High-tech help in emergency

By ADAM GIFFORD

Book into the new Auckland Hospital at a typical hour, say 11 on a Saturday night, and you will notice changes in the way you are treated.

Let's start with the blood sample taken from your arm as you are wheeled in the door.

By the time you are through the security doors and into the emergency area, that sample could have been sent through to the lab by vacuum tube and analysed by a machine which automatically feeds a preliminary result into the clinical database.

Less than a minute after the sample is processed, the medics at your bedside can see the results through the monitors beside every position in the emergency suites.

And as the emergency crew go through the basic triage routine, staff in the records section will be digging up any paper records on you and feeding them through a high-speed scanner to convert them to digital form, so they can be read by those deciding what to do once the bleeding stops.

X-rays or cat scans will be read not off celluloid held up to light boxes, but off large plasma screens in the emergency areas and operating suites, or off high definition thin-film transistor screens everywhere else in the hospital.

As you are being wheeled in, you may notice cameras in the ceiling. The hospital has spent $4 million on its camera security system to protect staff and patients.

When you come to in the neighbouring Admission and Planning Unit, the clinician may be looking at all your records, x-rays and even documents sent in by your GP on a Compaq tablet PC wirelessly connected to the network by an 802.11 "WiFi" card.

It's not ideal for viewing images, but it should be good enough for a bedside consultation.

If the clinician needs to consult a specialist or your GP, the other party can see the same records from home or office through a secure internet connection.

Dr Nigel Murray, general manager of the hospital building programme, said about $30 million of the $500 million budget for the project had been spent on information technology.

The pay-off will come in increased efficiency, more effective care and better use of beds. Murray said a new hospital was a once in a lifetime opportunity to reconsider the way hospitals operate.

Much of the innovation is in the assessment unit, which is next to the emergency department.

"We want to be able to move people from acute assessment to APU as soon as possible," Murray said.

"This then becomes the engine room of the hospital. We can bring patients here and rapidly assess them, using technology to do that."

Rather than trying to assess people in emergency and then sending them to a ward or discharging them after treatment, the new unit will collect all the information needed to plan the complete stay, conditions of discharge and the likely outpatient care needed.

Murray said that when the Auckland District Health Board was planning the hospital, it decided to invest in technology infrastructure because it recognised Auckland was well behind other hospitals in the region.

To aid future regional integration, it adopted many of the software platforms and products in use at Waitemata and Counties Manukau district health board hospitals.

Key elements include the Eclair digital lab results system from Sysmex Delphic and the Concerto portal software from Orion, which give clinicians access to a range of different databases and applications within a common interface from wherever they are.

Other vendors were Hewlett Packard, Vodafone and Microsoft.

Murray said about $10 million was spent on the picture archive system. It includes imaging technology from Agfa, which allows x-rays, cat scans and other images to be viewed over the network.

Another $10 million has been spent on equipment to scan clinical records.

The hospital will put paper records into the system when a person is admitted, rather than scanning records of people who may never come back to the hospital.

Older records are scanned in chronological order, but newer records - such as the notes doctors take in the wards - are going into a system of folders, which should make searching easier.

"This is a transitional environment and maintains the benefit of working on a computer - there is nothing worse than having to switch from the computer back to paper records all the time," Murray said.

"The amount of information in digital form will increase over the next five or six years and we will scan much less than today."

About $8 million has been spent on digital clinical records systems, including the packages from Sysmex Delphic and Orion and the new PIMS theatre management system from iSoft - which is a module of a larger iSoft patient information management system which the hospital is considering buying once a freeze on new software projects is lifted.

Murray does not expect everything to go smoothly from day one on October 4, and $1.6 million has been set aside to fix flaws found during the commissioning process.

The hospital is holding an open day on Sunday. Entry is by tickets, available from Ticketek.