At a slight swipe of finger, the iPad shows a graph of blood test results. Moments later, the doctor promptly orders a vital research while recording her decision in the digital health file... while sitting at the hospital café. Thanks to IT-chief, this is daily routine for standby doctors at a large Estonian hospital.
«In our hospital database, there’s a sea of digital data on every patient; but it is difficult to obtain them from there as one wants to analyse a patient and assess the dynamics,» said North Tallinn Regional Hospital (PERH) iWard engine, neurosurgeon Kahro Tall.
Gone are the days when a doctor, needing vital data, had to run to her office and do some heavy clicking with the mouse; now, all it takes is fingering a tablet computer.
«We surgeons work at the operating theatre and all else needs to be as easy as possible,» underlines Mr Tall while introducing the computer programme, made after the desires of doctors.
To make information from hospital main database easily accessible for doctors, it is displayed visually if at all possible.
«A normal analysis is marked green, out of norm comes red. You press the «development» button, and the corresponding graph appears,» said the surgeon, proud of his creation.
Indeed, having recently seen the way family doctors see results of analysis, the PERH graph is impressive. Even a patient will understand this, one with no medical education.
Instant key picture
Mr Tall is convinced that thanks to the visual solution, «painting abnormalities red in block letters», the doctors will have fewer errors. «Red is red, abnormality is abnormality; one can no longer easily miss a hazard,» he stressed.
The neurosurgeon points out blood tests where, in addition to the usual haemoglobin and leucocytes, lots of other indicators are searched out. «The ordinary clinician will overlook these as there can’t be anything bad there; even so, if you know the condition of the patient, sometimes there can be [something bad] and then the programme will also point it out,» he said.
Personally, Mr Tall uses an iPad to document surgeries. «During an operation, I am not taking the pictures as my hands are sterile, an operation theatre technician does that,» he specified, showing a picture taken by operation microscope of a brain blood vessel before and after surgery. «I may indeed describe the situation, but now the surgeon also has the picture memory of how the situation really looked.»
Into health files of some patients, Mr Tall has also copied X-rays from pan-Estonian picture bank. «I operate on 450 people a year, consulting some 1,500, and I do not remember everything; but this way I immediately get the so-called key picture of what was wrong,» explained the doctor.
The option makes his work much faster, as in the middle of a working day ordering a shop from the picture bank may take 40 minutes, but the doctor has half of that for reception.
For a large medical institution like PERH, it also significant that by use of the new solution, a doctor finds the patient quicker.
«Here, it’s easier to mark the patients as some are in the intensive [care unit], some at the reception, some are at some other departments due to lack of beds. Used to have a slip of paper in my pocket, where I wrote where the people were,» said Mr Tall.
The surgeon dispelled fears of a doctor at the bedside tinkering with his iPad, instead of communicating with the person.
«I check the needed data before I go,» assured the man, underlying that work with papers and people are two separate things. «This (record keeping – edit) is getting more and more abundant; an iPad makes it more convenient and saves our scarce resources,» said Mr Tall.
The iWard project is the brainchild of PERH’s own IT-specialist Allan Kändmaa who tailor-made it as the doctors wanted. As a part of it got completed, it was tested in real doctor work – and proven to work – they continued with the next interface. «Takes more time this way, but the thing will be decent,» said Mr Tall.
Must not fit all
Asked if inventing the wheel like this, in the house, is worth it, the PERH IT-director Marko Kilk says there aren’t too many identical programs in this world; and these that be very expensive.
Though the hospital has done a year’s worth of hard work at its iWard, Mr Kilk thinks not that other Estonian medical institutions ought to employ it. «What matters is that you get the needed information, not that ell use the same program. All must not wear the same clothes and drive the same cars,» was his firm conviction.
According to Mr Kilk, a pan-Estonian system would come with certain costs. «By the way, booking.com is not a single system, but is directs the user to various mediators,» he said, to bring an example. This is the very portal that Estonian officials love to point to when talking about the need for single digital registration.
According to Mr Kilk, the current problem is that some entries are well understood by computers, and some are not. «There needs to be an agreement concerning the structure and the semantics,» said Mr Kilk.
While, years ago, Estonia was leading the way forwarding documents digitally, the solution no longer fits.
«We need to forsake the documents-centred thinking. The paradigm must change,» underlined Mr Kilk. «Today, no one simply knows who is pulling the thing; is it the doctors, the patients or the financers?»
According to Mr Tall, the tablet-solution for doctors might in days to come be adjustable on user basis, so to speak, as different doctors need differing data. «I have the luxury to be its creator; in many ways, this my vision as a surgeon; but doctors with other specialties have other preferences. Maybe for the, the analyses and pictures – so vital for me – are not that important,» said he.