Data Follows the Patient

Thanks to many years of efforts towards standardization, the University Clinic Munich’s IT system is a healthy one. The aim was to design both primary and secondary work processes as effectively as possible, in order to reduce personnel costs. The main purpose of the clinic IT system is to relieve medical personnel of as many tasks as possible that are not directly related to patient treatment. New technologies aim to improve the processes to the benefit of staff and patients alike.

Healthy basis for clinic IT

SAP forms the basis of the IT system in the clinic. In order to put internal administration, in particular, on a solid foundation, the University Clinic Munich introduced SAP as standard business software in 1993 – at that time still SAP R/2. The clinic upgraded to SAP R/3 at the end of 1996. The hospital has also been using the SAP industry solution IS-H (Industry Solution Hospital) for patient accounting since 1996. Since 2000, medical documentation has been managed with IS-H*MED, a program developed jointly by the Berlin-based GSD and T-Systems Austria.
One prerequisite for optimum process support is standardization, reports computer center manager Udo Poth: “The closed, homogenous system that we have created over recent years has replaced numerous stand-alone solutions.” And there were a lot of these, as many of the individual specialist clinics operating within the University Clinic worked with their own systems for diagnostics and analysis. It was therefore often necessary to maintain analysis data and diagnoses twice or even three times, if a patient was examined several times in different areas of the clinic during treatment. However, it has not been possible to replace all the stand-alone solutions by the standard software, states Poth. Some areas continue to use essential special applications.

All patient data accessible in the portal

The standardization of the software also meant a standardization of processes. While this was relatively easy to achieve for the secondary processes, it caused considerable upheaval for the 19 IT employees in the medical area, because each clinic is a high-quality specialist department that has particular requirements with regard to workflow. “The tasks, requirements, and structures are completely different in gynecology and accident surgery, for example,” explains the computer center manager. The difficulties are less of a technical nature, and more related to the definition of processes. “Around 80 percent of our work is organization, and only 20 percent the technical mapping of the processes,” reports Poth.
While the requirements of an individual clinic were previously at the forefront of the workflow, the route the patient takes over the whole treatment period has now become the central focus. This starts with admission, when a patient is entered in SAP R/3 with a personal ID and case number. Subsequent posting in IS-H*MED is not required. All programs that are relevant in the context of the treatment are integrated in a portal. In this way, the physician can call up all patient data from a standardized interface and even look at x-rays using an integrated viewer. The physician also always works with the same familiar interface. “In the clinical network, physicians do not usually have their own PC. The working environment has to accompany them,” explains the computer center manager. Employees of the University Clinic usually only have PCs outside of the clinical network.

Visits without breaks in media

Electronic patient records have replaced hard-copy documentation in the clinic. The physician thus has all the relevant data in every treatment room and the consulting room. However, one gap remains: physicians do not have access to the system during visits, for example. Breaks in media cannot be avoided, and the results of the visit are recorded on paper and entered into the system at a later point in time. The University Clinic wants to close this gap in the future by using tablet PCs and bring the electronic patient records directly to the patient’s bedside.
The decision in favor of tablet PCs – in this case for “convertibles”, which can be used like normal notebooks – was made as a result of pragmatic considerations. “We want to make as few changes as possible to our applications,” explains Poth. PDAs (personal digital assistants) were therefore out of the question from the start. As the tablet PCs are run with full Windows XP, only a few changes in the way individual applications are used were needed, according to Poth. “We are mainly concerned about ergonomics. Our main considerations are how the software is used, the weight of the devices, and similar factors.” One alternative would have been a PC in every room, which the physician could use to access the system. However, this solution was abandoned for reasons of costs.

Security issues to be clarified

One particular challenge that the IT employees are currently facing is how the tablets are connected to the clinical networks. WLAN (wireless local area network) is the only real possibility for mobile devices, so that access can be provided from every single location in the clinic. However, it must be possible to guarantee 100 percent security of the wireless network, because after all, patient data is highly sensitive. The existing clinic network is extremely secure. It prevents all incoming connections from the outside world, for example. “Not even email is allowed in the clinical network,” explains Poth. Only SAP-internal communication is permitted. This level of security must also be guaranteed in the WLAN.
However, Poth expects this issue to be solved. From the start of next year, the first devices will be used in a pilot project. The computer center manager is also confident about the return on investment. Much time will be saved in documentation, and can thus be used directly for treatment. “Ultimately, the purpose of the system is not to record patients’ meal requests,” stresses Poth. Efficient processes have already been implemented for this.

Maximum efficiency for appointment planning

The University Clinic does not just want to streamline working processes internally. Some of the general practitioners will also be involved. In a current pilot project, a Munich practice was affiliated to the Tumor Center of the hospital. For their patients, the admitting and consulting physicians can access all functions that they have been given access to. These include, for example, appointment planning or data on medical findings. The obstacle here is legislation on data protection: the admitting physician must not send his/her findings when appointments are made, because if the patient ends up going to a different clinic, there is no reason for the University Clinic Munich to receive this information. As a result, the clinic system obtains this data in a “pull” process, when the patient actually appears for the agreed appointment and has been entered in the clinic system.
Poth is not yet able to say whether this project will work out in the long term. It requires a huge investment, and the clinic must wait to see what savings it will bring. The priorities in the hospital’s IT system are clearly defined, stresses Poth: “We want to support the primary medical processes as effectively as possible with optimum IT applications.”

Jan Schulze
Jan Schulze