Dr. Rounds-Technology White Paper
Electronic Medical Records Integrated Query System for Hospitals with Multiple Branches

1.1 Overview

As difficult as it is to believe, the fantastic story we're about to share with you didn't come from a book of fairy tales — it's terribly real. Our story takes place in the world of healthcare. Our setting is hospitals and clinics and pharmacies. The villain of this large and ever growing tale is paper. Paper's inherent static nature, its non-digital form, its heavy weight, cost, fragility, inconvenience, and more make it public enemy number one. In a miraculous twist, once our hero, paper is now, in the digital age, nothing more than a villainous liability. No worry! A hero has arrived! Displacing paper is SYSCOM Integrated EMR Solution and Microsoft Surface. Our medical records platform, SYSCOM Integrated EMR Solution is rescuing medical patients, caregivers, and tax payers from paper's static clutches.

Before rounds, doctors spend considerable time preparing patient records including backgrounds, drug reactions, prescriptions, treatment details, instructions for nurses, lab reports, examination results, and more. In other words, an almost never ending stream of paper that documents everything about a patient, but the problems are many and growing. Doctors refuse to lug an unpotable paper library of records.

Collecting, organizing, and parsing reams of paper uses time better spent elsewhere, not to mention the cost of the paper itself. As patients' records grow, the paper-load also grows, becoming rather heavy further encouraging doctors pick and choose what data to as to a patient's record, especially recent data. When visiting the wards, doctors almost always carry an incomplete and to some degree flawed record of their patient's medical situation. Health care quality is diminished, data is incomplete and inconsistent. Paper-based records vary from site to site.

SYSCOM Integrated EMR Solution integrates real-time data into a single screen for complete, consistent data and supports sharing to hospital branches, clinics, pharmacies, and partner locations. The results are sometimes incremental improvements in patient care and other times lifesaving results. From any location, doctors, nurses, pharmacists, and medical staff easily and quickly query a complete and consistent record of patient data culled from persistent record storage and mixed with shared data sources from partners.

The benefits of completely integrated medical records are tremendous, but in achieving this we face challenges. Nevertheless, the business benefits are huge and the social benefits are priceless.


1.2 Challenges

The SYSCOM Integrated EMR Solution addresses these healthcare industry challenges:

a. When government regulators mandate changes to patient medical forms or when new forms are created, these changes must reconcile with existing forms and the massive stockpile of existing patient data. Fields and their data types, version control, and the managing the content of the medical records themselves, are only a few of the items that must be carefully handled so at all times meeting regulatory requirements while insuring the medical records system is available for use.

b. Culling the most vital data from a patient's electronic medical records for presentation via a single screen dashboard. As data fields change matching existing data with these new fields is critical and system administrators must be able to maintain data fields after project development.

c. Sign-Off History:
Care givers must have a highly efficient electronic signature mechanism for medical records. While the mechanism imparts security and responsibility throughout the system it is also important that proxy signatures be supported for times when certain personnel are not available for the signing process.

d. Query Management:
Fulfilling both internal and external query requirements is a big challenge. Security of medical records is critical. Patients should also be able to query their own records from any hospital branch location. A comprehensive security system is needed to connect all hospital locations.

e. Migration from Legacy HIS:
Efficiency and security are important while medical records are transferred from old disparate systems to the new Dr. Rounds HIS core system.

f. Scope and Purpose:
Operating a fully integrated medical records system when various departments and locations have very different data requirements. Among hospital branches are dental offices, medical specialty departments, and many others that are not ubiquitous but rather unique to certain hospital locations. Ultimately, the electronic medical data standard, known as CDA R2, must be followed for all data fields in support of inter-hospital record exchange.

g. Audit Management:
The management of who is allowed to query and what they are allowed to access is a tremendous challenge. With thousands of caregivers and dozens of health care roles in combination with the sheer mass of patient medical data, query and audit management quickly grows into a monster sized problem. Just one example, a record of all data transfers must be maintained for later audits.

h. Resource Utilization:
Making use of electronic medical records to generate statistics for research purposes is tremendously beneficial. The challenge is making data available to the people who can make use of it, offering data in ways that it is useful, capturing data that is needed and helpful, and maintaining security and privacy yet leveraging the mass of valuable data for research and useful statistical analysis.


1.3 Solutions

SYSCOM Dr. Rounds is proven to save doctors and nurses from 3 to 7 minutes per patient visit during hospital rounds. These 3 to 7 minutes would otherwise be used searching for a particular sheet of paper, thumbing through pages of paper report to find one critical data element, finding the correct sheet of paper on which to add notes about medicine dosage and then a different sheet of paper to add notes for the nurses.

During rounds, 5 to 10 patients are visited. The load varies based on many factors but for our task at hand, this range is sufficient. This means the minimum time savings is 15 minutes and that can climb to a maximum of 70 minutes saved during patient rounds. This is a daily calculation and for just a single caregiver. In 2004, Taipei City Hospital had a total of 799 doctors and in 2011 nurses totaled 2,100. The table shows how much time SYSCOM Dr. Rounds would save this hospital.

The saved time is time not wasted using paper-based systems and can be used by caregivers in many ways that are beneficial to the patients and the hospital. It isn't our role or expertise to enumerate how these saved hours can be better used and we leave this task to the professional caregivers of the health care industry.

Hours saved at Taipei City Hospital based on 3 to 7 minutes saved per patient visit using SYSCOM Dr. Rounds and 5 to 10 patient visits per rounds and rounds performed once daily.


1.4 Case Study

Our solution is appropriate for any care provider that operates more than one care facility. Care providers include hospitals, clinics, and so on. Care facilities includes hospital buildings, medical campuses, hospital branches, clinic locations, clinic branches, pharmacies, etc.

Our solution is in use now by the Taipei City Hospital Medical Institution at their 10 hospital branches which employees 2,900 care providers. Additionally the solution extends to 5 clients, which are partnered with Taipei City Hospital, and employee hundreds more care providers. In all 2.6 million residents are served throughout all districts of Taipei City.

Using our solution an average of 18,000 patent medical records are accessed at each location each day throughout the hospitals and clinics.


1.5 Summary

SYSCOM Dr. Rounds integrates real-time digital data into a single “sheet” of complete and consistent data and supports data sharing to other hospital branches, clinics, pharmacies, and partner care providing locations. The results are nothing less than any other medical miracle — often small incremental improvements in patient care and other times lifesaving results because from any location doctors, nurses, pharmacists, and medical staff are able to very easily and quickly query a complete and consistent record of patient data culled from persistent record storage mixed with shared data sources from hospital partners.

Regardless of the patients' arrival at any of various hospital branches, the benefits of completely integrated medical records is there, but to achieve this we do face some challenges. Nevertheless, for hospitals the business benefits are tremendous and society, the benefits are priceless.