 FIGURE 1: Remote monitoring device and tele- triaging by a qualified nurse for assisting home monitoring and planned admissions/outpatient visits for patients with chronic diseases (Courtesy DOCOBO, Mauritius – UK)


role in their own care and thus facilitate progressive primary care especially for chronic conditions such as diabetes, asthma, heart failure, and renal failure. Through remote monitoring using healthcare devices and with commitment and participation by the patients and healthcare providers one can expect a better quality of life for these patients primarily due to reduction in unplanned hospital visits and admissions (see figure 1).


Digital health enables effective patient management, increased efficiency through remote diagnosis and reductions in management and treatment costs. Digitization promises to connect doctors not only to everything they need to know about their patients, but also to other doctors who have treated similar disorders. Healthcare insurance is already bleeding the economies of the


 FIGURE 2: Picture Archival & Communications System (PACS) – the system configuration and components are depicted (Courtesy VISUS, Germany)


developed nations – for example the cost burden of healthcare in the USA is close to $2 trillion. Optimised patient monitoring conceivably would be able to reduce long-term healthcare costs by reducing hospital admissions. In addition to these direct cost reductions – digital healthcare also impacts the environment favorably by reducing paper and film usage as it emphasizes online scheduling, electronic records, computerized physician order entry (CPOE), paperless billing and claims management and picture archival and communications system (PACS) (see figure 2). Despite all these so called advantages, many developed countries still lag behind in the usage of digital health concepts. In the USA, fewer than 15-20% of hospitals and less than 20-25% of small physician groups use some form of standardised electronic recording system. Hence, the health and information technology for economic and clinical health act (HITECH 2009) has included more than 19 billion in stimulus to encourage the use of ICT in healthcare (see figure 3). The drawbacks and challenges include new privacy regulations,


regulatory compliance, infrastructure capital cost (who pays and who gains?), integrations of various technologies etc. Digital healthcare, to be successful, must be built on a multidisciplinary approach from the healthcare, business and technology domains. Healthcare processes, at times will have to be re- invented/re-engineered and considerable time, effort and money may have to be dedicated towards the change management.


 FIGURE 3: Sample image of a electronic medical record with essential parameters


ACKNOWLEDGEMENTS I would like to thank the management of British American Hospitals Enterprise Limited for supporting the digital healthcare project from day one of opening of this hospital. This project would not have been successful without the commitment and collaboration between the ICT and Medical Records departments and the patience and support from the healthcare professionals at ApolloBramwell hospital.


012 HOSPITAL BUILD & INFRASTRUCTURE MAGAZINE ISSUE 1 2012


DIGITAL HOSPITAL My own personal experience at ApolloBramwell hospital, a tertiary, multispecialty hospital in Mauritius, was enlightening as to the challenges encountered in opening a hospital with a vision to be paperless and filmless, as far as possible. We started with fully functional PACS and a WIP version of HIS with more than 60% of the modules available from day one of operations. In the last two years the modules have undergone appreciable changes, thanks to inputs from the end users and the system per se has become more robust with negligible bugs. This has come at a price of severe stress on the ICT and MRD teams due to several change requests in a short span of time. We realised that more than 75% of our time was being utilised towards end user training, which despite initial resentments and resistances from physicians has ultimately reaped benefits in the form of quicker patient throughput and compliance to hospital policies and procedures/protocols. Halfway through the progress we also found that there was a tendency for becoming computer centric rather than patient care centric – a fact quickly identified and corrective actions taken. As a result, currently we are practically filmless and paperlite i.e. only diagnostic reports, outpatient prescriptions and discharge summaries are being printed. We have found digitisation of medical forms and charts particularly challenging and sometimes insurmountable – so much so that the MRD module has a separate tab for uploading paper charts. To our surprise the hospital information system (HIS) is supporting our endeavour towards accreditation for quality certification and integration of care pathways into day-to-day practices.


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