Data saves lives: AHMC delivers better healthcare at lowertotal cost through digital innovation

Healthcare in the Philippines is going through important changes – some good and some bad. Life expectancy is up, but we also failed to meet targets on maternal and child health under the Millennium Development Goals. Fertility is down. Infectious diseases like cholera and dengue are re-emerging – brought on by overflowing urban populations and climate change – and old ones like HIV/AIDS are reaching epidemic levels in Cebu, Davao, and Manila.

Quality healthcare at Asian Hospital. Photo Source: AHMC

This is exacerbated by the fact that access to quality healthcare has long been a problem in the Philippines. The quality of healthcare is wildly inconsistent from hospital to hospital, and between urban and rural areas.4 Meanwhile, out-of-pocket spending on healthcare as of 2014 was at 81.7 percent per the World Health Organization, far above the 45.5 percent global average.

Faced with these challenges, some of our best hospitals have begun looking closely at medical informatics, or health informatics, as a critical part of the solution. Defined by the US National Library of Medicine as "the interdisciplinary study of the design, development, adoption and application of IT-based innovations in healthcare services delivery, management and planning", medical informatics offers unprecedented means of collecting, packaging, and analysing clinical data to improve the quality of healthcare.

Among these hospitals, perhaps the most committed to data-driven healthcare is Asian Hospital and Medical Center (AHMC). While many decision-makers in the health sector struggle to realize the benefits of information technology (IT), AHMC has gone beyond simply going digital to leveraging advanced analytics that promise better outcomes for the hospital’s patients at a lower total cost of care.

Exceeding international standards of care

“We look at digital and IT as a means of providing value healthcare,” says Dr. Juan Antonio Javellana, Director of Medical Informatics at AHMC. “Integrating these technologies with modern medicine allows us to treat patients better and more quickly, as we deal with changing risk factors and new infectious diseases.”

AHMC began its journey towards data-driven healthcare by going digital in its medical record system –by itself a significant step forward from most of the paper-reliant health industry. After AHMC received its second Gold Seal of Approval from Joint Commission International in September 2016, Chief Quality Officer Dr. Jose Acuin called on the hospital to improve efficiency and service delivery though an integrated information system.

Said Dr. Acuin: “What we need to achieve is quality beyond accreditation. We shouldn’t be satisfied with simply meeting standards of care – we should exceed them.”

Treating patients more efficiently and quickly

The Medical Informatics team took on this challenge by rolling out a comprehensive plan for AHMC to achieve a kind of healthcare that had IT-enabled data and analytics at its heart. They realized that the hospital would not be able to provide the best care to patients if they didn’t have an accurate picture of what diseases were being treated each day and the state of patients when the left the hospital.

“Our first order of business was to get information to decision makers in the hospital in more or less real time. We needed to show hospital leadership what our daily operations looked like with the help of dashboards and advanced metrics. We also needed to be able to do some analytics on our historical information so we could plan accordingly moving forward,” says Dr. Javellana.

AHMC’s Medical Informatics team then made the decision to adopt from SQL Server Reporting Services (SSRS) to Power BI, a new suite of business analytics tools from Microsoft built to give users a 360-degree view of an organization with constantly updated information and full inter-operability with other Microsoft products. The deployment of Power BI would find a wide range of applications within the hospital, with AHMC looking at even more ways of leveraging data to provide superior healthcare.

“In the past, the preparation of reports required our stakeholders to ask the IT team to extract raw data that would then have to be pieced together – a very tedious process,” explains Darren Blanco, who helps oversee the hospital’s Application Development Team. “But this was all flat data, without much detail about what was happening throughout the day.”

For AHMC’s management to offer the best possible kind of care, the Power BI-based system would have to continuously track key pieces of data. They wanted to find out: how many people were received in the outpatient department? Which services had more utilization?What kinds of patients were we treating in our in-patient wards?What were the diagnoses?

Dr. Javellana says: “Our hospital information system is code-based, following standards set by the International Classification of Diseases. When a patient comes in, a code is given to them that’s then entered into the system. This allows us to see, for instance, how many pneumonia patients we have, what kind of surgical procedures are being done, which ancillary services are being used most, and the top diagnoses for in-patients. And we can see this day-to-day, month-on-month, year-on-year.”

By looking at a constantly updated picture of the hospital’s case mix, patient demographics, and clinical unit utilization, AHMC is now better able plan the resources committed to the hospital floors to serve the specific needs of its patients and make day-to-day operations more efficient.

Power BI also gives the hospital management committee ways to understand historical trends such as month-on-month patient surges and ER overflows. This allows AHMC to make strategic planning decisions over the longer term, on things like their pool of on-call nurses and the number of beds to assign to the various floors during specific points in the year.

The platform also helps AHMC comply with its commitments under the Joint Commission and other international standards, such as keeping an adequate pool of interpreters and other specialists. 

The system also provides rich insights for the financial aspect of AHMC, allowing management to easily know who the payers are and which health policies are being implemented. Along with tracking year-on-year growth and other financial information, this allows the hospital to plan spending for further improvements, including data storage, infrastructure, improved facilities, and manpower.

Altogether, this new system allows AHMC to deliver on its promise of value healthcare: treating patients as effectively and as quickly as possible, resulting in lower overall cost for payers.

A roadmap towards digitally enabled healthcare

AHMC management however feels that there remains a lot to be done, even as the hospital is now regarded as one of the best in the Philippines. Having more specific, more detailed, and more accurate clinical data is now one of the biggest concerns of the Medical Informatics team.

Having digitized all of the hospital’s lab information, the Medical Informatics department is now working with AHMC’s pharmacy module. The vision is to provide clinical decision support, such as alerting doctors about patient allergies to certain medications or instances where too many interactions between medications take place.

Another important digital-enabled project is AHMC’s Patient Flow System, which allows doctors to track how long it takes a patient to go from one treatment area to another. By understanding patient journeys from ER physician, to diagnostics, and then to exit, AHMC has achieved an average of only three hours in the ER, which is better than most international standards. 

According to Dr. Javellana, the hospital will soon deploy that same system onto the floor so managers can see how patients go from one area of the hospital to another, ultimately letting doctors treat them faster and better.

Says Dr. Javellana: “Among the things we’re looking at bringing into Power BI are expanded quality measures such as our return to ER rate within 72 hours.Which and how many patients made unintended returns to the operating theatre within 30 days? What is our door-to-balloon time for angioplasty patients? Having this information and making it relevant to stakeholders has many uses, from seeing what kind of clinical studies would be most valuable to making sounder procurement decisions.”

Security and data privacy, along with easy integration with other IT assets, were also important factors in AHMC’s move towards Power BI and data-driven healthcare. Having complied with the recommendations of the National Privacy Commission, AHMC is looking to take full advantage of the security features of SQLServer and other Microsoft solutions, all of which are controlled by the Medical Informatics team within the Office 365 interface. 

“There will come a time when all diagnosis and treatment information, and even Philhealth information, will be sent digitally,” says Dr. Javellana. “And as we move towards having our own hybrid cloud facilities, our goal is to provide the best healthcare while keeping patient data safe. Power BI, Office 365, and SQL give us the capability of delivering the best care we can in the most secure way possible.”