Improving the patient experience at Bumrungrad International Hospital, Bangkok, Thailand
Bumrungrad International Hospital was founded in 1980 and has since grown to become one of the most reputable hospitals in the region. The recipient of numerous international awards and accreditations, Bumrungrad International is one of the largest private hospitals in Southeast Asia, catering to over 1.1 million patients from over 190 countries annually.
In an exclusive interview with MIMS, Kenny Lim, Chief Information Technology Officer of Bumrungrad International Hospital shared his views on how the hospital has continued to improve its services to patients with particular emphasis on the use of clinical decisions support tools.
In line with Bumrungrad International Hospital’s mission to deliver innovative clinical and service experience and accomplish operational excellence, how has the implementation of a clinical decision support (CDS) system benefited patients and healthcare practitioners at the hospital?
Kenny Lim: Bumrungrad International is a very well-known institution and it is important that we maintain a high level of patient safety and quality-of-care. The ability to detect drug-drug interactions and drug allergies at the point of prescription is very much a part of improving patient safety as it enables our healthcare practitioners to detect anticipated issues before it occurs. After all, prevention is always better than cure. Having a CDS embedded in our hospital’s system is valuable as the alerts are triggered at the point of prescription.
Bumrungrad International has a multidisciplinary team of experienced healthcare professionals who are well-placed to deliver quality care for all types of patients and complex care needs. Patient care often takes place in a multidisciplinary setting involving nurses, general practitioners, pharmacists and in some cases, surgeons or specialists, with each party responsible for different stages or different aspects of care. In such settings, the CDS plays a valuable role as it can notify the healthcare professional involved at a particular point of a patient’s management if a new drug interacts with a previously prescribed medication. Once an alert is received, the healthcare team involved can then decide on the next step. This directly benefits the patient as it not only increases the speed of treatment decision, but also the accuracy of patient history-taking.
A CDS tool is a unique system which provides healthcare practitioners (including doctors and pharmacists) with timely and regularly updated prescribing information on pharmaceutical products. Importantly, a CDS provides healthcare practitioners with clear warnings on drug-drug interactions, as well as warnings about potential drug allergies. It also generates a cross-reaction warning for allergic cross sensitivity between drug groups.
How does having a decision support tool influence the relationship between healthcare professionals, in particular the pharmacist-physician relationship at Bumrungrad International?
Kenny Lim: In the past, if a pharmacist identified a drug or allergic interaction in a doctor’s prescription (which may have been missed by the doctor), the doctor will be immediately notified via a phone-call or in person. With an advanced decision support tool in place, the phone-call is now essentially replaced by a computer-generated alert, which will be received by both the doctor and the pharmacist. The “alert” is likely the same, but is much faster with the CDS in place. Once the alert has been received, the doctor can then decide to select a therapeutic alternative, or ignore the alert, and proceed with the medication. Ultimately, the decision as to whether the effects of treatment outweigh the possible risk of drug interactions or allergies lies with the doctor and his or her multidisciplinary team.
From a management point of view, how has technology helped Bumrungrad International continue to evolve to improve its services?
Kenny Lim: At Bumrungrad International, we believe that safety should never be compromised and all errors are preventable. Bumrungrad International is committed to providing “World Class” services by using the Malcolm Baldrige National Quality and Magnet criteria as the framework for achieving our overall organizational performance objectives. By utilizing technology such as the CDS which can help reduce the risk of human error, we believe this translates to a reduction in incidents of drug-drug interactions and allergies. What I also find valuable with the CDS is its ability to monitor the number of alerts which are either acknowledged or ignored (whereby a healthcare professional decides to proceed with a medication despite having received an alert). Having this type of information on hand enables us to continuously review and improve our processes.
A common complaint among users of CDS systems in general is alert fatigue, a phenomenon which can contribute to alert overrides. [J Am Med Inform Assoc 2006;13(2):138-147] What has been the experience at Bumrungrad International with regard to this issue?
Kenny Lim: Alert fatigue is definitely a problem whenever a CDS is in place, and it’s really up to each organization to decide on how to best configure the alerts. At Bumrungrad International, this decision on alerts configuration is a joint decision by the pharmaceutical group, the medical board, and the management. While individual doctors are not allowed to change the alert settings, this can be done at the specialist group level. For example, due to the nature of their practice, consultant oncologists may only want to receive high-level or critical alerts. By improving the specificity of the alert system, healthcare practitioners can experience less alert fatigue, override fewer alerts, and provide better care for patients with conditions that warrant immediate intervention.
What are some of Bumrungrad International’s key priorities for the future?
Kenny Lim: The field of precision medicine has developed rapidly in recent years and Bumrungrad International plans to become a key player in this field. With this in mind, a system that could incorporate gene-drug interactions could be a valuable tool.
Another one of our key expansion goals is to focus on providing more specialized services, a field in which we are well known. In this regard, the MIMS CDS system has an important role here as we continue to elevate the standard of care and safety of our patients, as well as our healthcare professionals and management experience.
Thirdly, Bumrungrad International treats over 1.1 million patients from over 190 different countries yearly. To serve such an immense international population, close to 50 percent of our staff are international staff. In terms of how the CDS can continue to aid us in this respect, I believe it would be useful to have drug information available in other regional languages to complement the multilingual support we provide.
Internationally, Bumrungrad International now has a presence in Myanmar and Mongolia, with referral offices in up to 22 countries globally.