DIGITAL CLINICAL DATA: A Contribution of Instituto Traumatologico de Santiago de Chile to Hospital Management

Abstract

Instituto Traumatológico developed an innovative project to gather clinical data in a digital format, thus generating the information necessary to make decisions. The ultimate goal of the project is to provide our patients with the best attention possible. The impact of incorporating health care informatics to a hospital’s daily routine is profound, especially when those who are in charge of change have not learned about this topic or encouraged their students to incorporate new technologies to their work. The results of this project become even more significant when it is implemented in Latin American public hospitals, where the resources invested in technology are scarce. The success of this project could be considered a case of study for the region and the country. Although many efforts and resources have been invested in systematizing information, few cases have shown positive results. This project started with the systematization of the process of attention at the Emergency Department and the adaptation of the Emergency Information System. Once the implementation of this system was over, the project was applied to install the Polyclinic Information System, and Hospitalization Information Systems. The Electronic Health Record includes interfaces for specialties such as upper limbs, spine, hips and lower limbs, which makes it easier for specialists to handle the required information. The large amount of recollected data has been translated into statistic charts and indicators, which support the administration processes that take place in intermediate and superior areas of the Institute.

Introduction

Dr. Teodoro Gebauer Weisser Traumatological Institute has, among other things, the mission of diagnosing and treating people with conditions related to the musculoskeletal system so that they can recover fast and are effectively rehabilitated and reinserted in society. In order to do this, the Institute offers a personalized and human attention to their patients in a friendly and respectful environment. In academic terms, our mission is to participate in the formation of new specialists in our field and to produce relevant and useful scientific information that will contribute to the development of the specialty. It was in this context that, in December of 2005, the Institute started to adapt and implement the Information and Clinical Administration System in order to computerize every single clinical process. This structure keeps track of 400,000 patients and approximately 2,000,000 appointments. The employment of this system has allowed the Institute to meet its goals and objectives, which are directly related with fulfilling the aforementioned tasks.

The main focus of this project has been to gather “clinical data”, or information generated by each medical process, in order to improve the doctor-patient relationship, minimizing the possibility of errors and supporting and optimizing the doctor’s diagnoses. Furthermore, this recollection may also serve as the basis for new statistic processes, oriented to the different levels of clinical administration, and as a teaching resource, given the formative character of the Institute’s trauma specialists.

Learning about the cultural characteristics of a specialized hospital was very important when it came to incorporating the information and communication technologies (ICT). This new discipline, Health Informatics, is here for good, and although it was not easy to accept it and incorporate it into our culture, the benefits it currently generates are absolutely quantifiable and congruent with those achieved in developed countries. All costs, beyond financial ones, decrease. The information generated by the stored data benefits those who are at the core of any medical center: the patients. One of the main goals today is to improve the quality of the services that are provided to patients, especially because now it is possible to visualize elements that in the past could only be identified through intuition. As it will be shown later on, the benefits that are associated to information and clinical administration systems are unquestionable. Now, we will describe the experience we had when we incorporated ICT to health care.

Objectives

The main objectives of our project is to design an information and clinical administration system, supported by ICT, that integrates patient admission, emergency wards, polyclinics, operating rooms, intensive care units, hospitalization, kinesiology, occupational therapy, radiology departments, laboratories, pharmacies and statistics, through an informatics system that allows us to have exclusive data of the patients that are treated at Traumatological Institute (Hospital). In order to do so, we used PhilaxMed®’s Information and Clinical Administration System as our structure, which was developed by R&M Tech Ltda., a Chilean engineering company. The system is supposed to provide with the information necessary to administrate every level of the Hospital, from the actual user to the director.

These were secondary objectives of our project:

1. To build an optical fiber digital highway for all the clinical areas of the hospital. For safety reasons, the network must be closed.

2. To acquire necessary hardware equipment for each of the clinical areas.

3. To build a process map of each of the clinical areas, because the system must support all of the clinical processes that take place in the hospital.

4. To develop orientation and demonstration seminars of the system for everyone who gets involved in the change process.

Method

The project begun in December of 2005 with the analysis of the two first areas that received the new technology: patient and emergency admission. The admission process is the one in charge of gathering the patient’s demographic information, the medical history that precedes the visit, and the reason for which the person is being admitted.

The project started in the clinical emergency area for the following reasons:

1. The attention process of emergency patients has four well-defined stages: admission, triage, medical assistance and patient discharge. The incorporation of an ICT support only affects this clinical area.

2. The emergency department’s high level of stress puts the informatics system to the test, as clinical and administrative users are reluctant to try this difficult structure because their main concern is to provide patients with a good clinical attention and not to deal with an informatics system.

3. Once the emergency department Staff has gotten acquainted with the new system, they will want the new technology to be incorporated in all clinical areas.

4. Evaluating the impact that the new system has without affecting the whole of the hospital organization.

A patient admission unit, which was quickly assimilated by paramedics and administrative, was installed in the emergency department. The benefits became immediately apparent because patients only need to spend a few minutes talking to administrative staff in order to receive the information they need. All the actions that take place after the patient is called have been systematized. A new structure was created, in paper, to register the different actions that take place during a patient’s attention; we first worked with this system before implementing the informatics system. The structure and the paper format was the same that doctors would use once the interface was installed. Once we were able to prove that the systematization of the actions was working on paper, we installed the hardware equipment and started gathering data using the new system.

Once the patient has been entered into the system, the clinical staffs, who are working in the emergency department, has a screen that shows the information they need in order to decide who goes first on the priority list (Figure 1). The system provides with relevant information, such as the referential classification done by paramedics (the color depends on seriousness of the condition), the patient’s name and age, the waiting time and reason for visit. With that information in mind, the clinical staffs are able to prioritize the attention of emergency patients, which allows them to go on with the triage process and the medical attention. The totality of the clinical data goes into the system.

Figure 1.

Interface for clinical user

The second stage took place in the ambulatory care unit and the polyclinic. The polyclinic information system was incorporated, including patient admission units, a medical timetable and digital outpatient medical records. These systems were also incorporated into the emergency information system and the information of previous consultations appears in each patient’s electronic clinical history. By means of different colors, the medical timetable gives thorough information about the patient’s condition (Figure 2). The appointment process is also facilitated as it is possible to keep track of the times in which patients show and do not show to their appointments.

Figure 2.

Medical Timetable Interface

The structure of the electronic clinical records supports clinical professionals by giving them thorough information about previous visits, statistics about each patient, and an interface so that they can enter new information. The structure of the clinical records is designed to allow doctors to generate medical prescriptions, labs and x-ray orders, medical indications, consultation orders, doctor’s notes or any other document necessary to provide a good medical attention.

The following stages included the incorporation of information systems for the operating room, hospitalization, kinesiology and support units for macro hospital processes (Emergency, Ambulatory Care Unit, Operating Room and Hospitalization). The complete structure has 15 systems and units (Figure 3).

Figure 3.

Information and Clinical Management System of Traumatological Institute

Conclusions

The incorporation of ICT in the health area has allowed the institute to improve the clinical attention given to patients. After having put the ICT into practice and owing to the large volume of clinical data we have to administrate, we think it is appropriate to say these technologies are necessary. In order to culturally accept this paradigm it is necessary to face it with intelligence and to understand that this new experience, which needs to be fully embraced in each of its stages, will benefit the community by providing better health care.

The particularities and complexity of the clinical area require the development of interfaces that differ from traditional ones in terms of design. This new interface design, which has been key to the success of this project, has created a positive work environment by providing clinical staff with a system that adapts perfectly to their needs.

This system has allowed doctors to save significant amounts of time as they only have to enter the patient’s information once. Together with that, they are able to store large amounts of data which can later be used to support their research.

Nurses have also been able to save time doing administrative work (50% approximately), which has allowed them to dedicate more time to patients and to tasks that are directly related to nurse care.

Instituto Traumatológico Dr. Teodoro Gebauer Weisser has implemented the first Traumatology Digital Medical Record in Chile. There is no structure in the market that compares to the level of detail we have created for each subspecialty.