Imagine a future where hospital wards have no paper case notes or files. Information on a Patient\'s medical condition is automatically captured via intelligent context-aware devices and sent directly to the central computer systems.
"The Digital Ward project was initiated by Singapore Health Services (SingHealth), Singapore's largest public healthcare group, with the objective of transforming the way healthcare professionals capture and access clinical information."
The Digital Ward project team is made up of IT professionals from SingHealth's iTAG (Innovative Technology Application Group). The project team works closely with users such as clinicians, nurses and operations colleagues of various
SingHealth institutions, to innovate and develop systems that bring value to the patients and improve operational efficiency in the institutions such as:
Digital ward innovations
The various wireless technologies and devices being implemented in the digital ward are:
Computer on Wheels (COWs)
COWs are WiFi-enabled notebooks on ergonomically designed mobile trolleys, which enable clinicians to access patients' medical records and digital radiology images as well as document patients' progress electronically anywhere, any time in the ward.
Mobile Electronic X-Ray Computing (MERC)
MERC is a motorised WiFi-enabled system with dual, triple or quadruple panel display screens, which enable patients' electronic medical records and digital radiology images to be displayed across different screens. Clinicians can access these records and images wirelessly at the patients' bedside to explain various therapies and clinical options to them. This innovation serves to enrich the face-to-face communication not only with patients, but also with their family members.
The integrated wireless VEGA system enables remote automated monitoring of patients' vital signs, such as blood pressure, pulse rate, electrocardiogram (ECG), pulse oximetry (SPO2), temperature and respiration rate. The system also provides proximity contact tracing and location tracking.
The patients' vital signs are captured automatically via customised monitoring devices (using WiFi and Active RFID technologies) and clinicians can view the vital signs charts online. This reduces potential human errors and enhances patient safety. With this system, nurses also spend less time on tedious menial tasks, enabling them to devote more time in delivering quality patient care. In addition, patients can have an undisturbed rest without having their vital signs taken manually by the nurses.
To enable proximity contact tracing, specially designed wearable tags (using both WiFi and Active RFID technologies) are issued to the patients and hospital staff in the ward for the purpose of automatically and wirelessly recording and tracking people with whom they have come into contact within the ward. The contact data captured in the tag is then automatically and periodically uploaded into the server using industry standard WiFi access points. Hospital staff can search, view and print records of the contact tracing details online.
This system is especially useful in handling infectious disease outbreaks such as SARS and Bird Flu. It helps to ring-fence the spread of contagious diseases. In addition, it also has the ability to effectively track staff and patients' location within the ward.
Patient Bedside Terminal (PBT)
PBT is a touch screen integrated information system that provides both the clinicians and patients an efficient and convenient means to access information within the hospital and globally.
With PBT, clinicians can retrieve and display patients' medical records and digital radiology images, as well as discuss their medical conditions at patients' bedside. Through the terminals, patients can speak to the nurses on duty using a video nurse-call function, while nurses can order meals for patients electronically instead of ordering manually. In addition, patients can also access a wide variety of entertainment and Internet services.
Mobile Clinical Assistant (MCA)
MCA is a specially designed highly portable healthcare tablet PC, equipped with an integrated camera for visual clinical documentation. The built-in barcode / RFID reader is used to verify the patient's identification. MCA is also WiFi-enabled, empowering the clinicians with secured "anywhere, any time" access to the hospital's EMR systems and other clinical information systems. Through the integrated Bluetooth wireless technology, it can interface with other medical devices (e.g. vital signs monitors) to obtain patient data from existing medical devices and directly transmit captured patient data into hospital's clinical applications in real time.
Such a mobile point-of-care solution helps in improving the quality of patient care and enhancing the productivity by enabling clinicians to quickly retrieve and document patients' information. This is especially critical in a fast-paced environment like a hospital's Accident & Emergency Department.
With the use of smart card technology, hospital staff carries only one card for multiple purposes. Besides door access control, the same smart card can be used for tracking of attendance at staff events or trainings. Its "tap-and-track" method makes the whole process faster and easier. Staff immunisation records can also be tracked by the same smart card.
Future applications can be built into the smart card to automate processes and to continuously improve the physical security, patient services and operational efficiency of the hospital.
Case study results
Since the implementation of this Digital Ward project in 2004, the team has been gathering results on how the innovations benefit both staff and patients. The quantitative and qualitative results are summarised in the tables below.
The team has learnt many valuable lessons and acquired good experiences in the process of implementing the Digital Ward project. It has enabled the team to better manage subsequent projects. The lessons are categorised into two main groups, the stakeholders and the processes.
Research has shown that the innovative use of IT not only results in a more efficient and effective operational workflow in hospitals, but also brings about enhanced personalised patient care.
SingHealth is one such organisation that paves the way by introducing various IT innovations in its institutions. The innovation team at SingHealth makes continuous and concerted efforts to work closely with the hospital staff and patients in activities such as data verification checks, surveys on the systems, as well as to ensure that the systems are functioning effectively. Hospital staff are also trained to use the new systems and periodically briefed on the benefits of the new changes to motivate them to adopt the changes.
Creating such an innovation culture is an important step in SingHealth's journey towards embracing innovation as a strategic priority and bringing the Digital Ward into fruition.
Noah Tay Chin Seng More than 20 years' of working experience in the information technology industry. He is currently a Manager with SingHealth InfoTech department. As a team member from iTAG (Innovative Technology Application Group) which is part of InfoTech, he works with Clinicians, nurses and other collaborators in exploiting IT innovations to reap benefits in Healthcare services.
Fong Choon Khin is currently Group Chief Technology Officer of Singapore Health Services Pte Ltd (SingHealth). In this leadership role, he is responsible for the SingHealth IT Vision. He also oversees the Corporate Office Emergency Preparedness Committee, Business Continuity Planning and the Information Security Office. Choon Khin has more than 27 years experience in the IT industry.
Grace Ng Yi Lin is currently an IT Specialist in Singapore Health Services Pte Ltd. As a team member of SingHealth's Innovative Technology Application Group (iTAG), she works closely with clinicians, nurses and other collaborators in exploring, identifying, building and implementing new emerging IT solutions to bring an idea from concept to deployment.
Yvonne Eng is a Systems Specialist in the InfoTech department of Singapore Health Services Pte Ltd (SingHealth) and has 8 years of experience working in the IT industry. She is part of the Innovative Technology Application Group (ITAG). She has worked on pilot projects which test the concept and effectiveness of innovative patient-focused solutions.