The SIDCA Clinical Station, a solution developed by Everis for the Virgen del Rocío University Hospital in Seville, Spain, was acquired by FLENI after the Spanish hospital ceded them the rights. In an exclusive interview, the engineer Marcelo Martínez, Systems and Operations manager at FLENI, tells Ehealth Reporter Latin America about the experience.
EHealth Reporter Latin America: Was the clinical department computerized before or after the other departments in the Foundation?
Marcelo Martínez: It was the final step. The systems department started operations in 2000 with two major challenges ahead of it: firstly we needed to start up the data center in the Belgrano office, which required planning and new solutions for every aspect of operations, from the equipment, servers and desks to the formation of the human team. Secondly, we had to install the new Rehabilitation Center at Escobar.
EHRLA: Meanwhile, did the Belgrano office have efficient computer solutions?
MM: No, we also had to implement an administrative management system because the existing one was obsolete. We had to turn to a jdEdwards which is an ERP that integrates functions including accounting, purchases, payments to suppliers, inventories, etc.
EHRLA: Did you also plan to include the clinical department?
MM: Yes, but we didn’t have much success at the time. We tried to find a solution for an electronic health record by taking a look at what there was on the market, and we signed a contract with a supplier by they didn’t give us what we needed. Then the country started experiencing economic problems, there was the famous ‘corralito’ and we had to cancel the contract in 2003.
EHRLA: Did you resign yourselves to continuing with administration based on paper and big files?
MM: At the time, what we decided during the administrative phase was to resolve all the billing management internally, so we developed a system called FactHos, which included billing, out- and in- patient management, contract administration, budgets, appointment administration, etc.
The jdEdwards inventory module solved the logistical problems in the pharmacy, FactHos covered the administrative side, and we had already managed to resolve the computerization of the business-related processes but we still had to computerize the medical department, which was still managed on paper.
EHRLA: Was this difficult to achieve?
MM: Yes, it was quite difficult. We saw many interesting proposals but they were impossible to implement because of the high costs involved or because our Institution wasn’t yet mature enough to get into this area. It’s not the same to open one’s doors with the computer systems already in place, as happened at the Austral Hospital, as to implement them in places where the doctors have been working with paper for years and you have to ask them to change their habits and start working with electronic records. This was a cultural problem we couldn’t ignore.
EHRLA: But eventually you made doctors part of the solution.
MM: Exactly. In 2010, we had a chat in the hall with a doctor at FLENI, Dr. Roberto Lagos, and he told me about a conversation he had had with one of his colleagues at the Virgen del Rocío hospital in Seville about a solution they used there, and thanks to him we got in contact with the hospital and Doctor Eduardo Vigil Martín in particular.
They had a functioning electronic health record which we thought would cover all the aspects we wanted to implement. We travelled to Spain to evaluate the software and found that it was suitable.
EHRLA: Did the hospital in Seville show you how it functioned?
MM: Yes, and they were very willing to work with us. This was a great help because there is a big difference between a Powerpoint presentation where everything is beautifully presented and actually going to a hospital where they open their doors to you and you can talk to the people working there; with the doctors and nurses telling you what they find useful to improve their everyday work and what slows them down. The Seville Hospital’s excellent attitude needs to be emphasized; FLENI has also developed a very close medical relationship with them.
EHRLA: After this experience, what did you subsequently decide?
MM: We could see that implementation would be viable, especially with the interoperability we already had in place. This system has a messaging administration system, InterSystems’ Ensamble product, which made the necessary communication between the systems possible. For example, when an event (an admission, appointment, discharge, etc.) is entered into FactHos, a series of messages is sent to SIDCA in real time, allowing the doctor to carry out treatment using the electronic health record in real time; whilst they are attending the patient.
EHRLA: When did the new system start functioning?
MM: After the project was approved by our Executive Committee, and the funds were assigned to carry it out, we started the first stage of implementation in June 2011. In record time, by November, we were already producing the institutions’ transversal functions.
EHRLA: What aspects of the process contributed to achieving this goal?
MM: Personally, I think that it was achieved because we formed an excellent team, led by the medical director. It seems fundamental to me to understand that these projects reach further than the systems department, that we support and accompany their development but at the end of the day the tool is for the people who make up the healthcare team and they are the ones who use it. It is important to always bear in mind that the objective must be to facilitate the work to benefit the patient. Luckily everyone at the institution understood this.
Another key factor was the work of the resident doctors, who are young and used to computer tools. They rapidly realized that their use would make their work easier as they take care of patients, optimizing their use of time and making it possible to access SIDCA from anywhere they are in the institution.
EHRLA: Did you have external help?
MM: Yes, absolutely. During the implementation process we were accompanied by Everis España, the company that developed the SIDCA solution which the Junta de Andalucía shared with us. The person who actively collaborated with the implementation and supported SIDCA, defining the parameters for the health record to follow, was Doctor Eduardo Vigil Martín. We also sought out professionals from Everis Argentina who could contribute and assume local costs and continue the evolutionary development. So we managed to build a local working team, with the support of Everis España, which spends its working day at FLENI and is collaborating with the adaption, modifications and new developments. Using the SIDCA sources we were able to develop the system according to our particularities and needs.
EHRLA: And is it now fully operational?
MM: Not at the moment, because we haven’t implemented it to its full potential. What we did was to define 11 functions, also called sheets, and prioritized the ones that are transversal to the care of in-patients or the development of the surgery. We still have to examine the issues specific to the different specialties. For example, the development of sheets for strokes, multiple sclerosis, cognitive neurology, clinical pain, etc.
SIDCA is already integrated with FactHos via ESB, our Laboratory (Omega), Pathology Systems and our RIS/PACS (Carestream), as these are generators of information complementary to Electronic Health Records.
EHRLA: What benefits do you hope to achieve in the long term?
MM: The most interesting part of this system is the ability to exploit information, administration and knowledge. SIDCA, as well as generating clinical documentation and electronic health records, has a Warehouse module which allows, via the codification of information with international codes such as ICD 9, the generation of a rich database for information and research. The good thing is that this product is unlimited in scope, making it possible to integrate any solution you can imagine.