by Marika Azzopardi

When Hugo Agius Muscat became a medical doctor in 1985, little did he guess that one day he would hang up his coat and sidestep clinical practice. Yet, as National eHealth Co-ordinator within the Ministry for Health, the Elderly and Community Care, he is all but immersed in medicine as never before. Indirectly so, but there you have it.

“The last time I practised was in 2008 and had reduced my family practice to a part-time commitment. Now I am devoted fully to public health practice. I left full-time clinical practice in 1989 to work on health informatics. Do I miss the clinic? I would be lying if I said I didn’t.”

Dr Agius Muscat speaks of his present responsibilities with utter dedication, recalling the steps along the way. His interest in information and research was discovered during a family medicine vocational course he attended whilst working at Health Centres. He read for a Master of Science in Health Information Science at the University of Warwick and has a Certificate in Hospital Management from Birmingham University. He eventually became Consultant in Public Health Medicine, and later Chief Information Management Officer and Head of Knowledge Management in the Office of the Prime Minister.

“After five years at OPM,  certain policies changed so I decided to return to the Health Department. My studies in health informatics and epidemiology led my “e-profession” to develop in line with “e-developments” occurring within the health services at the time. I became involved in the migration process from St Luke’s Hospital to Mater Dei Hospital in 2006, which involved a huge IT tender I was requested to manage as Director of Information Management & Technology.”

His mission was not easy – to successfully launch an effective IT system at Mater Dei. One particular date is firmly etched in his mind, 12th November 2007, when … “Mater Dei went digital overnight during the ward migration process when we introduced what we call the PACS – Picture Archiving and Communication System – whereby medical images are created, stored, transmitted and viewed digitally.”

“Many people said it was impossible and a huge risk. We expected that but all doctors rose to the challenge, even older staff who had no affinity with computer systems. The credibility gap is not always easy to fill when you’re promoting new technology. Ultimately, doctors were satisfied with the system – they could prepare a diagnosis on  images viewed whilst a patient was still walking to their clinic from the Medical Imaging department, thus facilitating the patient’s experience within the hospital setting.”

Dr Agius Muscat’s work is not technical in itself, but involves change management to improve systems, creating an interface between IT and health. “PACS was an obvious case through which everybody benefited, revolutionising work flow dramatically. Doctors can hardly imagine ever going back to what had been standard practice for so long. It eased the process of consultation between doctors or consultants, especially where emergency services are concerned.” Another success was the Laboratory Information System. Today all lab results are sent directly into electronic patient records. Mater Dei laboratories have a shorter turnaround time than St Luke’s did and, coupled with the Lab Info System, investigation results are processed faster.

Routine monthly checking of recovery systems ensures everything works like clockwork. MITA has installed increased discipline and good practice in the way

government runs its IT systems. The next big step involves having all patient records go electronic. “Much bedside work is done with patient file in hand – we’re considering mobile devices so doctors can access information over Wi-Fi and update immediately. Providing 600+ doctors with such a system involves significant expense and organisation which takes time.”

A hot issue concerns access to patient records. Dr Agius Muscat acknowledges the weak link of communication between hospital and family doctors but states the solution isn’t to provide unlimited, uncontrolled, continuous access to patient records. Through the ‘myHealth Record’ system, patients and their trusted doctors will be able to gain access to hospital discharge letters and investigation results. “Patients are more articulate about health issues and more involved in their own health. It is the right of patients to know everything about their health, however control and security around data have to be high. Normal email transmission over standard systems is not secure. Where emergency care is concerned, certain divulgation of information without specific consent is justifiable, but otherwise, patients will be given the option to authorise or de-authorise doctors to access records as required.”

We speak of his varied publications ranging from a study on family practice published with Paul Carabot in 1989 to an extensive collection of research studies on old organs in Malta and Gozo, published in 1999.

In a side-track to high-brow IT talk, I prod this doctor cum IT specialist about his other passion – organ playing. “I became first fascinated during 1974, aged 13, during an organ concert by Dun Karm Scerri who was organist at St John’s. Today, only four organists hold an LRSM in organ performance, myself, Dion Buhagiar, Frederick Aquilina, and Elisabeth Conrad (whom I tutored).”

He has been an organist at Valletta’s St Paul’s Anglican Pro-Cathedral  since 1983. He also directs the St Paul Choral Society’s choir of 60 voices, having established its reputation as a leading polyphonic choir in Malta. Dr Agius Muscat does take a break to spend time with his family, wife, two sons and one daughter … “At the end of the day, I have more time to dedicate to my family and organ-playing than I had when fully immersed in clinical practice. However, I practise on my electronic organ at home, at night. It is akin to having a pipe organ at home, but of course I have to wear headphones to isolate the sound – otherwise not only my family but all the immediate families in the neighbourhood would raise a chorus of complaint.”