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Report: All-Digital in Southern Africa

November 10, 2010
by Mark Hagland
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U.S.-based IT consultants help create an all-digital hospital in Botswana—from scratch

What happens when an opportunity emerges to create a new hospital, literally from the ground up? Further, what happens when that opportunity presents itself in a developing country like Botswana, with a very different healthcare professional history, and a completely different set of operational elements than would be the case in the average U.S. facility development project?

Jeff White and Guy Scalzi, two principals in the Pittsburgh-based Aspen Advisors consulting firm, can say exactly what might happen in such a situation, as they—the Dallas-based White and the New York City-based Scalzi—have been involved in an exciting project of just that sort in Botswana. In fact, they were the key information technology leaders for Bokamoso Private Hospital, which opened as an all-digital, 200-bed hospital, in an area outside the country’s capital, Gaborone, and near the border with South Africa.

Bokamoso Private Hospital is owned by the Bokamoso Private Hospital Trust, which was formed by a public-private partnership between the Botswana Public Officers Medical Aid Scheme (BPOMAS) and PULA Medical Aid Fund, a private, not-for-profit healthcare provider organization. The state-of-the-art facility, which opened for care in January, has an EMR in a paperless environment, a radiology information system (RIS) and picture archiving and communications system (PACS), and a highly redundant medical-grade data network, including wireless service with 100 percent coverage across the hospital, as well as PCs mounted on mobile carts, and wireless IP phones. All of these elements are part of an IT implementation based on a strict U.S. $6 million IT budget. In addition, White and Scalzi became heavily involved in the planning for an uninterruptible power supply, and in the IT training of the hospital’s clinical staff (drawn from the U.S., Europe, and all over the world, as well as from Botswana), and of its IT staff, in the clinical information systems being implemented.

In a recent interview, White and Scalzi shared with HCI Editor-in-Chief Mark Hagland their experiences in facilitating the ground-up IT build at Bokamoso, and the lessons learned from their unusual and enlightening experience.

Healthcare Informatics: How did you two become drawn into this very interesting and unusual project?

Guy Scalzi: There are two insurance companies in Botswana, and a lot of their members tend to leave for South Africa for surgeries. So they decided to build their own specialty surgery hospital, and to concurrently open a medical school. They hired a retired dean from Duke University to manage the medical school. And they hired a management company called OR International to provide management reporting to the board, and to recruit the administrative people and clinicians. OR International hired me to be the interim CIO from August 2008 through the opening on January 11 of this year. Then they hired a permanent CIO. We built a data center and the wireless infrastructure. I did a system selection with the CMO and CNO; we selected a core clinical information system product from India. OR International wanted a paperless, filmless hospital, as much as possible. And because this was a totally new hospital, with totally new medical staff recruited from all over the world, it had no legacy systems or even legacy data. It was totally ‘green-field.’

HCI: How big is the hospital?

Scalzi: It’s a 208-bed hospital with eight operating theaters and an additional 30-bed rehab unit, with a footprint to build another 100 beds eventually. The medical staff is comprised of about 40 doctors recruited from the U.S., Canada, South Africa, Europe, and the Philippines, with an additional 80 to 90 physicians who are local and who are being trained in the surgical specialties. There are about 240 nurses, who are all pretty much local, with the exception of about 10 senior nurses from the U.S. and South Africa, who have augmented the staff and helped to train them. The people who run the hospital wanted a Western-style hospital with Western-style management techniques, staffing, and technology. And we drove a lot of the information technology to adhere to those standards.