The issue started around mid-February when we got news that the hospital server at Sultan Ismail Hospital (HSI), where I work, was having a problem.
There was no official news about what had happened, but the chatter among staff members was that the server caught fire and needed some repairs. Hence, the lag problem that has been occurring.
The delay in opening the HSI Metaframe power chart (which hosts all daily documentation and orderables) recently went viral on Twitter after one of the pharmacy officers posted a video regarding the lag.
It went viral because as everyone noticed, the program is running on Windows 2000, which is very outdated. The pharmacist later deleted her Twitter account a week after posting the video.
HSI’s server was down from 10.00 pm, February 20, 2023, for more than three days, going back up only on February 24, 2023. Initially, management emailed that the downtime was expected only until 4.00 am, February 21, 2023.
There was still a glimmer of hope as the hospital internet connection was still running at the time. HSI does have a backup system in case the server goes down, but its performance is sub-optimal at best. Let me run through the process:
- There are about two personal computers (PCs) in one ward that can be used during downtime, if the internet connection isn’t running.
- These downtime PCs can access BCS (business continuation services), and any documentation for registered patients can be done on them directly, including getting their previous records or medication prescriptions.
- The weakness of the system is patient imaging, which, most of the time, can’t be accessed from the system.
The second problem is that, even after documentation has been done on the PC during downtime, we have to manually open the system on the same PC again to save it into the main program, once the server is running again.
This is a redundant job that is supposed to be done by the IT department, but the task falls on house officers, medical officers, and specialists instead.
At least now we have the internet, which we can use to open and view imaging for patients, via HSI Rispac.
After more than three days of downtime, and numerous complaints to the IT department, the hospital finally decided to install BCS (Business Continuation Services) on all PCs in wards.
Before this, only two PCs in each ward can run BCS, which is software to prepare documents and order medications for patients during any downtime.
However, this system is very problematic. It takes a long time just to find and open patient details. Even to insert a new note and save into the BCS system takes about three to four minutes.
Furthermore, it does not automatically connect and save to the main server system. The IT department or the primary team in charge of patients has to manually insert these notes on the main server.
I can’t stress enough how much time it takes just to document just one patient, especially when some wards can have upwards of 80 patients.
On a normal day, the PCs are connected to the hospital Wi-Fi, and are able to open HSIApps (Hospital Sultan Ismail Apps, under Cerner 2005).
The apps will connect you automatically to Metaframe XP (a software with where daily notes, investigation orders, and medication orders can be done).
During downtime, the apps are basically inaccessible. The system is running on Windows 2000, and even though it has been 23 years, at least the software can still work.
Due to the slow BCS apps and huge patient load, specialists also have to bear the burden of seeing the patients. Rounds take a longer time due to the unavailability of previous notes and the very long BCS loading time.
I’m not sure how many documents need to be manually put back, now that the system is running again. Since some departments need ward rounds to run faster, their solution was to put daily patient documentation into the department’s Google Drive.
We are only in February 2023, but my department’s Google Drive is almost at full capacity. Again, I don’t know who will manually copy and paste all the documentation back into the main system.
It only takes one person, who is the email authenticator, to delete everything in the drive.
These are the basic document-related problems that we have faced during the server downtime. I haven’t even touched upon matters concerning blood orders, imaging, medication, appointments, and others.
I don’t know why the management can live with this kind of system. Why should we put up with such a defective system? I hope some improvements can be made.
Dr N is a medical doctor who works at Sultan Ismail Hospital in Johor Bahru, Johor. CodeBlue is providing the author anonymity because civil servants are prohibited from writing to the press.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
