BANGKOK - As Dr Chen walks up to the bed of a patient suffering a multiple leg
fracture, her tablet personal computer screen flickers, displaying the
patient's most recent three-dimensional CT scan, vital signs, medication and
photo, beamed automatically through a sentient wireless network via smart
routers. A photo ensures the doctor is dealing with the right patient,
preventing mistakes.
In the operating room, two urgently needed blood packets arrive. Almost
instantaneously the operating team hears alarm bells. Surgeon Patel turns to a
network screen where a message warns him of a blood mismatch. Pressured, but
relieved, Patel avoids compounding an overworked orderly's mistake.
These scenarios are an illustration of tomorrow's wireless networked
intelligent hospital, now becoming a reality as some hospitals apply proven
technology and systems to realize huge cost savings and cut clinical error
rates while improving patient care, led by suppliers and medical centers in
Thailand. Over the next decade, the hospital information-technology (IT) market
will explode. The United States spends US$50 billion annually on health-care
IT, globally the figure is something like double. "Health-care IT is the
largest market in the world, next is military IT spending," says Pat Downing,
chief executive of Global Care Solutions, a worldwide provider of IT solutions
developed exclusively for the health-care industry.
Asia's health-care IT spend is growing 10-12% annually as smaller budgets and
more patients force Asian hospitals to seek efficiencies, pressures that
cash-awash private hospitals in the US don't face. "A lot of this is economics.
Right now Bumrungrad Hospital [in Thailand] will do about $140 million in
business a year. In the US it would be doing about $1.4 billion. With that kind
of money, they can afford to have all these different systems. Departmental
leaders tend to think about what is good for them rather than the hospital,"
says Downing.
The hospital IT market is being led by suppliers and medical centers in
Thailand. Bangkok's 554-bed Bumrungrad Hospital, among the world's busiest,
handling 1 million patients annually, arguably uses the world's most integrated
and seamless hospital IT solution, handling patient records, X-rays and scans,
billing, inventory, administration and more.
In Asia, frontline doctors, dentists and specialist clinics tend to cluster in
and around hospitals to a much greater degree than in the West, increasing
patient numbers. Studies show that Asians, often seeking preventative
treatments, visit doctors more than Westerners.
Since deploying Bangkok-based Global Care's uniquely multi-lingual Hospital
2000 system, IT spending fell to 0.7% of gross revenue from at least 1.5% when
barely compatible function-specific systems were in operation. Hospitals
typically spend 1.5-3% of their income on IT. Bumrungrad's IT department shrunk
from dozens of employees to three engineers and seven assistants after the new
IT system was installed.
Mature hospitals now typically use 6-12 systems that provide various functions,
requiring dozens of expensive engineers struggling to ensure they remain online
and work together smoothly. All supplies are bar-coded, even recording details
such as a tablet pack's batch number and expiry date. Bumrungrad's inventory
turns over 25 times annually, against eight previously, which means less money
tied up sitting on shelves in supplies. Inventory discrepancies are down to
$7,500 quarterly, from $100,000.
In 2005, Bumrungrad will migrate to Global Care's latest solution using tablet
PCs, freeing doctors and nurses from desks. "The tablet computer is going to
revolutionize how doctors practice medicine, it's astonishing," says Downing.
Desktop computers keep medical workers away from patients, while failing to
automate much routine paperwork that can take up half a nurse's day. "By
mobilizing the data, you truly change the workflow by making it more centered
on the patient rather than the provider," says Dr Mark Blatt, Intel's
health-care strategies manager.
Global Care's solution will also use Bluetooth and later radio tags, now
appearing in major corporations' supply chains. Tags provide an extremely
accurate picture of where patients, staff and supplies are in a hospital.
China's Health Ministry has initially allocated around $3 billion for a program
to develop national-to-township level health-care IT standards, systems and
specifications, that eventually will cover 60,000 clinical units. An average
hospital will probably spend $6 million on new IT systems. With Beijing footing
only part of the bill, the remainder should come from provincial governments
and the hospital's own income.
New technologies and networks may well proliferate faster in developing Asia,
where hospitals are less computerized than in the West, thanks to rising
health-care budgets, hospital construction, falling equipment prices and fast
growing patient numbers. "These technologies will come into China very fast. A
lot of hospitals in China don't have legacy systems. There might be the
potential for Asia to leapfrog the rest of the world as many Asian telephone
systems leapfrogged landlines to wireless," says Blatt.
China's health-care IT development program is trying to use wireless networks
to improve hospital care, doctors' knowledge and health care access in poor,
remote areas. In the late 1990s, China's experiments with telemedicine using
satellites proved instructive, demonstrating the benefits for remote
communities, but were too expensive to maintain. "We want to use wireless
systems, we want to use mobile medicine, but it depends on different local
situations," says Gao Yanjie, who is directing China's health-care IT program.
"Telemedicine has a big future in China because the country is so big."
With radio tags on every inventory item, as well as staff and patients,
communicating with a sentient wireless network and finding people will be easy.
Security also will be better and patient records, X-rays, medical databases and
more will be at a clinician's fingertips on a tablet PC or some other mobile
device. That same network could allow staff to talk with each other, too.
Como Hospital in southern Italy, for example, uses blood-type-encoded radio
frequency identification tags (RFID) to ensure the right blood reaches the
right patient. "Hospitals are becoming almost as advanced as grocery stores,"
says Blatt. "Hospitals are finally using information technology the way other
industries have been for a decade."
Making hospitals safer is a crucial selling point for new systems. In 1999, the
US Institute of Medicine concluded that 100,000 people a year die in US
hospitals from process errors such as being given the wrong medicine,
mismatched blood or experiencing bad drug interactions. A retrospective by
Healthlink estimates that the study may have understated deaths by a factor of
two. UK studies reached similar conclusions.
Global Care's orders are accelerating after three years of hard marketing,
coming from Dubai, Malaysia, Saudi Arabia and beyond. "We're probably going to
have a really substantial order covering 15 sites in North America early next
year," says Global Care's Downing. "We started marketing in China full time
four months ago. We will definitely get a sale there in the next six months."
Owned by a low-profile Swiss-based investment group, Global Care took an
expensive, high-risk clean-sheet approach to developing such a universal
system. "No hospital wants to be a guinea pig for a radical system. Hospitals
are more conservative than banks. With Bumrungrad, we had a long relationship
and they could see the benefits of the system," says Downing.
Yet, such are the market's prospects that major players are not far behind.
"Global Care figured out how to do things in the least complicated, most
integrated way possible. Other companies are looking in that direction," says
Blatt. Among them are giants such as General Electric (GE) and Siemens, and
health-care IT specialists including UK-based I-Soft, India's Medicom and
China's E-Tone.
Integrated, comprehensive solutions like Global Care's may have better
prospects when tendering for new hospitals. "Global Care has a tremendous
advantage in that it can put in an integrated system into a hospital in one
shot whereas Siemens or GE might offer a component perhaps better suited for
older hospitals in the US or Europe with legacy systems," says Blatt.
Competition from cheap, emerging software powerhouses such as China and India
does not worry Global Care though. "I'm sorry my implementation costs may be
five times what an Indian company will charge, but I'm going to deliver a hell
of a system that will work," says Downing.
Patients' awareness and expectations are also growing, placing more pressure on
governments, hospitals and doctors, says Blatt: "Would you go to a bank without
an ATM [automated teller machine]? At some point the consumer starts to push."
(Copyright 2004 Asia Times Online Ltd. All rights reserved. Please contact
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