Clinical I.T. Modernisation at a University Hospital Hospital Universitario Son Dureta Palma de Mallorca, Spain Located in the centre of Palma de Mallorca, Hospital Universitario Son Dureta is the largest health facility in Spain’s Balearic Islands. It operates 900 beds and employs 4,000 people across five facilities: a general hospital, a paediatrics department and three separate outpatient departments. The hospital also hosts the islands’ reference laboratory, and is used for specialist tests that cannot be performed elsewhere. Approximately half of all clinical activity in the Balearics is conducted at Son Dureta.
““Hospital Son Dureta has chosen to implement a normalized clinical database combined with webbased clinical applications with technology from Oracle Healthcare and Orion Health because we believe that this offers the most solid IT platform to assist our clinicians in their work.” -Joan Marquès Faner Chief Information Officer Son Dureta Hospital
Customer Website www.hsd.es
Scenario First phase of a programme to introduce electronic records in a paper-based University Hospital
Business Situation A 50 year-old 900 bed hospital, largely paper-based, was looking for a realistic programme to digitize its patient records systems and processes
Business Solution The recent tourism boom in the Balearics has enabled the development of a public services infrastructure that is unparalleled in Europe. The region’s government is committed to delivering the highest standards of healthcare, enabled by the latest technologies.
Clinical web portal, electronic whiteboard, web-based orders module and normalized CDR integrated to existing IT systems.
Business Benefits
The Orion Health implementation at Son Dureta comprises three major, inter-related automation projects: a clinical web portal, a central repository for clinical data (provided by Oracle Healthcare Transaction Base), and an electronic whiteboard for the accident and emergency department.
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Clinical Web Portal Son Dureta chose Orion Health’s Concerto as the clinical web portal through which clinicians can search and view information pertinent to their daily tasks, such as: • Hospital intranet • Existing web applications • Relevant patient demographics • New clinical applications
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Single point of access to electronic patient data Continually updated patient information and management for ED Faster access to patient records
The Concerto clinical web portal also provides access to Orion’s web-based orders module, so that clinicians can also order tests electronically via. These orders are sent automatically to existing laboratory, radiology and anatomy/ physiology systems. Electronic Whiteboard for Emergency Department Management The Emergency Department at Son Dureta University Hospital is undergoing a process of computerisation in which existing systems are being connected through the installation of Orion Health’s electronic whiteboard and orders solutions. The Emergency Department, which used to rely solely on paper-based files, is the starting point for a computerisation project which aims to create an electronic patient record for the entire hospital. “We began with the Emergency Department, which treats 300 patients every day, because it’s a department where all medical specialities come together. It’s also a way to bring the hospital into the digital age”, explains Joan Marquès Faner, Head of IT Services at the Son Dureta University Hospital.
The system displays up-to-date information about the patients currently in the Emergency Department, including triage category, submitted orders, available lab results and summary demographics. This data is extracted from other information systems within the hospital and is updated every 15 seconds, providing an accurate “snapshot view” of current patient activity within the Emergency Department. The solution also manages the various clinical workflows in the Emergency Department, allowing clinicians to transfer patients to wards, hand over patients to other clinicians and discharge patients. These solutions mean that by looking at just one screen the emergency doctor can see details of all the patients who have entered the department, the length of time they have been waiting and all the processes which are still pending. “This information is also available to any family members present in the waiting room. This means that they know where their relative is at all times and their worries are not
Technology In Use Concerto™ Medical Applications Portal Concerto Clinicals Order Entry Concerto™ Clinicals Electronic Whiteboard Rhapsody™ Integration Engine Oracle Healthcare Transaction Base
compounded by a lack of information” says Marquès. The system also includes a feature which manages requests for laboratory and emergency tests as well as pathological and radiological investigations. Centralised Repository for Clinical Data Son Dureta uses Oracle Healthcare Transaction Base (HTB) as a centralised, standards-based repository for clinical data. Relevant data from the hospital’s various existing systems is converted into in HL7v.3 format and fed into HTB via Orion Health’s Rhapsody Integration Engine. Clinical information stored and maintained in Oracle HTB at Son Dureta includes: • Clinical orders • Lab test results • Patient demographics
Data stored in HTB is available for immediate recall and viewing by authorised clinicians via Concerto Medical Applications Portal. Concerto presents the HTB data in an on-screen format that is easy to read and act upon. “Hospital Son Dureta has chosen to implement a normalized clinical database combined with web-based clinical applications with technology from Oracle Healthcare and Orion Health because we believe that this offers the most solid IT platform to assist our clinicians in their work,” said Joan Marquès Faner, Chief Information Officer at Son Dureta Hospital Marquès points out, “the information stored in HTB - clinical orders, lab results and patient statistics – is instantly available and can be consulted by authorised medical personnel via the web portal.” Son Dureta is the first site in Europe to implement the joint Orion Health-Oracle Healthcare solution for an electronic health record and clinical applications portal.
Challenges Overcome “Any change which takes place in a hospital that has previously relied on paperbased systems will be a challenge, and the essential, unavoidable task of computerisation is certainly not free of difficulties” states Jordi Puiguriguer, Head of the Emergency Department at the Son Dureta Hospital. “However, the Orion/Oracle project definitely offers us the chance to take on these challenges with guaranteed results. We are creating an innovative and flexible web application for our Emergency Department and its design will be applicable to other emergency frameworks.” For Joan Marquès Faner, one of the main challenges overcome was the integration of the laboratory system, which was made complicated by the use of multiple suppliers and software types, but was satisfactorily dealt with using the Orion Health Rhapsody Integration Engine and Oracle HTB. The medical staff, made up of a total of more than 500 doctors of all specialities who pass through the Emergency Department, have taken well to the new system. “I thought that there would be much more resistance to the change but the doctors are adapting really well. One notable success has been the method of working closely with them, coordinating ourselves and trying to meet their needs”, he says. Future Projects Joan Marquès Faner also mentions future projects, such as the computerisation of clinical notes, which will involve the monitoring of patients while they are in the hospital and the extension of the request manager to other laboratories. A telemedicine project for electronic clinical orders is also underway with Palma prison. As Joan Marquès points out, “the Son Dureta project is a pilot aimed at eventually using Oracle HTB and the Orion clinical portal and systems all hospitals in the Balearic health service (IBSalut)”.
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