By the first quarter of next year, patients at the KK Women’s and Children’s Hospital will have their medicines packed by a robot.

While nothing as human-like as C-3PO in Star Wars, the robot will be able to search for pills that arrive at its store rooms – be they in buckets, or in vacuum packs – according to the prescription that doctors order electronically.

Developed by European logistics solutions provider Swisslog, the robot will not only pick, cut (for those in vacuum packs) and pack the tablets, it could even bar code them and ring all the medicines for automatic dispensing to a particular inpatient.

“The doctors are already prescribing drugs electronically now,” explained Low Cheng Ooi, chief medical information officer at SingHealth. “However, the pharmacists need to transcribe the prescriptions into their own computer system, which raises the risks of errors being made. “Under the robotic pharmacy packing system, safety alerts, automated packing and barcoding of drugs will help reduce risk of errors and increase patient safety.”

The system is set to be a major step in SingHealth’s plan to move towards a total electronic medical records system. Although the healthcare group, like other players in the public healthcare infrastructure, has started to adopt electronic medical recording, there is still some way to go before it can achieve a fully paperless environment.

“The missing part is electronic documentation, which is lacking,” said Dr Low. “I don’t think the clusters are all electronically documented yet. E-ordering must also come in. And there are many components in e-ordering: ordering of lab and radiology tests, ordering of medication, and ordering of nursing notes, diet and management.”

SingHealth is rolling out electronic orders in phases beginning with laboratory and radiology orders, then inpatient medication and lastly nursing orders. Electronic orders of laboratory and radiology tests as well as outpatient medication prescriptions are already implemented at the Changi General Hospital, but doctors at the Singapore General Hospital and KKH are still placing their clinical orders using paper forms. As for nursing and diet notes, they are currently recorded in a paper file.

The robotic pharmacy packaging system is part of the e-order component. Following the pilot of the system at KKH next year, SingHealth plans to roll it out at all its hospitals by 2012.

When fully implemented, the system will free up some of the manpower currently required to physically repack tablets in bulk containers into smaller dosages.

“For inpatient robotic packing system, the number of Full Time Equivalents (FTE) freed was estimated for KKH at three and for SGH’s outpatient packing system, the number was estimated at seven,” said Dr Low, who is also chairman of CGH’s Medical Board. “The difference in number is attributed to the difference in workflows for each of these areas. The cost savings made is not just in terms of FTEs, but also reducing the ‘human’ component of errors.”

Come next year, SingHealth will also be introducing an electronic nurse charting system. With it, nurses will be able to enter patients’ information into an online record. Physician documentation, through structured templates, is likely to be the last piece to complete the electronic medical record system. The difficulty, said Dr Low, lies in designing the user interface that will be friendly to most doctors’ patient management processes. It is also a challenge to meet the varied needs of doctors in different specialities and with ranging levels of IT-savviness.

“We are now going into a documentation system that captures things in a structured manner so that we can analyse,” said Dr Low. “If I just want to make electronic a process, I can scan every document. That is the simplest way of doing it. But can I search through every word? Can I google the handwriting? Can I do anything of value from it? The answer is no, because you merely automate your system, not transform.”

The utopic electronic system that Dr Low is aiming for is one that can add value to analyses of clinical outcomes and disease surveillance. For example, it should be able to group patients of a certain disease together, track their reaction to medications, commonalities in health histories, and recovery progress.
While it is still early days to be able to measure the benefits of going electronic, Dr Low said that implementation at the outpatient level has shown that digital documentation has eliminated errors from illegible handwriting and dosing errors.

“Because we went electronic, and we no longer use X-ray consumables, we don’t have a patient carrying X-ray folders all over the place, we now save about $400,000 a year. Not to mention the fact that we don’t need storage space for all these X-ray folders and the work effort that we used to need to move them all over the place when patients come.”

‘Under the robotic pharmacy packing system, safety alerts, automated packing and barcoding of drugs will help reduce risk of errors...’ – Dr Low Cheng Ooi