Aided by Artificial Robotic Process Automation Software (RPA Software), Bahrain’s King Hamad University Hospital (KHUH) has taken a giant technological leap towards revolutionising the healthcare industry.
KHUH has recently hit the headlines after it adapted to Amazon Web Services (AWS) and developed a long-term storage solution without making changes to its existing Picture Archiving and Communication System (PACS).
The 600-bed hospital faced limitations on the data maintenance front as their on-premise storage of medical images kept on getting bigger with every passing year. The AWS solution has helped the healthcare facility to reduce its data storage costs by 40%.
KHUH’s journey as the tech pioneer in Bahrain’s healthcare sector is sure to be a textbook reference for hospitals in other parts of the world wanting to make it big in the industry.
KHUH’s cloud-based solutions
By January 2022, the hospital had accumulated around one million image studies in some 476 million files. While the total data volume is around 44 TB (terabytes), to date, the hospital has been adding around 1 TB of new data monthly. Out of those one million image studies, only 94,000 from the timeline of 2011-19 were retrieved in 2021, and these nine-year data alone formed a 3TB volume. To simplify the equation, only 7% of PACS data was retrieved annually.
While these storage upgrade works kept KHUH’s IT staff busy until 2021, a state-of-the-art archival solution became a necessity. The innovation required to be an adaptive one towards future technological breakthroughs, while making minimal changes to the PACS system. That’s where Amazon Web Services stepped in with its S3 File Gateway and S3 Glacier. Now, the new on-premise data storage architecture keeps only medical images generated in the last four years, whereas AWS archives the remaining data. The hospital is now having the best information and communication technologies in Bahrain.
KHUH’s data infrastructure
While the Amazon S3 File Gateway provides a file interface into Amazon Simple Storage Service (S3), these two together create a service and virtual software compliance, through which the hospital can store and retrieve objects in S3 file sharing, using the file protocol Server Message Block (SMB). The software gateway is deployed in the KHUH on-premises environment as a virtual machine (VM), which is running on VMware ESXi. The gateway then allows the medical image-related data to be accessed in S3 as files or file share mount points.
While KHUH used the solution to transfer the image data to the cloud without much modification to the existing PACS system, the latter uses the SMB protocol to store data on a Windows file server. If the data volume rises, the hospital adds IBM SAN (Storage Area Network) Volume Controllers (block storage virtualisation appliances from the IBM System Storage product family) to the Windows file server and creates new file shares.
These new file shares are then added to the PACS storage manager. The S3 file share added as another file share, helps the PACS system to store medical images on the S3 File Gateway.
While the initial solution architecture was developed with AWS, the Amazon S3 Glacier Flexible Retrieval storage class got roped in as well, as the healthcare facility onboarded more and more solutions. S3’s induction was done to store those archived data which may not be required immediately but can be easily retrieved as per the hospital staffers’ demand. The feature has flexible retrieval options, balancing cost with access times. KHUH’s goal was to avoid manual interventions in the data retrieval process, which is why the healthcare facility automated the whole operation. If the PACS system attempts to access a file from the Glacier Flexible Retrieval storage class, an error message will be sent to the Amazon CloudWatch logs, resulting in an AWS Lambda function, aimed at retrieving image files via S3 batch operation.
“We have achieved our digital transformation by focusing on three vectors. Robotic process automation, AWS storage technology, and most importantly, empowering our in-house engineers,” said Hamad Saeed Abdulrahman, Director of ICT at King Hamad University Hospital.
But then, there was a catch as the KHUH didn’t have access to the image data in any of the S3 File Gateway cache or S3 bucket in the AWS Cloud, which prolonged the recovery process. To remove the obstacle, the medical facility deployed another S3 File Gateway virtual machine in their data centre. These gateways are addressed through a single domain name system with failover alias records.
Following the AWS Storage Gateway user guide, KHUH didn’t write multiple file shares to one S3 bucket and configured two Identity and Access Management (IAM ) roles to put the bucket in the failover architecture. The hospital’s on-premise application monitoring system checks the S3 File Gateways. If one of the gateways becomes unavailable, KHUH’s IT team gets a notification about the glitch.
While the hospital reduced the storage cost by some 40%, it achieved benefits such as higher durability for medical images, a reduction in administrative efforts like expanding the on-premise storage facilities yearly, and long planning cycles for infrastructure development. The KHUH can even carry out quicker changes in the archiving department.
KHUH Healthcare information system recognised by oracle
“After trying many other systems, we realised we had to build our own. Today, we are very proud to have developed HOPE. It has shown that it is a robust, user-friendly system with proven excellence over the years,” said Major General Dr. Shaikh Salman Bin Ateyatallah Al Khalifa, Commander, King Hamad University Hospital, in a recent Oracle report.
KHUH has been using HOPE since 2017. From scheduling, admissions, electronic medical records, lab testing, speciality care, pharmacy, catering, revenue management, or any other healthcare service, HOPE is the answer.
While the facility offers over 40 specialised treatments, it was finding it difficult to come up with a responsive hospital management information system. Eventually, they found a capable solution in the form of Oracle Application Express (APEX). This cost-effective framework provides application development at a faster rate compared to Java and Net programs. KHUH’s development of the HOPE portal relied heavily on APEX.
The hospital now has one application, which carries a suite of over 40 modules. Under it, the application development speed not only got increased by five times, but it also resulted in the creation of a paperless modern healthcare information portal, while saving 80% of the operational costs of the KHUH during its 10-year budget period savings exceeding the $40 million mark.
The healthcare facility has now diverted the saved money towards fulfilling the goal of becoming the first and only healthcare facility to connect to Bahrain’s National Electronic Medical Records (NEMR), National Healthcare Insurance Information System (NHIIS), and Drug Utilization Review (DUR).
KHUH has taken innovation to the next level with the development of its fully automated robotic pharmacy and chemotherapy preparations. During the COVID pandemic, apart from having robust virus testing and vaccination services, its telemedicine mechanism proved to be a game-changer as well.
Bahrain Oncology Center (BOC), under KHUH, currently possesses a fully integrated chemotherapy protocol workflow. Under it, some 300 protocols have already been integrated, with 30 more to go, to meet the goal of a cost-saving, safe medication management programme. Services, especially on the chemotherapy front, improved by leaps and bounds, as few errors and incidents got reported.
Currently, the hospital app has 5,000 users, including its physicians and staff. It registers some 4 to 5 million hits daily, apart from arranging 8,000 to 10,000 sessions in the same timeframe.
While access to real-time data and reporting has brought transparency in hospital finance and accounting, the institute now has an efficient budget control mechanism under its wings. All these are helping the hospital to prioritise patients and reduce waiting periods.
Robotic Process Automation: KHUH’s answer to COVID
King Hamad University Hospital has been no stranger to the entity called automation. Since the start of COVID, KHUH has worked to have robotic process automation that empowered it to make drastic changes to its operations to cope with the pandemic fallouts.
Beginning with the declaration of COVID symptoms, an RPA (Robotic Process Automation) mechanism was developed to integrate and operate multiple silo systems. The rota system sent an actionable email to all healthcare staff members to see if they had COVID symptoms. Following the identification of the infected personnel, an infection control mechanism will be activated, in which the healthcare facility will schedule testing appointments, initiate a quarantine action in the HR system, and notify managers/team leaders of the isolated employees. The system was operational from the start of the pandemic until mid-2022. Furthermore, this system enabled KHUH management to monitor trends and spikes, giving the hospital agile and proactive quarantine measures, which ensured healthcare provisioning and continuation of services.
The RPA took one week to create and another week to test. This quick rollout utilising current in-house technology had a significant impact on the hospital. A positive case would cause the action of having symptoms to be triggered by clicking on a staffer’s email prior to the start of the designated shifts. All of the preceding actions would be activated, and they would be assigned time slots to be tested in the quarantined COVID testing tent. The HR attendance system would be locked for the duration of the testing results, and their managers/team leaders would be notified so that any necessary shift changes could be made.
The rapid and agile deployment of the RPA inspired multiple applications and systems that coped with pandemic challenges, such as the lack of human resources and the extended duration of material deliveries. This will be discussed in depth in the next part of the article.
Migrating the hospital in Zero Operations Downtime
In early 2020, KHUH faced the complex challenge of core network replacement. Even though the cycle refresh was due, the medical facility wanted to ensure that not a single second of hospital operations would be disrupted. Putting matters into perspective, all KHUH systems that supported operations were on-premises. The hospital leadership came up with a three-tier plan.
Firstly, through Microsoft M365 SaaS (software as a service), KHUH was able to shift communication from on-premises to a cloud solution. That enabled two main success factors, more versatility in the user experience and connectivity, and independence for the current infrastructure.
The second plan was to virtualise all systems in place. Going from physical to virtual was a challenging task as all the systems were live and had to be accessible during working hours. KHUH utilised VMware virtualisation technology, with ICT engineers creating virtual copies of current running systems as they were running, and then utilised the time between hospital shift changes to replace the live physical system with the virtual copy.
KHUH was left with the access server hardware after virtualising all of the systems. Therefore, it enabled the hospital to have multiple server clusters, meaning that those servers could be moved seamlessly from one data centre to another. This was the main success factor behind KHUH’s core network migration.
The last tier was to segregate the network into different zones. In simple words, this operation was all about splitting a complex setup into many small segments, which are easier to manage. Furthermore, it meant that the engineers could migrate systems from affected segments.
Because all of the tiers were in place, the hospital’s migration went smoothly and was completed by mid-2022. Furthermore, the performances of all systems have been exponentially great. Faster response, increase in storage space and having an agile infrastructure are some of the added features achieved in this endeavour.
Going beyond standard Oracle Enterprise Business Suite
Another aspiring endeavour was the vast implementation of proactive systems that were developed and deployed in record time. The KHUH IT team has worked extensively to boost its current ERP (Enterprise Resource Planning) with agile and proactive features to face the challenges imposed by the post-COVID period.
With its HR portal, mass hiring of health care professionals was already in place. However, maintaining the vast quantity of documents and licenses for each employee was a great challenge, especially during the pandemic times. Therefore, KHUH ICT developed an employee profile management system, in which staffers’ medical licenses with dates were maintained, managed, and scheduled. This system ensured zero congestion with renewals and regulation compliance-related issues.
The hospital’s ICT team also streamlined the maintenance of the healthcare facility’s bio-medical systems, through the creation of its custom bio-medical assets management system. Under this, all assets’ locations are tracked. It also listed the history of the maintenance works done on the assets. It also sets the planned periodic maintenance of each asset. The solution expanded the life of the medical equipment in KHUH, apart from enabling the pre-ordering of consumable parts per item, prior to shortages and supply chain stagnation.
Lastly, KHUH ICT managed, maintained, and automated the hospital’s sub-store inventory. This system empowers these sub-store managers for accurate item consumption history throughout days, months, and years. This also enabled department managers to easily transfer items between sub-stores and have the deliverables tracked and confirmed. Finally, an in-depth investigation on the maximum and minimum requirement of each item in each store has been digitised to enable auto reordering of those products, thereby stopping item shortages hospital-wide.
As for what is next in KHUH ICT plans, they have finished the initial testing of a supplier portal and moved it to a selective release in November 2022. This system completely transforms the procurement operations in the healthcare facility, as it enables its suppliers to update and upload their proposals and bids for any open purchase order, check the status of the awarded bid, and track the delivery dates through two-way communication and a delivery calendar.
King Hamad University Hospital’s case study is not any other success story of a healthcare facility. It shows the game-changing effects of disruptive technologies in the medical field. Embracing the technology has not only cut down the hospital’s daily mundane paperwork and operational costs, but it also ensured an improved patient care mechanism. Days are not far away when the KHUH model will not only be replicated across the Middle East but will emerge as a viable solution across the world as well.