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