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26 Apr 2011

A premature baby receives treatment in the high-tech neonatology ward of the Centre Hospitalier de Villefrance Sur Saone

It is something that patients in many countries are acutely aware of: while our personal lives are effortlessly kept in sync by the internet and mobile devices, the management of our healthcare can seem stuck in the dark ages.

Hard-copy patient records are easily neglected, lost, or delayed in transit between busy clinicians. And even when an individual hospital or clinic uses computers, these may not be connected to the internet or to any other part of the wider health service.

Some countries, like Hong Kong, have succeeded in putting patient records online. But others have struggled: most notoriously, the UK has spent £12bn of public funds on centralising its IT, but the program is years behind schedule and has had to be scaled back.

We've worked with hard-pressed hospitals that have spent a fortune on IT and yet uniformly the staff don't even know what's going on with individual patients", says Gregg Webb, chief executive of Service Heartbeat.

His company sells communication technology to hospitals in the UK and US. The system uses smartphones as a replacement for old-fashioned beepers.

"We couldn't believe it at first. Compared to the way a supermarket chain manages the its stock, healthcare is way behind. Cans of tomatoes are being treated better than patients."

Mr Webb's company is one of a new breed that takes a non-traditional approach to healthcare IT. Instead of putting patient records at the heart of the system, these companies emphasise the need for timely, easy communication between health professionals in any location.

This approach sidesteps the most expensive and complicated obstacle: that of digitising millions of existing patient records and putting the information into a mammoth central database.

And when you remove the need for billion-dollar IT projects, which inevitably favour billion-dollar IT companies, then suddenly much smaller enterprises are in with a chance of getting their products into hospitals.

'It's not about the money'

"You can spend as much as you want on IT and still have nothing to show for it", says Dr James Britton, founder and financier of a small company called MeddServe.

"We can only invest a tiny amount compared to other companies, and certainly compared to the British government. But it's not actually about the money."

Meddserve has developed a cloud-based hospital management system, giving doctors, administrators and patients the ability to share information via a website, regardless of where they are.

Meddserve has just completed a trial of the online service at a 2000-bed super hospital in Chennai, South India.

"It's a relatively poor part of the world. But now patients there are getting a more efficient, more high-tech service than patients in the UK", says Mr Britton.

But so far, MeddServe has only got its product into hospitals in the developing world, which have the benefit of a 'fresh start' - they have no incumbent software and no central government policies getting in the way.

And this highlights a potential downside of hospitals going it alone with new technology products like Meddserve and Healthcare Heartbeat: if hospitals adopt different products ad hoc, then it may be harder to integrate them in future.

A fragmented future

A hint of these difficulties is already being seen in southern France, where hospitals have adopted different systems and are only now trying to share information.

Doctors and nurses at the Centre Hospitalier Villefranche-sur-Saone, near Lyon, walk around with laptops rather than clipboards, and they are proud that their hospital has made the leap online.

"The nurses have got everything on computer - heartrate, breathing, video, the patient's file," says Dr Phillip Rebaud.

"This allows a completely coherent set of data, which helps us to refine our treatment of the patient."

But although the hospital is wired-up internally, it's Health Information Manager, Jean-Francois Botton, admits that there are problems "achieving wider connectivity".

In an ideal world, all hospitals might integrate via a single online platform. But things have gone way past that point, and now Mr Botton has to cope with many systems working in parallel.

Villefranche-sur-Saone uses Orange Healthcare's "Connected Hospital" technology for some of its IT applications - such as allowing the parents of premature babies to log in and watch their babies via the web.

It uses a separate system, Crystal-Net, designed by the University of Grenoble, to connect its various departments and administrators. In turn, Crystal-Net has been bolted onto a regional network that connects with other hospitals around Lyon. And finally, the whole lot has had to be tacked onto a national network, Dossier Médical Personnel, that is being rolled out this year.

But while this sort of fragmentation might sound like a headache for Mr Botton, he strongly believes that his hospital did the right thing in choosing its own technology.

"Governments try to concentrate everything into a single central system - but it is too complicated and it makes data vulnerable.

"Our system is based on communication, rather than concentration. Every hospital goes its own way, but we still manage to share information. It's just easier to make that happen."


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