Commodity software; the next wave in contemporary hospital information systems

 Hospital de São Sebastião

Earlier this year, I shared the amazing story of Torrevieja Salud Hospital in the Valencia Region of Spain. Hospital IT staff at Torrevieja Salud had built a very robust, end-to-end hospital information system using commodity, off-the-shelf developer tools, software, and technologies from Microsoft. They did it for just a fraction of what is typically spent in American hospitals on solutions from the big HIS vendors.

The first week of June, I visited another hospital that has taken a similar approach. The hospital, Hospital de São Sebastião, is located about 30 kilometers outside of Porto, Portugal and services a total population of about 383,000 people. I visited Porto to speak at our EMEA Health Leader's Forum. The first day of the two-day event, we were treated to a tour of Hospital de São Sebastião provided by the hospital's CEO, Dr. Hugo Meireles; CIO, Rui Gomes; Internist, Dr. Luis Pedro, and ER physician, Dr. Jorge Teixeira.

Hospital de São Sebastião is a 317 bed, acute care and trauma facility built in 1999. From the very beginning, hospital planners wanted an organization that would be a significant cut above other public health hospitals in Portugal. Rather than buy a hospital information system, CIO Mr. Rui Gomes and his small but dedicated staff of 11 full-time employees set out on a quest to build the IT foundation, business, and clinical applications that would best serve the hospital and the people who worked there. It has been an iterative project that appears to be serving hospital workers and the patients they care for extremely well.

Internal Medicine specialist Dr. Luis Pedro shows me how he accesses patient information and documents his work while caring for patients at Hospital de São Sebastião located just outside of Porto, Portugal.


Over the years I have toured some of America's so-called "most wired" facilities. In fact, the Seattle area hospital where I served as Vice President, CIO and CMIO for many years was often cited in that most-wired category of leading American institutions. But quite honestly, I must say that I have rarely toured a hospital where I have seen physicians so seamlessly using information technology as I observed during our tour of Hospital de São Sebastião. This is all the more remarkable when one considers that they built most of the solutions they are using all by themselves. And, they did it using commodity software that costs just pennies on the dollar compared to equivalent solutions used in US hospitals.

Doctors roamed the halls with Fujitsu Tablet PCs while wirelessly connected to the hospital's network. They had complete access to all patient data including imaging, lab results, etc., and they performed all of their charting from admission to discharge electronically.

Screen shot of HIS solution in use at Hospital de São Sebastião

Nurses and other caregivers also used the hospital information system. In the emergency room, an electronic triage system not only helped to prioritize treatment, but timed and tracked exactly how that treatment was delivered; sending gentle reminders to staff whenever patients were left waiting longer than necessary

Screen shot of ER triage application at Hospital de São Sebastião

To be fair, the system didn't have all the bells and whistles that might be found on big vendor solutions used in American hospitals. CPOE was still a work in progress although doctors were using an electronic prescribing solution. But that is precisely my point. The system was designed to do exactly what the staff really needed most. It has an interface and tools that make it intuitive, fast, and highly functional. What it lacked I would place in the category of "nice to have" rather than "have to have". And perhaps that is why the home-built HIS solution in use at Hospital de São Sebastião is so popular with physicians and other caregivers at the hospital.

In case you are wondering, some of the Microsoft products and solutions IT professionals used to build the HIS at Hospital de São Sebastião include; Active Directory, SQL Server 2005, SharePoint Services, SQL Reporting Services, Balanced Score Card Manager, ISA Server, BizTalk, Exchange, .Net Framework, and Visual Studio 2005.

My congratulations to Rui Gomes, his IT staff and caregivers at Hospital de São Sebastião!

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

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