Streamlining medical records into a centralised system at UMSC Malaysia

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>