“We have long forgotten the importance of [the healthcare] workforce over the years and taken them for granted. Even in the pre-COVID-19 days, we have been asking them to do more with less, in less time and increased complexity,” said Dr Charles Alessi, HIMSS chief clinical officer and moderator of the session titled “Empowering and protecting the care team,” on Day 2 of the HIMSS APAC Malaysia Digital Health Summit.

Joining Dr Alessi are guest speakers Dr Tan Hui Ling, managing director, Bagan Specialist Centre and Oriental Melaka Straits Medical Centre, Malaysia, and Arvind Sivaramakrishnan, chief information officer, Enterprise Digital Transformation Expert, Apollo Hospitals, India. Dr Tan and Sivaramakrishnan shared their experiences in implementing new solutions and processes at their respective hospitals, and some of the key lessons in engaging their staff to improve work processes and the quality of care for patients.

Integrated systems in hospitals and their challenges

Dr Tan explained that at the hospitals under her care, the vital signs monitoring process has been digitized by automating the early warning score and integrated into the EMR system. There were two initial challenges in setting up the automated early warning score system: work processes and clinical safety issues. 

Vital signs monitoring is a basic work process in the nurses’ routine work and every patient admitted into the hospital will have their vital signs monitored. A manual system of vital signs monitoring was adopted earlier but this meant increased workloads for nurses, transcribing errors, calculation errors and delays in the escalation of care. 

When healthcare partner Philips came onboard to offer a digitized process of vital signs measurement and automate the early warning score, Dr Tan seized the opportunity. Philips’ vital signs machine has the early warning score integrated with it, so when nurses performed the vital signs measurement, the total early warning score will automatically be calculated and they will be prompted on what to do next.

These data will also be sent to a general dashboard, in which the team leader or doctor can have a bird’s eye view and status on the patient as required. More significantly, if there is a high risk score or high risk patient, the team leader or on-call doctor will an alarm to take the next course of action, which reduced the delay in the escalation of care.

With the adoption of the digitized vital signs monitoring system, key benefits included a 2-minute reduction on the time spent on the patient, a reduction of code blue incidents of up to 25% per 1000 admission days and a reduction of 40% in death incidences per 1000 admission days.

Dr Tan summarized some of the key challenges in the adoption of new tech at her hospitals. Firstly, there is a lack of exposure and experience with HIT in Asia and it was difficult for staff to visualize the digitization of their routine workflow, as well as use tech to improve their work processes/quality of care. This requires exposure and training. Next, in terms of mindsets, there are two groups of people – one who is excited to embrace IT and the other who is resistant to change. These two groups need to be handled differently, such as getting the excited ones to influence and help train the nonchalant ones.

Lastly, different experts and users have very different expectations from the HIT systems, so feedback that will create high value improvement in the workflow needs to be prioritized, and expectations need to be mediated between the different stakeholders. 

Approaching the continuum of care

Dr Alessi asked Sivaramakrishnan how a large hospital network in India like Apollo Hospitals approached the continuum of care for its patients. The latter explained firstly that every patient has a single unique identifier or ID and secondly, from a technology and IT standpoint, the use of a single software for more than 10,000 beds and 32 hospitals in its network means a “single version of truth”, but also a challenge to keep the records pristine, accurate and responsibly maintained.

There is also a single sign-on process, in which the HIT system presents itself based on the role and work that is assigned to the user/healthcare staff so it enables them to do their job(s) easier, rather than requesting the system to help the staff, Sivaramakrishnan said. “The system is in alignment with the work process, the work process is not made to fit the technology.” 

When it comes to handover of patients from one staff member to another staff members, there might be lapses in care, Dr Alessi said. However, Sivaramakrishnan responded by saying that these lapses are minimized as there are checklists integrated into the HIT system and at every point of care, which reduces the anxiety around handovers. 

Challenges faced in data mapping from early warning support system to the EMR

Addressing a question on the challenges faced in data mapping/interfacing from the early waning support system to the main EMR, Dr Tan said that in the early days that there were indeed issues interfacing with the EMR. “One of the biggest challenges was in the element of the security policy of our care partner, as well as our EMR partner.”

There was a period of a ‘cold war’ as both partners did not want to take a step back to ‘relax’ on the security issue. Dr Tan said that after many rounds of negotiation and focusing on the outcomes of the solution, the issue was resolved and the interfacing was done.