Minimum or no paper trail: Paper workload has been
significantly reduced at the level of 6 and no paper trail at the level
of 7 certificate public hospitals.
Public: “MoH requires the consent form with the wet signature of
the patient and only this document is kept in the patient’s files, the
rest are stored in digital archives. Hospital electronic archives
should be securely protected against the risk of cyber-attacks. That’s
why archive backups are made on a regular basis and were kept in the
Provincial Health Directorates in addition to our hospital.” (Pubhosp7)
Private : “ After scanning patient medical records, we
store them in our electronic archives. Only the signed consent form was
kept as a hard copy in the patient file. However, we are trying to
eliminate that hard copy by searching the technology to be able to
digitalize the signed consent form as well” (PrivHosp6).
Electronic patient records : Results of all patient examinations
were transferred to e-pulse via HMIS in a few days and stored in
electronic archives.
Public: Patient records are able to be tracked from admittance
to hospital and continue until the patient leaves the hospital. We only
get signatures for the consent form. This is controlled by the Ministry
of Health. (Pubhosp5).
Private: “Digitalized X-ray images, and results of blood,
pathology, or other examinations are transferred directly to e-pulse
thru HMIS with in few hours or days depending upon the complexity of
X-ray images and the results were also accessed thru hospital web site
as well” (Prvhosp7).
Decision support system : It works with a software program to
provide a direction to diagnosis and treatment by offering
recommendations to healthcare professionals thru alerting system.
Decision support system prevents physicians or nurses or any healthcare
professional from making a mistake or skipping any important step in the
patient care. The HMIS possess a warning system for the doctors and
nurses for situations when any changes occurr in patients’ vital signs
and the system itself presents various suggestions when the need arises
concerning tests or any change in treatment algorithms. For example, the
system sends a warning to the nurse about the necessity of changing the
patient position to prevent pressure soars and delivery of medicine and
other care.
Public: “We have established decision support systems that are
triggered by vital signs or laboratory results. This system provides
great convenience to doctors and nurses.” (Pubhosp5)
Private: “It is an important system to prevent doctors and nurses from
making mistakes. For example, if a patient who has a pacemaker is going
to undergo MRI, the system gives a warning to a doctor to check the
patient.” (Prvhosp6)
Closed loop medicine system : As soon as the medicine order was
entered, the order appeared both on nurse and pharmacist screens
simultaneously. When the doctor writes an e-order, he or she can be
warned about the possibility of drug to drug and drug to meal
interactions with the prescribed medicine by the system. After the
approval of the medicine by the pharmacist, the pharmacy prepares unit
doses either through automation or manual and delivered in the smart
cart allowing the nurse to administer the right medicine at the right
dose at the right time to a right patient. Smart cards were expensive;
therefore, some hospitals reported using locked medicine cabinets in
each service and the medicines which were kept in these cabinets were
delivered by the nurse after pairing the medicine with the patient.
Public: “Closed loop medicine system is the most important
application in the digital hospital. We as a hospital cannot afford
smart carts and for this reason, we designed our own cart and put the PC
on it. We also made a packaging device for delivering unit dose
medicine. This device can produce 1,200 packages per hour. We are
actively using it with the barcode reading system.” (Pubhosp6).
Private: “We don’t have expensive smart carts yet; we use locked
medicine cabinets in each service and the daily dose of medicine is delivered in a plastic bag for the patient. Medicines packed in unit
doses are delivered on a daily basis by the nurse after the pairing the
medicine with the patient. (Privhosp5).
Table 7 displays expected technological advancements mentioned by
participants in digital hospitals in the future.
Table 7: Future technologies