The Australian designed WinChart clinical information system has been chosen by Queensland Health for its automated anaesthesia record keeping (AARK) project. The contract is a big win for the company and its creator, Peter Toth, as Kate McDonald reports.

Late last year, Queensland Health gave the go-ahead for the roll out of Medtel's WinChart clinical information system, making it one of the largest integrated hospital ICT projects in the country. WinChart beat out some major competitors to win the project, which aims to use software to interface with biomedical monitoring equipment to produce clear and concise electronic pre-op, anaesthetic, post-anaesthetic and acute pain service records.

For the system's creator, Peter Toth, it was a particularly exciting win, given the magnitude and breadth of the project. Toth first began developing the system in the mid-1990s and is now the product manager for Medtel's clinical software division.

'In the mid 90s I was working in the anaesthesia department at the at the Adelaide Children's Hospital, as it was known then, sharing an office with Dr David Sainsbury, who (apart from anaesthetising) was collecting data from the patient monitoring devices in theatre and storing that data on mobile computer carts,' Toth says.

'We had the idea of creating a software tool to arrange this data graphically and allow anaesthetists to enter drugs, fluids and notes etc, and so the first Winchart anaesthesia record was born.'

Toth says Sainsbury was a very talented computer programmer and electronics enthusiast as well as a consultant anaesthetist.

'I learned so much from him. I recall us being very excited with the introduction of Windows 95 because we then had a robust platform to introduce touch screen and 3D user interfaces.'

'It evolved over the next few years when in the late '90s Eddy Stanley of Medtel contacted me and subsequently bought the product. Medtel invested heavily in bringing it to market, and I was fortunate to remain involved in managing the new business unit.'

Toth describes WinChart as a perioperative clinical information system that includes a suite of modules to manage a patient's journey through the surgical process. Some modules, such as the anaesthesia and recovery room modules, automatically capture clinical information from patient monitoring equipment and peripheral medical devices, as well as electronic feeds from other hospital systems. The touchscreen clinical PCs allow clinicians to easily add notes, drugs and fluids.

This information then produces an electronic patient record, which can be printed and archived. It has a number of modules, including a theatre management system, web-based self assessment and informed consent modules, pre-operative clinic, surgical operation report module, acute pain system, an ICU module , a clinical analysis and reporting module (CARM), and an 'enterprise portal' which collects all reports electronically and displays these on a timeline for easy review and retrieval.

Medtel's first big break came when the Cairns Base Hospital bought the system for its anaesthesia and recovery departments at the beginning of 2000, Toth says.

'We fitted out the operating theatres, their induction rooms and recovery room departments. The head of anaesthesia there was Dr John Archdeacon, who saw the vision and invested a lot of time, patienceand design as the product matured over the next few years.

The company then began expanding across Australia and overseas. It has installations in Asia, the UK and South Africa, which was a major challenge, he says.

'It was a very busy time for everyone as we came across so many devices and legacy systems out there. We had to really beef up our support mechanisms too as the international base grew, catering to different time zones, amongst other challenges.'

Those challenges include the requirement for a strong convergence of hospital departments for WinChart to be successful, he says. 'The system requires cooperation from various backgrounds such as government, hospital management, nursing, biomedical engineering, IT, anaesthesia, surgical and so on. All these entities have views that matter and our job became integrating these disciplines.'

Implementation process
Queensland Health's AARK project involves the roll out of WinChart to its 32 public hospitals, and the project team is well into the implementation phase of stage 2. This is the implementation of the anaesthesia and recovery room modules to nine hospitals, as well as the delivery of the clinical analysis and reporting and WinChart enterprise portal modules. At the end of the roll out, the team will have installed WinChart on over a thousand clinical PCs.

'The contract involves several stages, initially installing medical-grade touch screen computers on all anaesthesia machines in public hospital operating theatres, induction rooms and recovery or PACU bed locations across the state,' Toth says. 'These then need to connect to the medical devices to acquire data automatically. To furnish that part of the install we are rolling out the Anaesthesia and PostOp modules of the Winchart system to these locations.

'The next planned stages include PreOp and Acute Pain modules as well as the Winchart enterprise portal, called WEP. This is an electronic repository of health records that can be viewed in a timeline fashion in a secure web browser. There has been a lot of preparation work ahead of these stages and Queensland Health have a very professional project team driving it.'

According to Toth, to ensure a successful implementation, processes and practices had to be integrated with the system. This meant the creation of interfaces to existing QH services such as pathology, operating room management, hospital information systems and client directory, as well as the large array of medical devices in use.

'Queensland Health have an excellent enterprise IT platform across the state, and this made things a lot easier for Winchart to mesh with it,' he says. 'One example is the QH Client Directory web service which allows WinChart to search for and uniquely identify patients regardless of their different UR numbers at other hospitals. It has been an enjoyable experience working with the enterprise divisions of QH, working alongside the skills and technology abundant in their health IT sector.'

Eye on the prize
The contract spans three years, and in its first year has been rolled out to Princess Alexandra Hospital, RBWH, Cairns, Caboolture, Redcliffe, Rockhampton and Toowoomba. Toth says most of the first year was taken up with preparatory work such as site surveys, testing and interfaces and is now experiencing a fairly brisk roll out schedule.

There is more expansion in the pipeline, however. While the Queensland project has kept the Medtel team pretty busy, and there are other installs on the cards around Australia, the company is keeping one eye very firmly on the export market, Toth says.

Medtel is taking Winchart a step further later this year, hoping that with the introduction of emerging technologies and new government e-health initiatives, such as the NEHTA unique identifier, to propel the health portal more directly into the patient's control.

'We have done a lot of work in areas of privacy and security and recognise the urge for patients to be able to see their health records history and decide who they would like to share that with or not. It's an exciting new division in which we expect to see growth over the next year.'

Article appeared in Hospital and AgedCare Magazine - June 2010