I refer to your article “Once Flagship, Selayang Hospital’s EMR System Now Busted” dated February 13, 2023, particularly the section on the Backup Health Information System (BHIS). As the radiologist referenced in the article (i.e. the one who developed BHIS), do allow me to share my thoughts.
Notepad For Windows
As a frequent user of Notepad (I’m typing this on Notepad right now), I am honoured that BHIS has been compared to software that was released in 1983, and has remained essentially unchanged for 40 years.
Snappy comebacks aside, the major consideration during the initial development of BHIS (all four hours of it) was that the majority of Selayang computers was running Windows XP with Internet Explorer 6.0.
Writing a web application that could run in this browser version meant that I had to forgo text formatting and tables. Having seen the clinical notes entered by my fellow doctors, I’m always impressed at their ability to document patient information in plain text.
In addition, the hospital network speed was limited, and the initial virtual server I was given was only allocated 1Gb of RAM. This meant that I had to balance loading speed and programme complexity with nice-to-have, but ultimately non-essential functionality.
Limited resources also meant I had to forgo standard SQL databases and had to resort to designing my own filesystem-based storage.
The B In BHIS
People often forget that the “B” stands for “Backup”, and that it was only designed to help support the hospital for a few hours to a few days. Like the Emergency Medical Hologram (EMH) on Star Trek Voyager as they journeyed through the Delta Quadrant, BHIS was forced to support the entire hospital for far longer than it was meant to, including through the crazy months of the Delta wave.
It was during this time that I integrated it with the Backup Radiology Reporting System (notice the “B” here as well) where my fellow radiology colleagues and I did our best to report dozens of chest radiographs and CTs that came through our department every day.
Fellow radiologists – you read that correctly. The Backup Radiology Reporting System improved the workflow to the point that we were able to report the majority of Covid-19 chest radiographs in Selayang Hospital during the Delta wave.
Errata
Contrary to what was stated in your article:
- BHIS was not designed to handle CT scans (we have a PACS for that)
- Only X-rays of active Covid-19 patients were available on BHIS, designed for “single-click” viewing for the benefit of my PPE-wearing colleagues
- Integrating lab investigations would have been a costly exercise due to the number of lab analyzers that would need to be reconfigured
Also, I’d like to point out that comparing BHIS to the Ampang Hospital THIS is like comparing a rope ladder you throw out of a burning building to the stairs at Batu Caves. It’s a totally unfair comparison.
Data Security And Privacy
BHIS implements an audit trail that logs user information every time a patient folder is opened. It also logs user information every time a note is entered and deleted.
Despite requests from users, I did not implement note amendments due to the computational complexity of the process and risk of data corruption.
BHIS was developed to assist my fellow doctors in their time of need. As such, the idea of bad actors purposely messing about with BHIS did not really cross my mind. Every accidental action was reversible, but there was nothing to stop purposeful destruction of data (which would also have been traceable and reversible).
Nonetheless, I did implement some basic security, laughable by modern standards, which meant that it was, at the very least, secure against casual hackers.
There’s a reason why optimistic dreamers end up as doctors, and paranoid pessimists become computer security experts.
Leaving Government Service
I had planned a long career in government service with the hope of helping to bring the Ministry of Health’s IT systems into the future, pursuing health informatics and artificial intelligence at the expense of interventional radiology (a significantly better-paying sub-specialty).
A toxic work environment resulted in me having no choice but to resign for the sake of my mental health. The last straw was actually related to BHIS – I was accused of using the fact that I developed BHIS as some sort of leverage to extract preferential treatment from the hospital.
Before I left, I had trained and put in place a team of IT professionals who could maintain BHIS, as I could no longer have access to government patient records. Unfortunately, this team was contracted under the recently terminated IT vendor, and BHIS was ultimately left without maintenance.
Not being privy to the exact circumstances, but knowing enough of the architecture in Selayang Hospital, I believe that the reason BHIS became non-functional after 18 months was not because of design issues, but because of the absence of preventive maintenance due to the termination of the maintenance team, despite available additional resources.
The Whole Point Of This Letter
I wrote this letter as your article presented a few misconceptions about BHIS which I wanted to clarify.
I do this not to defend myself, but to point out that BHIS, despite its many shortcomings, is likely revivable and is the best bet to ensure integrity of patient notes, especially with regards to migration into any new hospital information system Selayang Hospital finally implements.
To the pseudonymous Dr Cinta, Dr Lili, Dr Dahlia, and Dr Melly, I thank you for sharing your thoughts about BHIS with CodeBlue, and I sincerely apologise for each and every time that BHIS has let you down.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
