Knowledge and Technology in the Service of Health Care

A sophisticated telecommunications system allows Saudi and American physicians at hospitals in Riyadh and the U.S. to teleconference. The new system is part of an effort to further raise the quality of Saudi health care.

As a country dedicated to the concept of providing the best health care possible for all its citizens, Saudi Arabia has spared no effort, and in the process has employed every available innovation, to achieve this lofty goal. The Kingdom's newest tool in this national effort is state-of-the-art telecommunications. The country is now one of the leading practitioners of telemedicine anywhere in the world, using the cutting-edge technology both for clinical applications and educational purposes in the field of medicine.

Saudi Arabia's quest to establish a modern health care system that could meet all the needs of its citizens began in earnest with the introduction of the first of the five-year development plans in 1970. That year witnessed the launching of a long-range health care program that emphasizes steady qualitative and quantitative advances, and which continues to this day.

Over the last 25 years Saudi Arabia's achievements in this field, as in many others, have become legendary. Today, a vast network of 279 hospitals and 3,254 clinics and primary health care facilities blankets the country, providing the whole range of medical services, from prenatal care to advanced surgical procedures. Whereas Saudis suffering from serious illness once were obliged to travel abroad in search of treatment, hospitals in the Kingdom now routinely perform organ transplants and other complex operations once associated with only a handful of Western hospitals.

Although Saudi Arabia's ratio of one hospital bed per 411 people is already among the lowest in the world, the Kingdom is continuing to build new health care facilities. With adequate numbers of general hospitals already in place, most of the new ones are specialized institutions. Among those already under construction is the King Fahd Medical City in Riyadh, a massive health care complex with a 525-bed general hospital complemented by a 300-bed children's hospital, a 250-bed maternity hospital and a 300-bed psychiatric care hospital. Work also was recently begun on the Prince Sultan Bin Abdul Aziz Medical City near Riyadh which will serve the handicapped and the elderly and a 300-bed pediatric care hospital in Jeddah. Additionally, more than 2,000 new primary health care centers are being established to provide preventive, prenatal, emergency and basic health services.

With most of the necessary hospitals and other medical facilities either established or under construction, the emphasis in Saudi health care in recent years has steadily shifted to improving the quality of care and broadening the scope of specialized fields of medicine covered by the Saudi network. To this end, most Saudi hospitals, both those run by the Ministry of Health and other government agencies - which constitute the majority of health care facilities - as well as those operated by the private sector, have instituted extensive programs to evaluate the quality of their services and introduced steps to ensure that they are abreast of the latest advances in the field.

An aerial view of the King Faisal Specialist Hospital and Research Center (below) in Riyadh.

One of the most wide-ranging quality evaluation and improvement programs instituted by any hospital in the world has been underway for the past four years at the King Faisal Specialist Hospital and Research Center (KFSH/RC) in Riyadh. A tertiary care hospital which handles special cases referred to it from all over the Kingdom, the facility has since its establishment in 1975 been at the forefront of health care and research. Its hospitals handle thousands of patients a year, performing organ transplants, neurosurgery and a variety of surgical procedures. Its extensive research center conducts studies on pharmacology, oncology, pathology, toxicology and a wide range of other fields.

Already an acknowledged leader in the Middle East in the quality of health care it provided and the research it conducted, in 1991 the board of directors of KFSH/RC initiated studies designed to help prepare the facility for the challenges of the 21st century.

The underlying principle of the entire program has been to find ways of enabling the hospital to provide the best possible health care to people in Saudi Arabia. One of the challenges of successfully establishing a health care system as sophisticated as the one that has been set up in Saudi Arabia in a short period of time is that the fast-paced growth of hospitals, clinics and other facilities tends to outstrip the system's ability to rapidly provide the necessary indigenous manpower to fill the tens of thousands of medical, nursing, scientific and technical staff positions required to run it. In the 1970s, the stopgap solution was to hire foreign specialists to complement Saudis working in hospitals and clinics across the country. At the same time, Saudi Arabia embarked on an ambitious plan to train thousands of doctors, nurses and medical technicians. New medical and nursing schools were established in the country and thousands of students were sent abroad. As a result, the number of Saudis in the health care system has been growing steadily, particularly in the past ten years.

A dedicated satellite link provides real-time connection between specialists at King Faisal Specialist Hospital and Research Center and at U.S. hospitals, allowing an exchange of information and consultation.

But as the system has grown in complexity, the demand for specialists in cutting-edge fields of medicine and allied health care, particularly those that are required to operate a tertiary hospital such as KFSH/RC, has also grown. To acquire specialization in some of the advanced fields of medicine today, Saudi physicians have to spend several additional years at leading universities and hospitals, thereby making the process of educating and training specialists needed in modern hospitals a long-term proposition. In the short-term, hospitals are forced to hire the best specialists available abroad to take up the slack while more and more Saudis are undergoing long education and training periods. While the percentage of Saudis occupying top clinical, teaching and research positions at KFSH/RC has been increasing year-by-year, the facility still has a need for foreign specialists. Hiring such specialists, particularly of the caliber and status that KFSH/RC requires, is a costly prospect.

KFSH/RC's response to this challenge was a unique one. It sought a solution that would allow its patients, as well as physicians and scientists, to continue to have access to the best specialists in various fields of medicine in the world, but at the same time avoid the massive cost of maintaining these specialists on staff. Such a scenario would have been unthinkable only a few years ago. How could a health care facility in Riyadh use the experience and knowledge of one of the world's leading experts in, for example, pediatric oncology in Texas without hiring him full time or at least periodically flying him in at great expense to perform clinical, educational or research functions?

The King Faisal Specialist Hospital and Research Center employs the most advanced telemedicine network in the world to improve the quality of its health services.

Today, KFSH/RC is routinely doing just that thanks to satellite and computer technology. As an example, before conducting a particularly complicated neurosurgical procedure on a patient, surgeons at the hospital consult specialists at leading hospitals in the U.S. Facing large monitors at their respective locations, they can see live shots of each other in one corner of the screen, thereby talking face-to-face. While discussing the patient, they can review his MRI scan, pathology and radiology in other corners of the screen on demand. If need be, specialists in the U.S. can even watch the surgical procedure live and comment on it while it is being performed in Riyadh. Similarly, seminars are organized on the latest developments in medicine, and new surgical procedures being performed in the U.S. are demonstrated for surgeons in Riyadh.

The system that makes this possible is a marvel of modern technology. A dedicated satellite link connects telecommunications hubs at KFSH/RC and IMED Link in Bethesda, a Maryland suburb of Washington, D.C., through ground stations in the two countries. Each hub is at the center of a network, radiating communications lines to teleconferencing facilities in each country. In Saudi Arabia, teleconferencing sites are located at various departments in the KFSH/RC and its affiliated medical centers and agencies, including the Children's Cancer Center and the Women's and Children's Hospital. The Bethesda hub is connected to Baylor College of Medicine/Texas Children's Hospital, George Washington University Medical Center, Yale University Medical Center, Duke University Medical Center, the University of Virginia Medical Center and other medical facilities in the U.S.

Specialists at Saudi and U.S. hospitals can practice telemedicine using large monitors that not only allow conferees to see each other, but facilitate the exchange of radiological, pathological and other data.

The telecommunications system can provide real-time links between any combination of conference rooms at the Saudi and U.S. hospitals. Up to 32 simultaneous conferences are currently possible, with further growth planned into the system.

Each of the conference rooms is equipped with meeting and lecture facilities and an array of scientific support equipment. Computers at the conference centers render radiology into digital data that can be transmitted real-time. Similarly, pathology section samples can be inserted into an electronic microscope, transferred onto computer files, and the photos can be downloaded from one center to another instantaneously. Three dimensional images of organs can be called up for consultation or educational purposes. These images can be viewed individually or in conjunction with others in split screens, allowing a free exchange of information and views among participants spanning continents.

A sophisticated system of computers and telecommunications connects the Riyadh communications center with others in Saudi Arabia and the U.S.

The program, called the Saudi-U.S. University Project, has immense clinical, educational and research advantages for Saudi Arabia. It virtually places some of the best medical experts, teachers and research scientists on call to KFSH/RC. It is the next best thing to being in the same room and using the expertise of world-renowned specialists and facilities. It allows physicians and researchers in Riyadh to call on their colleagues in the U.S. for second opinions and consultation. It allows young doctors and residents at the KFSH/RC to tap into a vast storehouse of experience and knowledge which would otherwise be unavailable to them.

For educational purposes, KFSH/RC also utilizes the new system in its residency and fellowship training program in the school of medicine and in continuing medical education for its physicians.

The system has other highly useful applications. As an example, it reduces downtime for valuable equipment, such as catscans. Technicians at the hospital in Riyadh can teleconference experts in the Kingdom or abroad, to seek repair advice on multimillion dollar machinery, thereby eliminating the time required for onsite visits.

Furthermore, the Saudi component of the telecommunications system provides direct real-time teleconferencing between the various hospitals of the KFSH/RC in Riyadh. This capability allows physicians and specialists in different locations to exchange information and consult each other.

As part of the project, a separate state-of-the-art computer network was established at KFSH/RC for clinical and educational uses. The system can interface with every patient's files on any monitor anywhere in the complex, accessing X-rays, pathology samples, patients' records and pharmacy drugs. Hooked up to the teleconferencing system, the network allows physicians at the hospital center to teleconference with colleagues in other departments of the Riyadh complex or abroad and review a patient's data and case. They can even prescribe changes in medication or call for tests that can be entered directly into the computer.

With the ongoing improvements in telecommunications in Saudi Arabia, especially the installation of fiberoptic telephone lines across the country, KFSH/RC is studying plans to establish similar links to hospitals in other cities in Saudi Arabia, thereby extending the reach of teleconferencing for clinical and educational purposes.

Another component of the hospital's effort to improve health services was a plan to bring in top specialists from the five U.S. university hospital centers for consultation. During 1994 and 1995 a total of 245 physicians and specialists took part in the program, helping to train KFSH/RC staff in medical specialties, hospital administration, pharmacology and other disciplines of modern health care.

Under the auspices of the University Project, KFSH/RC has also sent a total of 126 of its physicians, nurses, administrators and scientists to the five U.S. universities to undergo onsite training in a variety of fields.

As part of its effort to achieve excellence in medical care, KFSH/RC recently established an extensive liver transplant program. Saudi specialists were trained not only to perform the actual surgical procedures but also to conduct the entire operation, including management of referrals, donations and bloodbanks and supervision of nurse directors, transplant anesthesiologists and surgeons.

Among the many other programs under consideration at KFSH/RC is one to establish a nursing school at KFSH. It will educate men and women nurses and nurse practitioners who will act as health care providers. Similar plans for a new freestanding medical school to expand the existing one are also being discussed.

Employing the latest innovations in medical science and technology, KFSH/RC is leading other Saudi hospitals in their ongoing quest for excellence.