Bumrungrand Hospital Essay Example

January 2003. This award recognizes companies in Asia that utilize innovative IT solutions to improve operational excellence and customer service capabilities. Judges from ten leading consulting firms, including 'DC, Accentuate and Gardner, selected the winners of this award. Vanguard Hospital became the first healthcare institution in Thailand and the entire industry to receive this prestigious recognition. It was lauded for successfully implementing the Hospital 2000 information system. These accolades for Hospital 2000 were not limited to the Intelligent 20 award and other awards were also bestowed upon Vanguard for its exceptional achievements (see Exhibit I).Vanguard was recognized by CIO Asia magazine in February 2003 for its forward-thinking approach in implementing an advanced hospital information system (IS). Similar to other leading hospitals of that time, Vanguard's IS primarily focused on the accounting and billing departments. However, the hospital's IT operations were divided among four systems, each running incompatible applications. As a result, additional staff had to be hired for maintenance purposes and accessing up-to-date patient data was time-consuming. Vanguard sought an advanced hospital IS that could address multiple needs simultaneously. This included streamlining internal operations, such as billing, by integrating all applications from the pharmacy to the dining facilities to facilitate instant generation of consolidated medical bills. In addition, Vanguard desired an IS that would cater to foreign patients by providing information in their preferred language and allowing them to book appointments and accommodations online. The IS was also expected to expedite treatment for attendees at on-site clinics and ultimately help save costs.Vanguard, a privately managed hospital in Thailand, has adopted Hospital 2000 IS to facilitate quicker treatment for patients at clinics within the premises. This

implementation has not only saved the hospital's time and money in administering medical services but has also completely transformed the way hospital operations are managed. Hospital 2000 follows ANSI standards, a global standard for exchanging clinical data and managing healthcare. It has kept pace with the IT requirements of a modern healthcare business. Patrick Downing, CEO of Global Care Solutions, the company that installed Hospital 2000 at Vanguard, commented that the system takes advantage of modern devices found in a healthcare facility, such as paper scanners and cameras, allowing healthcare providers to capture necessary information and attach it to the Electronic Medical Record for better patient care. Established in 1980 with an initial investment of Thai Baht 90 MN, Vanguard was originally a 200-bed facility jointly owned by Bangkok Bank and the Sycophantic family. In 1989, it went public and its shares were listed on the Thai Stock Exchange. Over the next decade, Vanguard implemented various innovative practices to become the best privately managed hospital in Thailand.

Over the years, the number of domestic patients at Vanguard has significantly increased, resulting in a substantial rise in revenues. In January 1997, Vanguard relocated to a new facility in Bangkok's center. This 12-floor building, costing an estimated $110 million (with $60 million raised through offshore loans), boasted 554 beds and 21 operation theaters. Equipped with state-of-the-art technology, the hospital employed 600 physicians, many of whom were internationally trained and came from various parts of the world. However, these physicians were not officially employed by the hospital.

To manage the hospital effectively, Vanguard engaged an international management team headed by American professionals. The CEO, Curtis

Schroeder, had previous experience running a hospital in California. Unfortunately, in July 1997, Vanguard faced a difficult situation due to Thailand's economic recession caused by the Southeast Asian currency crisis. The devaluation of the Thai Baht severely impacted the middle-class Thai population, who constituted the majority of Vanguard's revenue source. As a result, these patients began seeking free or lower-cost healthcare at government hospitals.

In response to this challenging situation, Vanguard decided on a new strategy: targeting foreign patients, including expatriates in Thailand and nearby countries. Additionally, they planned to attract patients from developed countries in Europe and the US.

Schroeder described the situation, stating that they had two options: shutting down and laying off employees, or using it as an opportunity to gain market share. They chose the latter, following the approach of General Electric and Jack Welch. Vanguard then began a marketing campaign to position itself as a global hospital that meets international standards. By March 1997, they had already received ISO 9002 quality certifications for all their departments and systems. In 1999, Vanguard became the first healthcare company to receive the certification as a Comprehensive Tertiary Acute Medical Centre. Schroeder acknowledged that third-party validation is important for international success, regardless of the industry. Vanguard also used the Internet to promote its healthcare services to foreign patients through its website, www.Vanguard.Com, which provided user-friendly features for accessing information on medical facilities and available treatments.

The main feature of the website was the 'Find a Doctor' section, which allowed patients to choose from 600 doctors and make appointments online based on their preferences and requirements. The website received 800 hits a day by mid-1999,

leading Vanguard's management to realize the need for further modernizing their information system to improve customer service. The intensifying competition in the healthcare industry and the goal of generating international appeal prompted Vanguard to seek ways to enhance service quality. However, existing deficiencies in their information system were impacting the quality of customer service and causing high maintenance costs. Vanguard's IT operations were managed by four Unix-based systems and varied applications, such as Access and FoxPro, which created operational challenges.The hospital did not generate the necessary information for efficient operations, and the information system (IS) was unable to provide information for future business direction. Vanguard needed an IS that met immediate and future IT needs, including complete Electronic Medical Records (EMMER) to manage operations and provide information for doctors and support staff. Retaining the best doctors was a challenge as they could choose to work at other hospitals, so Vanguard aimed to create an ideal environment with advanced IS to attract top doctors. Schroeder emphasized the importance of having the best physicians and an excellently designed information system to practice medicine effectively and build strong patient relationships.We aimed to provide our doctors with easy access to clinical information so that they can make better decisions. In the healthcare industry, service efficiency is evaluated based on the quality and time taken for treatment. The less time patients spend at the hospital, the lower their expenses. Patients assess their hospital care in different ways, and the speed at which they move through the system is an important factor. We had already made progress in reducing patient time at the hospital, but we needed better information to continue

improving our service and decreasing patient days. Additionally, we wanted to utilize our IS to enhance our online initiatives, such as allowing international customers to book appointments through our website and facilitating communication with suppliers and insurance companies. To meet these requirements, we decided to replace our existing IS with a new one provided by Global Care Solutions (ACS), a Luxembourg-based IT company. On December 17, 1999, we successfully implemented the new IS, although the process was challenging due to the numerous tasks involved.The main tasks included in the project were the conversion of data from four existing UNIX systems, providing training to staff and doctors, and the installation of necessary hardware and software. The data conversion process involved retrieving information from a commercial out patient system, a commercial accounting system, an in-house in-patient system, and a document management system (DMS). Each system used different database engines such as Oracle, Ingress, Informing, and Sybase, which added complexity to the task. To ensure accuracy, much of the information had to be filtered to remove unnecessary and ambiguous data. Additionally, mapping the data to align with the Hospital 2000 IS posed challenges due to a significant portion being in the Thai language.

One specific challenge encountered during the conversion process was with the DMS of Filet Corporation. Filet had its own communication protocol, which complicated the task. The DMS contained around five million documents related to out patient records spanning three and a half years. These records were easily accessible by physicians, nurses, and support staff. To convert this large amount of data, ACS developed a program called 'Filet Converter', which converted each document in the DMS into

TIFF files and saved them in a Microsoft ANTS file system. The program ran continuously for six months without any interruptions.The program was implemented at the hospital during specific times of the day and throughout the night to avoid disruption. At the time of installation, Vanguard required 450 desktop computers, 100 network printers, and 120 scanners to be distributed across the hospital. The Vanguard IT team successfully completed this task. ACS then remotely installed the Hospital 2000 software on all the PC's using a proprietary distribution method. This method allowed for seamless pagination in the application without significant interruption for clients. The installation of Hospital 2000 was completed quickly with collaboration from Vanguard's IT team and ACS staff. Instead of gradually transitioning from the old system to the new one, Vanguard chose a one-time switch over. Although this approach carried risks, proper planning ensured a smooth installation process. The ACS staff remained prepared for any potential issues that may arise during the switch.Within 48 hours, the ACS and hospital staff addressed all major system issues. ACS personnel remained on-site for the next 15 days for system and network optimization. Training was another important task, with ACS staff and Vanguard's education and training department working together. Senior members from each work area in the hospital were selected and trained on the Hospital 2000 system, becoming trainers for their respective areas. A simulated training setup with 40 connected PCs was created at the training center, resembling all hospital departments. The four-week training ensured that both staff and learners gained full knowledge of the system's practical usage. ACS staff clarified any doubts about system functionality, and the successful

completion was due to the willingness of hospital staff to learn and efforts of the education department.

HARDWARE AND SOFTWARE The hardware for Hospital 000 consisted of 450 Dell Optimize PC's (clients) with a 400 Maze Echelon processor and 64-128 MOB Read Access Memory (RAM), [18] 4 Pentium@-lll Exeunt-based Dell Power Edge 6300 Clustered Servers, and a Dell Power Vault OFF Fife Channel storage system. The combination of clustered servers and a Powerful OFF supported the simultaneous operation of the 450 clients located in different areas of the hospital. The Power Vault OFF channel storage system ran on the MS SQL platform and served as the database for Hospital 2000 IS.

The clients were standardized in configuration to facilitate integration with Hospital 2000 IS. Additionally, a uniform configuration made maintenance easier for the IT team as they could develop a basic understanding of the system. The systems could also be easily upgraded to meet future requirements at any time. The Operating System used was a combination of Microsoft Windows 2000 and SQL 2000, which was one of the first sites where this combination was employed.

The systems were connected to the Internet through leased lines and satellite connections. (Refer to Exhibit II for a list of hardware and software used in Hospital 2000 IS).

The architecture of the Hospital 2000 IS consisted of three tiers: PC-based clients, clustered servers, and the database. The clients were responsible for inputting data and extracting data from the database. Each client located throughout the hospital had access to the complete Hospital 2000 suite. The middle tier, composed of clustered servers, facilitated transactions within the hospital.

These servers were clustered using the MS Windows 2000 clustering service to handle high workloads during peak hours. The middle tier served as an interface between the clients and the database, allowing transactions to pass through it. It retrieved necessary data from the database and made it available to the clients. Additionally, it ensured that the database was updated with every transaction performed by the clients.The integrity of the data was maintained, as the database server received and processed queries from the middle-tier transaction servers. The servers supported data warehousing and online analytical processing, storing and extracting valuable information critical to Vanguard's operations. During peak hours, the server processed 170 SQL statements per second.

To enable a uniform flow of information, the clients, transaction servers, and database servers within the hospital were properly connected in a network arrangement. Together, the database server and middle-tier servers formed the data center, which supported the clients. The TCP/IP protocol was used by both the servers and clients. A network architecture diagram is provided in Exhibit IV.

Within the hospital, clients were grouped based on their purpose or any rational basis. They were linked to network hubs placed in their respective departments or on each floor in wiring closets. Each hub was connected to a switch unit point. This unique network architecture allowed for an increase in the number of clients without disrupting workflow. Additional hubs or switches could be easily added to accommodate expansion.The use of fiber optic cables allowed for faster data transmission between clients and the data centre. The successful deployment of Hospital 2000 IS by Vanguard avoided unnecessary expenses and allowed the system to operate smoothly. The

entire deployment, including data conversion, training, and hardware and software installation, was completed in 45 days, showcasing the coordination and teamwork of the hospital IT staff and ACS employees. Vanguard estimated that they spent IIS$ 6 MN on the system.

As Vanguard's operations grew, the number of clients increased from 450 in 1999 to 900 in 2004. In order to provide better service to patients, Vanguard continuously updated the Hospital 2000 IS with new features. In February 2002, they incorporated a useful feature called Picture Archive Communication System (PACE) into the system. Known as Amalgam, PACE operated on a Microsoft Windows 2003/SQL Server platform. The estimated cost of implementing PACE was 28 MN Thai baht. PACE allowed for digital storage of X-Ray images, enabling Vanguard to process radiology studies without using films. The system provided diagnostic software and image manipulation and reporting tools for radiologists.All radiologists in the hospital had immediate access to digital images and medical studies through PACE, both online and through local area networks. PACE allowed for information exchange in multiple languages and received positive feedback from doctors at Vanguard.

Within six months of implementation, 99% of X-ray studies at Vanguard were conducted using PACE. The system was embraced enthusiastically by the doctors, who praised its advantages. Pat Downing emphasized that with access to comprehensive historical study information, doctors were able to make better-informed decisions.

Digital radiology provided numerous benefits, including faster reporting times, elimination of lost films, and the ability for multiple doctors to collaborate simultaneously. Reports were available online in real time upon submission. Amalgam PACE stored approximately four gigabytes of images per day, which could be accessed by physicians and hospital staff

from any PC within the hospital.

The efficiency of the system was evident in the fact that X-ray images up to 7 MOB could be retrieved and viewed in less than 2 seconds.PACE, which stands for Picture Archiving and Communication System, had multiple benefits for the hospital. It eliminated the need for X-Ray films and reduced costs associated with storage, maintenance, and the risk of damage or loss of images. This implementation resulted in an estimated annual savings of 17,000,000 baht at Vanguard. Additionally, the database size increased by approximately 1.5 terabytes from February 2002 to October 2003. PACE also allowed for the easy transfer of soft copies of X-ray reports to other hospitals upon patient request for further examination and treatment. Overall, Hospital 2000, the IS used at Vanguard, greatly improved operational efficiency by combining all front office systems, medical departments, and back office accounting functions into one database. It was applied across various departments including labs, radiology, pharmacy, cardiology, patient registration, administration, operation theatre scheduling, billing, purchases, inventory management, room management, and medical records.The text describes the benefits and features of a new healthcare system implemented at Vanguard. The database contained records of 2 million patients treated over the past 20 years, including prescriptions. A unique feature of the system was its ability to translate and print medical records, bills, and drug labels in multiple languages such as Japanese, Chinese, and English. The system processed 1.7 billion transactions annually and had a 99.999% uptime at Vanguard. It also facilitated faster patient treatment, allowing Vanguard to handle approximately 3,000 patients daily. Medical test results were accessible at 900 clients throughout the hospital, simplifying workflow. Doctors

could input comments on patients via typing or scanning, providing convenience for both doctors and patients who could visit the hospital anytime without carrying prescription or test records or needing an appointment.The patient's allocation to doctors with the shortest queue upon entering the hospital accelerated treatment. The doctor-patient ratio of 24 patients per day also contributed to faster treatment. Despite this, most doctors still preferred to give handwritten prescriptions, which were easily scanned into the system. Vanguard provided flexibility for doctors in their operations, allowing them to continue treatment by accessing the entire patient data, including medical records and test results. This included X-rays and ultrasounds, unlike other corporate hospitals. Vanguard's Hospital 2000 IS was essential for their operations, as stated by Ruben Doral, manager of their International Program.