King Faisal Specialist Hospital and Research Centre

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EXPERIENCE OF KFSHRC IN IMPLEMENTING DOCUMENT
IMAGING AND ARCHIVING SYSTEMHamad Al-DaigChief
Information Officer (CIO)King Faisal Specialist
Hospital Research Centre
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King Faisal Specialist Hospital and Research
Centre
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King Faisal Specialist Hospital Research Centre
Healthcare System

• 900-bed tertiary care hospitals
• Three tertiary care facilities
• Provides variety of health services, includes
  open heart surgery, bone marrow transplant,
  kidney transplant, liver transplant, specialist
  diagnostic services, etc.

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King Faisal Specialist Hospital Research Centre
Healthcare System

• KFSH Healthcare System is linked to 15 MOH
  Hospitals Via Telemedicine

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KFSHRCHS Telemedicine Network
WHO
International Telemedicine Network
MD Anderson
KFSHRC
Johns Hopkins
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Integrated Information Architecture of KFSHRC
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The Interface Architecture Looks Like

• No Consolidated View of Patient Activity
• Redundant Process Execution
• Diminished Patient Satisfaction
• Dependence of Paper-based Documentation
• Labor Intensive Record Management
• Inability to Measure Performance

Current Disparate System Architecture
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Current IT offering for Healthcare Industry
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Modern Healthcare Information Technology

• Integrated Clinical Information System
• E-Business (Finance, HR, Purchasing, etc.)
• PACS
• Document Management and Archiving System
• EIS / DSS
• Telemedicine

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Modern Healthcare Information Technology
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The structure of healthcare is changing
dramatically
Integration and specialization, managed care
Consolidating laboratories
Care in the community
Primarysecondarytertiary
Disease management
Vertical integration through Information
Technology
One specialty hospitals
Centres of tertiary care
Pharmaceutical
Specialist Hospital
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Information is a strategic tool in todays
fast-paced global environment. Institutions
must realise that the key to successful
competition and growth depend on their abilities
to obtain the right information at the right time
for spotting trends, forecasting market changes,
and analysing performance.
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IT in the Healthcare Field

• In terms of Information Technology, the health
  care industry is now about where the auto
  industry was in 1980.

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IT in the Healthcare Field

• Miracle drugs are available to save off AIDS and
  heart attacks, but the prescriptions for them are
  still written and delivered by hand.

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U.S. HEALTHCARE SYESTEM According to Foroohar
(1997), Most experts estimate that 20 to 30
percent of the annual trillion-dollar cost of the
U.S. health care system is tied up in paperwork.
  
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HOSPITALS MOVE TOWARDS PAPERLESS AGE

• Despite Many Hospitals digital records system
  projects, which costs about 15 million to
  implement, these hospitals are not fully
  paperless. It still generates paper so that it
  can interface with the majority of the medical
  community that remains burdened with paper-filled
  records rooms.
• Evanston Northwestern Healthcare spent about 30
  million to get its three Chicago-area hospitals
  switched to a full electronic records system that
  about 6,200 employees began using last year. The
  goal is about 10 million in savings in the first
  year, largely by reducing the data-collection
  process.

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At KFSHRC we are continuously implementing
various components of Office Automation systems
to facilitate the processing, distribution and
co-ordination of information throughout the
institution. As, Office Automation systems are
shifting to unify collaboration, knowledge
management, Intranet, document systems and work
processes into an enterprise wide electronic
workplace.
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Office Automation systems in KFSHRC include

• Word Processing     
• Desktop Publishing
• Document Imaging for document management
• E-mails and Voice mails     
• Electronic Calendars  
• Desktop Database for data management
• Desktop Project Management Tools  
• Major Applications
• E-Business (Oracle ERP-Solution)
• ICIS
• Internet Applications

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  Gates and Hemingway (1999) in their book
BUSINESS _at_ THE SPEED OF THOUGHT reported that
Microsofts savings from using the electronic
forms amounted to at least 40 million in the
first twelve months of use in 1997-98.
According to them, the biggest saving came from
the reduction in processing costs. Microsoft were
able to reduce the number of paper forms from
more than 1,000 to a company-wide total of 60
forms after they started using the intranet to
replace paper forms.
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The San Jose Medical Centre in San Jose,
California has implemented a Document Imaging
System in 1992 with a cost of about 450,000. The
expected full payback was in less than 18 months,
partially through staff reductions and partially
through elimination of the estimated 13 cost for
retrieving each file manually. The most
realised benefits were in the retrieval time,
which was reduced from about 20 minutes to almost
instantaneously.   
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• Case Study
• Data Analysis
• A study was conducted in KFSHRC to
• Test KFSHRC willingness to change as it is
  important for the successful implementation of
  Office Automation.
• Automation of offices will bring benefits to
  KFSHRC.

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Case Study The questionnaire consisted of
three main sections Background, Change
Management and Benefit Realisation. The staffs
are grouped into Physician, Nurse,
Administrator, Scientist, Technical and
Secretary.  
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• Background
• There were a total 157 responded to the study
  
• 33 Physicians, 23 Nurses, 19 Administrators,
• 8 Scientists, 38 Technical and 36 Secretaries
  responded
• to the study.

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• Introduction of Office Automation
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• Towards, the question of what will be the result
  upon implementation of Office Automation, 117 out
  of 157 or 75 of the staffs felt that Office
  Automation would result in job empowerment, while
  less than 2 of the staffs felt it will result in
  loss of jobs. Figure 1.0 shows the breakdown of
  the staffs viewpoints.

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Change Management One of the key questions
in this area was to find the staffs opinion on
Office Automation, whether it will improve
organisations overall performance. Figure 2.0
shows the breakdown of the staffs viewpoints.
It Shows that 124 out of 157 staff or 79
agreed that Office Automation will improve
organisations overall performance. While less
than 5 disagreed.
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Benefit Realisation Towards, the key
questions of whether Office Automation will
improve inter-departmental communication. Figure
3.0 shows this breakdown of the staffs
viewpoints. It shows that 126 out of 157 staffs
or 80 agreed that Office Automation will improve
inter-departmental communication. Only 5
disagreed.
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Human Resource Data Analysis One of the key
questions asked in this area was to find staffs
opinion on Office Automation, whether benefit
could be realised through improvement of work.
Figure 4.0 below shows this breakdown of the
staffs viewpoints. It shows that 117 out of 157
staffs or 75 agreed that benefit from
implementing Office Automation will be realised
through improvement of work. Only 4 disagreed.
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Organisational Data Analysis   One of the
key questions asked in this area was to find
staffs opinion on Office Automation whether
benefits could be realised through improvement of
patient care services. Figure 5.0 below shows
this breakdown of the staffs viewpoints. It
shows that 116 out of 157 staffs or 74 agreed
that Office Automation would improve patient care
services. Only 5 disagreed.
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Benefit Realisation Taking this question of
Improvement of Patient Care Services further
for Physician group of staffs at a microscopic
level to relate their knowledge of computers with
job satisfaction, following facts were found as
shown in table 1.
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Table 1. Relationship between computer knowledge
and patient care improvement
Compelling fact here is that higher the level of
competencies on knowledge of computers, better
the responses were in terms of relating Benefit
Realisation through Office Automation.
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Significant Findings
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Significant Findings

• Office Automation will improve business
  processes and practices, reduce paper flow,
  result in work force re-alignment, result in work
  force reduction and improve organisations
  overall performance. The staffs viewpoints on
  these features were also positive with a minimum
  agreement of 68.

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Significant Findings

• Office Automation will improve information flow
  throughout the organisation, improve
  inter-departmental communication, improve
  availability of information and improve
  reliability of information. staffs viewpoints on
  these features were very positive. The lowest
  level of agreements was 71.

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Significant Findings

• The benefits could be realised through
  improvement of patient care services, cost
  reduction and avoidance, effectiveness increase
  for the whole organisation, turnaround time
  reduction for all processes and practices, and
  customer services improvement. The staffs
  viewpoints for these features were also very
  positive with minimum agreement of 65,

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Ultimate benefits

• The ultimate benefits of Office Automation
  could not be quantified at this stage within
  KFSHRC, as full Office Automation is still a
  vision of the hospital and we are working toward
  fulfilling this ultimate vision.

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Conclusion of the study

• We should effectively utilize and mobilize the
  positive perceptions toward IT initiative that
  exist among the staffs of KFSHRC to ease the
  Change Management efforts to realise benefits
  from the Implementation of Office Automation
  projects.

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PACS

• Cost reduction in comparison to conventional
  film-based radiology by reducing film and
  archiving expense
• Eliminates the time spent searching for images
  and transporting them
• Elimination of manual error-prone archiving
  procedures
• Integration with Cerner RIS system via HL7 based
  interface for ADT, Orders, Scheduling and Results
• Capacity as follows
• Network - Backbone ATM 622 Mbps, Distribution ATM
  100 Mbps full duplex
• Five years long-term archive image storage
  requirement (with annual growth rate of 6.4) are
  as follows
• Digital Modality Computed Radiology for KFSHRC
  is 18 TB
• Statistics of Radiology exam per year (April 1999
  - April 2000)
• KFSHRC Site total 168, 000

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KFSHRC DOCUMENT IMAGING ARCHIVING SYSTEM

• Implemented during mid 90s in the following
  departments
• Medical Records
• Personnel
• Safety, Security Communications
• Research Center

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CURRENT STATUS

• Currently, the System is in effective use in two
  departments
• Safety, Security Communications
• Research Center
• However
• Medical record - upon using the 30 capacity for
  small number of physical charts, they stopped it
  with capacity and indexing issue

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KFSHRC MEDICAL RECORDS

• Current Status
• More than 250,000 active records
• 150,000 inactive records
• 200,000 microfilmed records
• Current Problems
• Huge waste of space due to physical storage of
  folders and paper documents
• Risk of loosing documents whether by loss or
  deterioration
• Unavailability of folders to more than one person
  at the same time (can not be shared)
• Delay in accessing documents from other
  departments

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REASONS FOR FAILURES

• Change in scope
• Project implementation was not complimented with
  a clear plan of what are the documents to be
  scanned and keep for archival.
• The change in technology lead not to pursue the
  project further.

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Important Notes

• Document Imaging is still very important for
  Hospitals
• Clear identification of workflow is very
  important before initiating the DI projects
• Major efforts should be given toward Automation
  of Offices in hospitals

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SOLUTION

• Evaluate and streamline the processes in order to
  avoid producing document printouts
• Automate processes through electronic
  transactions
• In hospitals, to generate appointment and medical
  record services through Portal and SMS Messaging
  Systems
• Technology today is much more mature than the 90s

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Thank you