First published in The Tribune, in the column Young Man's View on August 07, 2010.

By ADRIAN GIBSON

ajbahama@hotmail.com

THE Princess Margaret Hospital is in a deplorable state and, in many instances, gives off an aura of sickness and death—hardly one for persons wanting to return to a hale and hearty state or one that reflects an efficient operation. There is a tardy response to patients; there are grimy and foul-smelling bathrooms, and unkempt elevators, in addition to the ogre-like behaviour of certain staff members and the petulant and inhospitable conduct of certain healthcare professionals. An air of ineptitude and narrow-mindedness only add to the depressing reality of the appalling state of affairs at PMH.

Frankly, it appears that medical negligence usually goes unreported in the Bahamas and is disavowed whenever such questions arise. Indeed, if you listen to hospital officials, their physicians are perfect, can make no mistakes and, it seems, are free from human error in their apparent status as demigods. Apparently, today the Public Hospitals Authority merely serves as a buffer between the hospital and the Ministry of Health. Who has oversight of wayward doctors? Why isn’t there a local medical watchdog? By and large, there appears to be a lack of accountability at PMH.

 Now that Doctor’s Hospital has achieved yet another world-recognized certification, one wonders how much longer will PMH, which is much older, give a picture of itself as a second-rate, banana-republic operation.

 Along with the ongoing redevelopment and improvements at accident and emergency, there must be hospital-wide upgrades of medical facilities. I am told that there are critical repairs and maintenance needs with the nation’s primary public healthcare facility. The insufferable attitudes of hospital officials have spawned much of the problems at the hospital in the first place.

 PMH must deliver quality care in a timely manner. What happened to the much-promised improvements in the efficient flow of patients? What happened to the patient care coordinators who were supposed to reduce overcrowding and congestion at the hospital, alleviating the jam-packed scene at accident and emergency?

 There must be some enhancement of communication between staff, patients and the families of patients, who are all dissatisfied with the lack of information and impolite behaviour of attendee nurse/doctors. That said, it must also be noted that there are some nurses and doctors who, no matter how tired they may be, are good-natured, extremely kind and most accommodating!

 The institution of a data collection system at PMH is essential. Indeed, there is a dire need for a properly functioning electronic integrated public health information system that encompasses the entire archipelago. The aforesaid system could increase the likelihood of evidence-based healthcare planning, produce timely medical reports and cause a reduction in the duplication of diagnostic investigations and drug treatment.

 The use of electronic health records (EHRs) is becoming a norm in hospitals across the globe, delivering healthcare more efficiently, although there are some concerns about privacy and security breaches of information containing servers. However, in the Bahamas, the risks of privacy breaches are clearly higher when records are contained in conventional paper file folders and can be misplaced and/or removed.

 In an article, writer David Bates asserts that physicians in the United States have been slowest in their transitioning to EHRs. The writer argues that hurdles to greater usage of EHRs at that time was reimbursement as physicians had to pay for this innovative medical approach; an apparent failure in terms of interoperability; capital and risk tolerance; the resistance of physicians who express disquiet about timing; questions relative to the vendors in the market and the fitfulness of these vendors (Bates, p.1).

  Since the United States is considered to be the Caribbean’s immediate neighbour, it is of note that surveys revealed barely thirty per cent of US-based physicians use EHRs as compared to countries such as Australia and Sweden (Bates, p.1). Studies show that in the United Kingdom—the former colonial master of the Commonwealth Caribbean – £8 billion has been invested in health information technology (Bates, p.1). It must be also noted that in the Commonwealth, large medical practices or hospitals have adopted EHRs far more speedily than solo practitioners who are faced with high costs (e.g. hiring a system administrator) and the reluctance, in some instances, of vendors who wouldn’t sell to sole practitioners as they cannot earn robust returns.  The recent economic stimulus, passed by the US Congress several months ago, contained the HITECH Act that aims to encourage doctors/facilities to use EHRs and threatens to trim down on Medicare payments to those physicians/medical offices who do not. The aforementioned Act offers financial incentives to those physicians making the switch.

  Electronic health records are beneficial in vast and varied ways as its implementation is believed to improve the quality of service, automate the writing prescriptions, electronically record patient information and retain treatment records.

Construct

 Authors Tracy Gunter and Nicolas Terry speak of EHRs becoming a national construct that would foster an amalgamation of patient information received on hard copy, alongside that which is later input into an electronic database. These writers assert that using information technology in medicine can greatly reduce medical errors and highlight the suggestion of the prominent US-based Institute of Medicine (IOM), which has pressed for “a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education.” It was the IOM’s ambition to rid medical facilities of the need to utilize paper and retain handwritten data by this year. However, one would say that this objective has not been attained.

 In the Bahamas, greater usage and implementation of EHRs can undoubtedly lead to great improvements in local health care—which for the most part is centred upon the use of manila folders/envelopes, handwritten information and files stuffed away in drawers. Moreover, EHRs can reduce the physical storage requirements of the respective local hospitals, clinics and other medical outlets. Even more, on a secure database, files will not be so easily “lost” or misplaced, neither would these files be subject to mildew, fires and so on.  Many Bahamians can speak to the archaic and time-consuming episodes that accompany the traditional handwritten method of obtaining or retrieving (e.g. chart pulls) medical records/attention.

 Whilst such an innovative approach to improving healthcare comes with a substantial price tag and may not yield immediate financial returns, it must be noted that some EHRs have failed in terms of their interoperability with other applications and there is the matter of allaying fears about confidentiality.

 In following Australia’s example, the Bahamas could establish a national health information network. In Australia, EHRs allow for the healthcare network—HealthConnect—to gather patient information locally and then upload that amassed information into a centralized HealthConnect database which is shared with an accessible to authorized providers/personnel (Gunter & Terry, 14/3/2005). Between some physicians, a peer-to-peer file exchange programme has been developed. Overall, this would undoubtedly reduce concerns—at least in the immediate future—about the interoperability of EHRs (Gunter & Terry, 14/3/2005).

 At many modern hospitals, EHRs maintain patient records relative to their medical histories, immunizations, test results, billing and payment information, prescriptions, scans and other images, demographics and so on. Research shows that it has also been credited with the reduction of healthcare costs (e.g. past scans and images are readily available) and medical errors are not as probable as that information and any shared ideas as to best practices are also readily available.

  Certainly, if medical information is being input and stored here or in a foreign country, it is expected that security measures would guarantee privacy and that agreements between patients and health facilities should reflect the facility’s ability to protect information via electronic monitoring and surveillance, password and virus protected servers, firewalls and, even more, a department specifically tasked with protecting information and ensuring patient privacy. Whilst US laws dictate that no physician or member of a hospital’s staff can share patient information without being subject to dismissal, criminal charges and possible jail time, in the Bahamas—though a small nation—the notion of physicians and nurses discussing patient’s medical information without their permission must be addressed compellingly and with immediate effect.

 EHRs give the advantage of having a server that is accessible even in the event of a fire and information would not so easily be deleted or dispensed with. Furthermore, it fosters an environment of accountability and transparency as files wouldn’t so easily disappear or be adjusted and persons accessing record must officially sign in/out. In the highly technological 21st century, EHRs are becoming a primary source of medical data, for which establishment in local healthcare facilities should be imminent.

 Indeed, there is a pressing need for another modern, well-equipped hospital on New Providence, as well as the construction of geriatric homes and mental health facilities that primarily focus upon addressing mental issues (not housing prisoners and geriatric patients).