healthcare, Computerworld Malaysia, viewed 22 September 2012,  <http://www.computerworld.com.my/resource/applications/how-vmware-is-helping-to-free-malaysian-healthcare/>

CHIP Malaysia, Making Sense of Medicine, September 2012, Online Dynamics (M) Sdn. Bhd., Petaling Jaya, Selangor Malaysia

Farhan, G 2012,  01/08/2012, Cloud medicine at UMSC, PC.com Malaysia, viewed 25 September 2012, < https://www.liveatpc.com/cloud-medicine-at-umsc>

Ryan, H 2012, M’sia hospital prescribes virtualization for healthcare sector, ZDNet, viewed 25 September 2012, <http://www.zdnet.com/my/msia-hospital-prescribes-virtualization-for-healthcare-sector-7000002976/>

VMware, viewed 22 September 2012, <http://www.vmware.com/>

VMware Customer Case Study, Medical Center’s Virtualization Journey Boosts Patient Care and Transforms Medical Systems, VMware, viewed 26 September 2012,<http://www.vmware.com/files/pdf/customers/
VMware_University_Malaya_Specialist_Centre_12Q2_EN_Case_Study.pdf>

Whither paper-based medical records systems?

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I have this infographic (below) to share which shows how technology has advanced over the last 50 years (from 1960 to today), yet most of us accept that medical records are still kept in paper files, and that’s the way it is. Technology has evolved over those many years and has brought sweeping changes, brought about many changes, whither paper-based medical records systems? Since back in the mid-70s when I started my career in Health Information Management (HIM) / Medical Records (MR) Management there is no way I would ever have dreamt of where we are technologically today. I wonder what our medical records systems will be like in 2020 technologically when Malaysia envisions being a developed nation.

2020 is just under 8 years more to arrive, meanwhile, have we thought about how much time is being wasted on paper activities that could so easily be streamlined?

This is how it looks (below) at a typical medical records department here in Malaysia.

Image credit: A typical scene in a paper-based medical records department in Malaysia, MyTawau, Facebook

Is your life as an HIM / MR practitioner going to become easier – and much more organised if we moved to computer-based medical records, lured by the promise that once you move to a paperless way of organising things?

Talk about getting rid of paper, I hope hospitals everywhere can go from a large file room with tons of paper in files to a large server with high-tech programs, surely we’ve saved thousands of trees and dollars by doing so.

Although access online is available 24/7 for everything from shopping to helping with homework, it is not available for medical records. Patients, doctors, and other caregivers who rely on the medical system may find themselves in a dire situation when data about the most critical information about health and quality of life can’t be accessed in a timely manner that would and should guide future treatment. Yet it ought to be. The cost comes in wasted time, diminished quality of care, duplicate testing, needless expense, unnecessary worry, and, worst of all, lives lost.

Is then the paper-based medical records system not good enough anymore?

The technology applied in ATMs and online banking provides universal access to financial records, and one can access them online, too. The paper-based system of medical information currently in use has no connectivity, no ease of access for either patients or providers and limited security and tracking of access. It is a barrier to improved treatment. This kind of technology could and should be applied to healthcare as it means more than convenience, this technology will definitely save lives. What is needed, is making the connection, and I think the technological answer to the need is within reach.

I hope the day is not far off when we can walk into an HIM/MR department of a hospital and not see any more medical records still kept in paper files!

17 POSSIBLE REASONS HOW ELECTRONIC MEDICAL RECORDS (EMR) might support day-to-day patient care

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I stumbled upon the post “Improving Patient Care through EMRs” from the Plus91 blog by Pooja Raval who used to work for Plus91, a healthcare Technology firm developing Innovative High Quality Solutions for the Indian Healthcare Industry based in Pune. Maharashtra, India.

In her post she offers a list of reasons why Electronic Medical Records (EMRs) is  a modern revolution in the field of healthcare with all its numerous benefits to doctors that eventually can improve patient care. She listed twelve good reasons. I thought her post was pretty interesting and decided to expand on it, so it would seem a little more comprehensive. So here I have reproduced her thoughts, and expanded on her post what I think from my literature search are the extra EMR benefits.

Now I have seventeen (17) reasons!

This list (as below) has no particular order of importance, nonetheless I have retained her order in writing the 12 reasons and added on the five (5) more reasons. Click on any thumbnail image to view the presentation in the same tab of your current browser window, press Esc key to continue reading the article).

I am sure Health Information Management (HIM) / Medical Records (MR) practitioners reading this post working in an EMR workplace, will know if these 17 reasons hold water. If these reasons justify a shift to EMRs, then HIM/MR practitioners at non-EMR workplaces who still practice on paper-based medical records could view these reasons as a reason to propose a planned cut back on paper-based medical records quickly and make the swift transition to EMRs.

However, I am certain It is common for individuals to have anxiety about the transition as it represents a change in their very comfortable routine. Others may be simply “technophobic” and deplore the idea of spending any more time interacting with technology than they already have to.

One way to address these issues creating buy-in from doctors and staff is to highlight the ways in which the EMR implementation may save time and make life easier.

There is no process in the office that will not be affected – and hopefully improved – by the EMR. Communicating this in a way that emphasises the positive aspects of the change, while carefully addressing employee fears and concerns, can build excitement for the transition and ultimately ensure its success.

References :
Carolyn, KS & Laura LSO, ‘Usability: Patient–Physician Interactions and the Electronic Medical Record’, in J Stephan & MG Frank (eds) 2012, Information and Communication Technologies in Healthcare, Boca Raton, FL, USA, pp. 123-144

Neil, SS (ed.) 2011, Electronic Medical Records A Practical Guide for Primary Care, Humana Press, New York, USA

Pooja,  R 2011, Improving Patient Care Through EMRs, viewed 22 August 2012, <http://technology4doctors.blogspot.com/2011/03/improving-patient-care-through-emrs.html>

Prathibha, V (ed.) 2010, Medical quality management : theory and practice, 2nd edn, Jones and Bartlett Publishers, Sudbury, MA, USA

How safe is safe for the future of Electronic Health Records?

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It’s late sunday afternoon, I was reading news feeds. One feed struck me as worthy of sharing on this blog this instance. I hope you like the Photoshop graphics I swiftly assembled to prepare along for this post.

A Bloomberg report, citing a privacy blog Dissent Doe reported that  hackers were able to access electronic medical records and emails belonging to the Surgeons of Lake County, a medical practice in Libertyville, Illinois, USA.

The hackers holding the data for ransom, demanded the practice to pay ransom money for a password to access the encrypted.The blog reported the practice declined to pay, it shut down the server and notified authorities but was clueless whether the practice was eventually able to access its Electronic Health Records (EHRs), or if it did, how did they do it.

This disturbing new trend emerging serves as a warning that unpredictable things can happen to data once it’s digitized when hackers (criminals) try to exploit the healthcare industry’s shift to digital healthcare information.

Also from this article, it quoted Bloomberg which reported two cases involving pharmaceutical prescription systems in 2009 and 2008, and also several cases prior to 2008 related to outsourcing practices.

In 2009, the Virginia Prescription Monitoring Program was hacked and hackers demanded $10 million from the state of Virginia (USA) after he or she claimed to have stolen and encrypted personal and prescription drugs for 8.3 million patients. Another hacker in 2008  demonstrated he or she had personal information on a few dozen members of the prescription-drug benefits manager Express Scripts and demanded ransom money, but never got the ransom demanded from this company. Four years earlier to 2008, several California hospitals were blackmailed after outsourcing their medical transcriptions overseas.

The Obama Administration is aggressively expanding the use of EHRs that it strongly believes is fundamental to reforming the U.S health care system. Billions of dollars worth of grants have been announced to help hospitals and health care providers implement and use EHRs. Many hospitals around the world have also moved the EHR way.

Criminal activities I am now quoting from this article, may seem one small event or events in an isolated area far away in the U.S and may not seem especially noteworthy, but it may offer the first tangible warning of a larger problem developing as the shift to digital medical records begins in U.S in a big way and even here on Malaysian shores as our hospitals begin to move the EHR way. I think hackers holding healthcare data for ransom may be described as a canary in a coal mine for the future of EHRs.

Abridged by R. Vijayan from the orginal article “Hackers Hold Health Data Hostage” by John Pulley for Nextgov, August 11, 2012

Medical Records Optimization

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Last friday, I was googling for casemix for a future post when I stumble upon the announcement by The International Centre for Casemix and Clinical Coding (ITCC), UKM Medical Centre, Universiti Kebangsaan Malaysia (UKM), Malaysia which was planning to organise the 6th International Casemix Conference 2012 (6ICMC2012) from the 6th -7th June 2012  in Kuala Lumpur , Malaysia.

Reading through this announcement, I noticed for the first time the words “Medical Record Optimization”.  The organiser was calling for invitations from local and international participants to attend and present their findings and papers in several areas, including on Medical Record Optimization.

I abandoned my search for casemix (after surfing briefly some casemix websites) and decided to find out what Medical Record Optimization was all about and blog about it soon after as in this post before you. More googling and reviewing my search led me to locate MedNeutral which stood out prominently in the search list.

MedNeutral which has its roots in the insurance industry is a Brahma Holdings company which provides transformational solutions to the insurance industry in the United States of America, is headquartered in La Jolla, CA, USA.

MedNeutral’s proprietary Medical Records Optimization™ (MRO) solution is a next-generation service comprising of a set of digital medical record solutions that performs a triage on the medical records for claims processors, legal counsel, financial personnel, medical professionals, and government agencies.

As you will be aware in the Malaysian hospital setting, medical records contain extremely important information for claims processing, and also for data analytics. As Health Information Management (HIM) / Medical Records (MR) practitioners still dealing with paper-based medical records in most of Malaysia’s public and private hospitals (as in most parts of the developing world and under-developed world regions), something as basic as illegible handwriting is still the biggest problem in paper-based medical records. Other challenges in paper-based medical records include the absence of medical context, missing or incomplete documentation, difficulty in accessing the necessary medical information and use of jargon and/or symbols.

MRO converts these unstructured data – as found in paper or imaged medical documents, housed in document management or claims transaction systems into highly structured information through file assembly.

Key features of MRO are:

  • medical records are sorted and arranged in chronological order (with sorts also available by other fields). Raw medical data in different formats, and hand-written are further transformed into a set of electronically scanned, chronologically based, consistently indexed, and formatted records packages.
  • medical abstracts for key record types, which summarize the medical facts contained within the files
  • search and indexing tools embedded in the MRO solution allow to quickly call up facts and medical context around specific treatments or body parts; tracking algorithms enable automated identification of changes in diagnosis, medication, provider or facility
  • MRO also features collaboration tools to facilitate rapid sharing of abstracts, facts and analysis which leads to improved organizational productivity and faster and efficient decision making

MedNeutral’s MRO solution (clicking on the image below for a larger view opens the larger view in a new tab of your current window) adds value in the following ways:

Soruce : MedNeutral, medneutral.com/solution-value/

Many top institutions like LexisNexis Communities  have applied MedNeutral’s MRO solution platform to streamline the medical review process and make more accurate and informed decisions for example during the Gulf Oil spill, as an example of a scalable solution capable of processing voluminous medical records, identify factors which impact value, establishes legitimacy of claims and expedites the resolution of claims from the rash of personal injury claims during this man-made disaster.

An on-going, systematic study by Accenture (a global management consulting, technology services and outsourcing company) of insurance claims performance dating back to the 1990s, showed that insurers have difficulty accessing the information in medical records due to unstructured data and believes that investment in information technology in this area, with a shift to a structured data approach, is necessary.

It was clear from the articles I sourced that the hurdles for optimizing medical records for a meaningful use are both technological and organisational. An area for investment is in developing and promoting industry standards for medical records. But what is really important is taking a comprehensive look at the way medical information is acquired and handled, a probable progression to electronic medical records.

As hindsight, I could not find any mention of MRO from the scientific programme for the 6th International Casemix Conference 2012.

I can only assume that the topic Medical Records Optimization was planned to be included for this casemix conference as the processes of digitization, indexing, abstraction, collaboration and analysis are similarly applied to optimize medical records contents for casemix.

After knowing what MRO was all about, I decided to refresh my rusty memory about Casemix as I vaguely remembered casemix is about the difficult challenge of reducing costs while maintaining or improving quality of care and access. I also remember that Casemix was about methodologies, which categorise patients into statistically and clinically homogeneous groups based on the collection of clinical and administrative data  and the interpretation of hospital patient data related to the types of cases treated, in order to assist hospitals define their products, measure their productivity and assess quality.

Casemix data also allows support for a unique collaboration between clinicians, statisticians, accountants, managers, funders and policy makers as it provides a common language that is freely shared with a strong focus on Peer Group review.

From further reading about Casemix lead me to believe that Casemix used similar techniques by MRO in claims processing, to optimize medical records. Casemix classified patients into a manageable number of groups (patients in the same group should cost roughly the same to treat) but poor quality information meant poor quality casemix information, and thus the quality of Casemix information rests with clinician documentation, clinical coders and accuracy of information systems, that is much needed and desperate call for a structured data approach in medical records.

I shall conclude that the reference to medical records optimization for the 6th International Casemix Conference 2012 had nothing to do with MedNeutral’s trademarked Medical Records Optimization™ (MRO) product solution that was largely used by companies for claims processing, but wanted would-be speakers to speak and present on how medical records could be optimised for Casemix purposes.

References :
Casemix for Beginners, The National Casemix & Activity Based Funding Conference, 3 to 7 October, 2011 – Radisson Resort Gold Coast, Queensland, Australia, casemixconference2011.com.au/

Casemix, Canadian Institute for Health Information (CIHI), cihi.ca/

“Mastering Medical Information”, May 2009, Accenture, accenture.com/

MedNeutral, medneutral.com/solution-value/

“MedNeutral’s Medical Records Optimization for Gulf Oil Spill”, August 19, 2010, LexisNexis Communities, lexisnexis.com/

“Optimizing medical claims: A data-centric approach”, March 5, 2010, Accenture, accenture.com/us-en/blogs/accenture-blog-on-insurance/default.aspx

The Irish Casemix Programme, casemix.ie