Customised Care at NHG Hospital

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A new IT system spanning all four hospitals under the National Healthcare Group (NHG) ensures all this and more, not just during the length of a patient's stay, but every time he or she returns. Called Nauticus, the system is designed to make hospital care more personal and help patients manage chronic diseases better, the group said recently. The system is already live at Alexandra Hospital, National University Hospital, Tan Tock Seng Hospital and the Institute of Mental Health and contains about two million records of patients' personal preferences, appointment booking schedules and billing histories.

Nauticus will complement the Electronic Medical Records or EMR system that already contains patients' test records and medical histories. It is also being extended to all nine NHG polyclinics. Stepping up 'patient-centric' care and better management of chronic conditions are among the Health Ministry's prime concerns this year. According to NHG's chief information officer Linus Tham, providing a 'single view of the patient' is one of the key benefits of the system. Previously, all patient-related administrative data - including their personal preferences, in and outpatient visit history and details of past appointments - were scattered around disparate hospital systems. As a result, if an NUH patient visited Alexandra or TTSH, for instance, he or she would have to go through the laborious process of providing personal information to counter staff. Now there is no need to do so.

'Providing a human touch in a sanitised hospital environment,' added Tham, is another key advantage. Staff will be able to access small but important details - such as whether a patient is prone to falls, has difficulty hearing or speaks in a particular dialect - and 'customise' care accordingly. Nauticus is also able to help people schedule appointments, particularly those who are elderly or have multiple illnesses.

Ho Wai Ling, a TTSH assistant manager in charge of familiarising staff with the new system, explained that an elderly patient could need to see a geriatrieian, a diabetes consultant and an orthopaedic doctor for routine treatment every three or four months. 'The system will be intelligent enough to schedule appointments on the same day, thus saving the patient multiple visits.' Those appointments will also be scheduled in a matter of seconds. The automated self-registration process, which enables outpatients to get their appointment details by scanning NRICs or appointment cards, should free up counter staff to help the elderly or infirm.

Bioterrorism

Carl Flynn, MD, a family physician in Caribou, Maine, a small city of 6,000 tucked into the nation's far northeast corner, never expected an act of terrorism to strike close to home. But it did. In what could be the largest arsenic poisoning case ever in the United States, one person died and 15 others were hospitalized last April when the coffee at a church social in nearby New Sweden was spiked with this deadly substance. It is believed that the poisonings were carried out by a respected member of the congregation, but the suspect killed himself shortly after the incident. The case remains open. Dr a family physician in Caribou, Maine and other local physicians were ultimately able to handle the emergency with help from the state toxicologist, who was preparing a supply of antidote in kits for shipment to all state hospitals as part of a bioterrorism readiness effort. Instead, the toxicologist pulled out the arsenic antidote and sent it directly to Dr. Flynn.

But getting to this step -- pinpointing the appropriate treatment -- was puzzling. Dr. Flynn remembers sitting with two other physicians, heads bent over textbooks as they wondered, "What are we going to put these people on'?" As it turned out, there is little information on what happens when people drink a large amount of arsenic all at once. The textbooks weren't helpful and are now being rewritten using the Maine patients as case studies.

The most important lesson learned from this incident is that physicians must keep their guard up, said Dr. Flynn. "Physicians need a high index of clinical suspicion that there could be something going on." Arsenic is only one of many possible chemical weapons that could be used by a terrorist, whether homegrown and self-educated or foreign-born and al Qaeda-trained. The possibility of accidental exposure to toxic agents should also be kept in mind. There is a vast array of chemicals close at hand almost anywhere in the country, and many already have a history of nefarious uses, according to the American College of Medical Toxicology. It has developed a course called "Chemical Agents of Opportunity for Terrorism: The Medical and Psychological Consequences."

As the terrorism alert warnings change from yellow to orange and back again, physicians would be wise to maintain their vigilance. In the world after Sept. 11, 2001, "terrorists can make the unlikely' happen," said Paul Wax, MD, the course director and a medical toxicologist at Banner Samaritan Medical Center in Phoenix. Dr. Wax and colleagues presented an abbreviated class version to congressional staffers and others on Jan. 14 on Capitol Hill.

The first step toward a safe community is understanding which toxic agents are already in the neighborhood, said Curtis P. Snook, MD, an associate professor of emergency medicine at the University of Cincinnati School of Medicine. About 850,000 U.S. businesses use, produce or store toxic industrial chemicals, said Dr. Wax. Among the chemicals on this long list of lethal substances are ammonia, chlorine, formaldehyde, phosgene, sulfur dioxide and carbon monoxide. Toxic substances can be found at farm and garden supply stores, photo labs, college labs and toxic waste dumps as well as the many industrial facilities in the nation.

The Environmental Protection Agency has reported that 123 chemical plants across the country have enough toxic chemicals to kill or injure 1 million people, according to course material. Dangerous agents can also be ordered over the Internet. Last year a high-school student poisoned a rival for a classmate's affections using potassium cyanide purchased from a Web site, said Dr. Wax

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