IT@2009- Runners Up

Dr. Pavel Trnka

MPOC Interoperability for Emergency Medical Care

The mobile point of care (MPoC) pilot project at Emergency Medical Service of Prague (EMS) named  “Replacing paper with electronic records” took place between February and April 2009. Rapid Response Unit physicians were equipped with laptops and wireless connectivity at emergency scenes to facilitate information flow and underpin fast and effective treatment.

Project Targets

The Prague Emergency Medical Service (EMS) implementation of the GEmMA emergency management system enabled EMS to manage its operations through the creation of Electronic Mission Records (EMiR). This included the compilation and reporting of statistical information on emergency events and the collection of billing information for insurance companies.

The project target was to replace workflow of handwritten medical documentation with primarily electronically created reports. A second goal was to utilise the mobile technology in the field and provide additional information from interoperable e-health and Insurance registers for decision support at the emergency scene.

Rugged laptop PCs were provided for physicians in the Prague EMS, to collect information at the emergency scene. Physicians can access the Emergency Service Centre via a 3G HSDPA connection and a central application server located at the EMS Centre. Data that is inputted in the field feeds into the EMiR. The solution has interoperability with the national central electronic health record system IZIP, which provides emergent dataset about previous treatments and allows responders using insurance numbers to check online whether patients are registered with the General Health Insurance Company.

When the physician is handing over a patient to an ambulance or hospital, a subsection of the EMiR is printed off (named the Electronic Patient Record) and then handed over to ambulance staff. If the EMS physician has accompanied the patient to the hospital, he or she hands this over to the hospital doctor. The electronic patient record summarises information about the course of the mission and treatments provided, thus replacing hand-written (and often hardly readable) reports.

Difficulties

During implementation, we faced many difficulties, from technical problems (e.g. lack of broadband HSDPA connectivity in some Prague suburbs; finding safe and ergonomic placement of hardware in the vehicle; software integration of dispatch centre system; emergency data set availability in EPHR profiles in repository) to “philosophical” dilemmas (i.e. finding consensus on structure of collected data; conservativism of some physicians / users).

Benefits

Despite these difficulties, the MPoC pilot revealed intangible benefits in areas of workflow optimisation, physician’s decision-making, work efficiency, patient safety and well-being and staff satisfaction. The solution showed a Net Present Value of €21,403, a 12 month break-even point, and Return on Investment of 149%. While these benefits were significant, the business value assessment of MPoC also emphasised that a holistic approach to technology implementation would benefit the entire health system.

Conclusion

As a result of the success of this pilot project, Prague EMS plans to implement this mobile solution in all rapid response and paramedicunits over the next two years.

Dr. Pavel Trnka, Managing Director, KTTP Ltd

Dr. Jiři Danda (Head Physician), Dr. Milana Pokorná, and Dr. Daniel Kobr, RRU Physicians, Prague EMS

Dr. Jaroslav Kratochvíl, Hospital Physician,

Dr. Ondřej Franĕk, Dispatch Centre Physician, Prague EMS

Dr. Jaroslav Valášek, Chief Medical Officer, Prague EMS

Ing. Petr Zajíček, Chief Information Officer, Prague EMS

Dr. Pavel Kubu, Business Development Manager, Intel

Padraig Coakley, Financial Analyst, Intel

Prague, Czech Republic

Jan Pejchal

Dark Fibre PC network - Public Internet Access Points in 5 hospitals

Regional Health Corporation (“Krajska zdravotni, a.s.”) consists of 5 hospitals with a long tradition and history - Masaryk Hospital in Usti nad Labem, Decin Hospital, Teplice Hospital, Most Hospital and Chomutov Hospital. The organisation was established in September 2007 to merge these 4 district hospitals and 1 regional (Masaryk) hospital under one roof creating the biggest healthcare provider in the Czech Republic. Masaryk hospital in Usti nad Labem wasone of the biggest and most modern healthcare institutions in the country. The founder and the only owner of this joint-stock company is the region ofUsti. The hospitals of the Regional Health Corporation (RHC) have 3350 beds and employ nearly 6500 employees (838 doctors and 2673 nurses). Their area covers about 820 000 citizens. RHC provides a wide spectrum of healthcare within its clinics and departments including a specialised unit. It also participates in pre-graduate and postgraduate education.

The RHC Centre of Information Systems operates its own regional optical network on the basis of dark fibre technology. It has a backbone transmittance of 10Gbps interconnecting its hospitals and also provides an indirect connection to a national research network (CESNET2+) that connects a large number of institutions in the region, with the connectivity of 10GE over DWDM. Masaryk hospitaloperatesas a data and communication RHC centre and is the first Czech filmless hospital,withits’PACS utilisedby all RHC hospitals.

The most significant step of ICT in supporting the transformation of hospitals into one company was to create a regional optical network.This providedhospitals with parameters that enable access to geographically remote working sites, allowing them tomerge intoone organisation, with one information and telecommunication infrastructure.

In September 2006, Masaryk Hospital in Usti nad Labem started a big project called “Public Internet in the Usti Region hospital network”, co-financed byEU structural funds. This project was completed in August 2007. Masaryk Hospital is The National Research Network CESNET2+ provider (10 Gbps access to CESNET2+ on DWDM). Clients of CESNET2 can access the research network through a RHC regional network. The Usti Region EMS offices are also interconnected through this network. The RHC hospital dark fibre network provides services of a federative identity management Shibboleth and participates on an international roaming system for teachers, students and researches EduRoam.

This project is supported by the grant of The Academy of Sciences of the Czech Republic, National Research Programme – Information Society (TP2), No 1ET202090537, “MediGrid – methods and tools for GRID application in biomedicine”.

The unique characteristics of this solution come out of conceptual approach of building regional information and telecommunication infrastructure for digitalisation of healthcare (e-health) based on best practices in the field and also open and prospective technologies and services (i.e. dark fibre, MPLS VPN networks, EduRoam, Shibboleth). The solution provided immediate benefit during the establishment of RHC (merge of 5 hospitals) andincreasedaccessibility of The Usti Region EMS to theinfrastructure(Integrated Emergency System)whileit wasbeing restructured. Thissolution is also agreat example of multi-source financing in the field of healthcare.

Jan Pejchal,

ICT Manager

Masaryk Hospital in Usti nad Labem - Regional Health Corp.

Martin Zeman, Martin Hostas

Usti nad Labem, Czech Republic