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Healthcare IT

Acute care, astute IT

By Jianggan Li | 19 January 2010

With big aspirations and professional international management, Prince Court Medical Centre in Malaysia puts IT at the heart of strategy, as its CIO, Harald Feiel, explains to Jianggan Li.

Going by its location in central Kuala Lumpur and state-of-the-art design, people tend to perceive Prince Court Medical Centre as a very expensive facility.

But Harald Feiel, PCMC’s Chief Information Officer, says this is a myth. “Although we aspire to become the best acute care hospital in Asia with unique, top-notch facilities, we are no more expensive than other private hospitals here in Malaysia,” he explains. “We have done market analysis and in most areas our fees are comparable with those of other hospitals.”

PCMC started off when Petronas, Malaysia’s national oil company, wanted to establish a burns unit so that injured workers from oil platforms don’t have to be airlifted to Singapore or Thailand for treatment. With no previous experience of running a hospital, Petronas engaged an international management company. VAMED, an Austrian consulting group was brought in, with the experience of running hospitals globally. The group advised Petronas that a mere burns unit would not be sustainable. After a bit of head-scratching, PCMC, a full-fledged acute care hospital, was born.

Doing things differently
The University of Vienna takes care of the clinical governance while Vamed manages the hospital. The soft launch came in September 2007, and so far, 120 beds out of 300 planned are open. New wards are opened every month. “We could go faster but there is a shortage of qualified nurses, a problem in many places,” Feiel explains. “In comparison, consultants and surgeons are easy to source.”

As the first hospital in Malaysia managed by an international healthcare management company, PCMC approaches many things differently. JCI-accreditation process was started immediately after its opening, and IT was put as one of the most critical investment decisions. MSQH (Malaysian society for Quality and Health) accreditation is currently under way.

“A fully implemented EMR (electronic medical record system) is one of the key differentiators to other private hospitals in Malaysia. The EMR at PCMC provides relevant clinical information to caregivers at any given time and thus dramatically improves quality of patient care as all information from clinical departments such as Radiology, Laboratory, Pharmacy, Emergency, ICU, Operating Theatres, etc. is available electronically.

PCMC is also actively looking at the convergence of medical equipment and IT. “For instance devices in the laboratory generate lots of data that needs to be integrated into the electronic medical records, again, to support decision making of the caregivers,” says Feiel.

“Last but not least the revenue of private hospital is directly tied with accurate coding of diagnosis,” he adds. An audio visual system suite links PCMC’s operating theatres to its auditorium for training purposes. One 120 inch and four 55 inch screens allow for viewing of live surgeries, with all supporting information from clinical systems, such as radiology images and vital signs on different screens, all necessary for decision making. Teleconference equipment is also in place to link with Medical University of Vienna such that an expert panel can easily participate on case studies.

Bridging the gap
Drawing from his previous experience as CIO of a 2000 bed hospital in Austria, Feiel says IT needs to play a very active role in anticipating the needs of clinical and business departments and proposing solutions to address these needs.

“IT investment is one of the most strategic decisions to make, and in a hospital the core business is and will always be patient care,” he says. “Yet many organisations have this gap which impedes IT from being innovative about the patient care process.”

Feiel reasserts that this is the role of a Chief Medical Information Officer, which remains rare across Asia’s care providers. “You need such an individual to make communications smooth and manage expectations from both parties.”

“Ultimately, regardless whether you are dealing with legacy systems or not, you need change agents,” Feiel adds. “With paper it is very easy to bend the rules. You need change agents who understand the importance and transparency of electronic systems, and promote them for you.”

PCMC’s IT department has 18 employees, most of which focus on the business analysis and business consulting side, which “brings lots of benefits to the organisation”. Regular IT services are outsourced and four people are dedicated at managing the outsourced service providers (i.e. support and maintenance). The other 14 are focused on the application side.

An important criterion for solution providers is “stable, international companies who are not subject to takeover by another company in the foreseeable future”, says Feiel.

ERP was a relatively easy choice as the market is more mature than that of clinical suites. “It was a tough decision at the clinical side,” says Feiel, adding that the solution provider had to be very dedicated to healthcare IT, with experience and support structure in the country. SAP was chosen for ERP and Cerner Millennium suite was acquired for the clinical side.

The value of IT
Feiel notices that as in many other industries, healthcare organisations often look at only the costs of IT but not its value. Therefore among the growing pains PCMC has gone through, he reckons the tough timeline was the biggest test. “We had to make some decisions not to do some customisation upfront,” he says. “We had to keep it simple first and when the first patients came in after our opening, we started with more specific customisation.”

One issue associated with limited customisation is that the value of IT was in the beginning not very visible to both the users and the management, and that had in turn put pressure on the IT department.

“This is a learning curve for everyone, especially the private sector,” Feiel says. Most of the employees came from other hospital, often without any previous experience on using the EMR.

“An IT system is only visible to people in defined processes,” he explains. “Therefore the critical success factor is defining the processes, mapping that in the IT system, and making sure everyone has the same understanding on that.”And the key success measure ‘first and foremost’ is system adoption, and whether users use the system correctly as it is supposed to be defines how good the system design is.

“If you can make these two areas right, everything else falls in place,” says Feiel.

Fast, non-intrusive input
Like many hospital CIOs whom FutureGov has interviewed, Feiel is also hoping for seamless voice recognition. He explains that keyboard is still a hurdle for lots of users, as it is a slow and intrusive interface – a clinician has to give up what he or she is doing in order to type something. “Touch screens are getting there, but they require the applications to be very fit for such input method,” Feiel adds.

Moving forwards, PCMC’s IT team will continue with its ambitious projects to increase the value of IT, especially on improving customer/patient experience. Part of this is making it more convenient for outside parties to connect electronically with the hospital.

That includes referrals from general practitioners and document exchange with insurance companies. The current process is paper based and ‘very error prone’. Feiel hopes these can all be done in a very structured way in the near future.

Video and music on demand, together with free internet access will be available to inpatients. A patient-oriented portal is also being planned, as increasingly patients use the internet to get the information before they contact a doctor or a hospital. The portal will be available in multiple languages to make it easier for medical tourists.

While aiming at a slice of the medical tourism pie, Feiel is aware that a hospital can’t be overly dependent on patients from overseas, as “a pandemic like SARS could easily reduce their number to zero.” PCMC expects 30 per cent of its patients from overseas and the remaining from Malaysia – “a very health proportion”.

“Medical tourism market is said to be quite saturated – we are moving in newly,” Feiel says. “We have to be better in terms of customer services, quality, by any means possible.”

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