Windows Vista Customer Solution Case Study

Paramedics Use Tablet PCs to Send Patient Information to Hospitals During Golden Hour

Overview
Country or Region: Ireland Industry: Healthcare Customer Profile Valentia Technologies, a Microsoft Gold Certified Partner, is a leading independent software vendor specialising in mobile and wireless technologies that directly contribute to improvements in patient care. Business Situation The Pre-Hospital Emergency Care Council in Ireland wanted to use public mobile networks to transmit patient data from ambulances for real-time display in hospital emergency departments. Solution Valentia Technologies patient-care reporting system uses Microsoft technologies, and a proof of concept for enhanced features uses Windows Vista and the Microsoft .NET Framework. Benefits Improved golden hour patient care. Greater data-transmission reliability. Elimination of paper systems. Improved paramedic management. Extendable to other services.

In addition to its ability to help paramedics find and organise information, were equally impressed by the enhanced security of Windows Vista.
Peter Nelson, Chief Executive Officer, Valentia Technologies

Healthcare authorities in Ireland and Dubai are commissioning mobile solutions in ambulances to help optimise use of the golden hour after paramedics collect patients. Valentia Technologies has been commissioned by the Pre-Hospital Emergency Care Council of Ireland and the Dubai Ambulance Centre to deploy a solution for the real-time transmission of patient data from ambulances to hospitals. Using ruggedised mobile tablet PCs and the Windows XP operating system, the solution works both on standard public mobile networks and TETRA. The solution gives emergency departments more visibility of inbound patients prior to arrival. Paramedics are relieved of the burden of paper records and receive a more structured patientcare workflow. Healthcare authorities can use the standardised data on pre-hospital emergency care practice for analysis and evaluation.

Situation
Healthcare authorities worldwide are seeking ways of using evidence-based practice to drive efficiencies and improvements in pre-hospital emergency care, starting after the patient first comes into contact with emergency healthcare practitioners, mostly ambulance paramedics. Appropriate pre-hospital emergency care administered before and during transit to hospital greatly affects the clinical outcome following a patients arrival in the emergency department. According to the golden hour principle, a critically injured patient should be in definitive carean operating theatrewithin 60 minutes of injury for optimal survival. Prospects for survival are improved even more if information about the inbound patients condition can be sent in real time from the ambulance to the hospital. This helps emergency department clinicians to be better prepared for the patients arrival. In traditional paper-based systems, carbonised standard forms are used by paramedics to manually record patient details and interventions administered during the care episode. Where possible, this data is written during transit, but it often involves follow-up by paramedics where details are incomplete. Originals of the forms are handed to the emergency department upon patient handover. At the end of the ambulance shift, the copies are returned to the ambulance depot, where they are aggregated for electronic data entry either by scanning or manual input. This is often time-consuming and problematic because of incomplete or inaccurate data, illegible handwriting, or damaged forms. When entered, the electronic data is used by healthcare authorities for various analyses, including healthcare service delivery, ambulance

deployment and operations, and paramedic in-field experience. But the ability to perform these analyses is dependent on the timeliness, completeness, and accuracy of the data originally recorded. Among those healthcare organisations taking a lead in the field of pre-hospital Electronic Patient Care Reporting (ePCR) are the Pre-Hospital Emergency Care Council (PHECC) in Ireland and the Dubai Ambulance Centre (DAC). As the statutory regulator of pre-hospital emergency care in Ireland, the PHECC has commissioned the deployment of a ruggedised mobile tablet PC solution. It records and transmits pre-hospital emergency care patient and incident data in real time from point-of-patient contact to emergency departments. The solution uses standard public cellular networks composed of a combination of general packet radio services (GPRS) and short message service. Most geographical areas in Ireland have a reasonably good global system for mobile communications coverage, but GPRS is not universally available. Also, there is currently no countrywide data-transmission server for emergency services, such as the Terrestrial Trunked Radio (TETRA) system. The PHECC also wanted an electronic solution flexible enough to incorporate its existing hard-copy Patient Care Report standard dataset design and recording system. Further requirements included the ability to undertake detailed analyses and evaluation of standardised data on prehospital emergency care practice, improving patient care through the implementation of best practice, competency monitoring, and clinical audit.

Additionally, the PHECC also wished to ensure the solutions ease of use by paramedics to facilitate enhanced care delivery during patient transit, as well as to improve professional development and job satisfaction. The solution was also required to be open-ended to facilitate interoperability with third-party systems such as ambulance Computer Aided Dispatch systems and hospital Patient Administration Systems. Similar considerations and requirements existed for the DAC, which has commissioned deployment of the solution across an installed TETRA system used throughout the emirates.

systems and the .NET Framework, Nelson says. Also, it was easier to support a tablet PC environment with Microsoft as opposed to other operating systems. The first users in the process are paramedics who use either a mobile tablet PC or a digital pen device to capture pre-hospital patent care data into the system from the patients sidewhether roadside, in the ambulance, or at the patients home or workplace. The data is sent in real time to a central database in the hospital and is immediately available to other healthcare professionals. Data is also provided for integration with the hospital Patient Administration System through an XML interface to ensure a seamless transfer of patient information. The Valentia Technologies ePCR system has been designed to optimise accurate and reliable data capture without compromising care delivery. Ahmed Javad, Chief Operating Officer, Valentia Technologies, says: It also offers an important additional care dimension: real-time transmission of in-field patient data to emergency departments, thereby enhancing use of the golden hour and improving the prioritisation of patient management or triage. This extends the continuum of care for patients. Robert Burke, Developer Evangelist, Microsoft Ireland, says: In addition to its existing Windows XP-based production version, Valentia Technologies has integrated Windows Vista-era technologies into its system to develop a new proof of concept for its ePCR system. Running Windows Vista on its mobile tablet PCs offers Valentia Technologies immediate benefits for its pre-hospital patient care system, including improvements to security, reliability, and management. Its developers have used the .NET Framework version 3.0 to visualise and report emergency care information in much richer ways. And

We had a choice to use open source technologies, but, because of the issues surrounding future development support, cost, and easy interoperability with other systems, we opted for Microsoft operating systems.
Peter Nelson, CEO, Valentia Technologies

Solution
Valentia Technologies, a Microsoft Gold Certified Partner and independent software vendor (ISV), was a natural choice for the PHECC and DAC because of its considerable mobile healthcare experience. It has a strong focus on using public mobile networks for the transmission of clinical information. Peter Nelson, Chief Executive Officer, Valentia Technologies, says: In addition to our mobile technologies experience, we also have healthcare informatics professionals with considerable development experience with mobile clinical applications. The Valentia Technologies ePCR system, called the CareMonX ePCR Suite, is designed on services-oriented architecture using the C# object oriented language, the Microsoft .NET Framework version 3.0, Windows XP, Windows Server 2003 for the back end, Microsoft SQL Server 2005 as the database, and Windows Mobile. We had a choice to use open source technologies, but, because of the issues surrounding future development support, cost, and easy interoperability with other systems, we opted for Microsoft operating

innovative features of Windows Vista have helped Valentia Technologies to securely provide more detailed, up-to-date information to in-field paramedics. The rich functionality of Windows Vista offers several advantages that enhance the value of the solution, including its workflow integration and graphical user interface, with its transparency and capability for 3D visualisation. Emergency care technicians can indicate much richer information to clinicians about a patients condition.

Benefits
The robust Microsoft operating system ensures paramedics can communicate patient care data seamlessly to a hospital emergency department after making contact with a casualty. Because clinicians have prior information about incoming patients, treatment can begin as soon as the patient arrives. Improved Patient Care in Golden Hour The quality of patient care will improve in Ireland and Dubai once the new mobile solution for reporting patient data is implemented in 2007. With the current system, information entered on the paper PCR is unavailable to the accident and emergency (A&E) units in both countries until patients arrive in their respective hospitals. Nelson says: With prior information about patients, A&E units can prepare properly to meet the special needs of any patient and prioritise patients correctly depending on the severity of their symptoms. This is essential in critical cases, where optimum use of the golden hour can massively boost the chances of a patient surviving trauma. Reliable Transmission of Patient Data By using Microsoft technology with tablet PCs, the ambulance services have overcome many of the challenges associated with realtime data transfer. Valentia Technologies has made negligible use of third-party tools, and the development environment is 100 per cent .NET technologies, ensuring high reliability. Nelson says: Since the system was designed to be used in the time-critical field of pre-hospital emergency care, it was essential it run on a robust operating environment, with Windows XP running the .NET Framework and Windows Server 2003 as the server. Since most users are familiar

With prior information about patients, A&E units can prepare properly to meet the special needs of any patient and prioritise patients correctly depending on the severity of their symptoms.
Peter Nelson, CEO, Valentia Technologies

Nelson says: In addition to its ability to help paramedics find and organise information, we are equally impressed by the enhanced security of Windows Vista. It provides new techniques for protecting highly confidential patient information in the mobile environment, helps us to conform to strict regulations, and even provides new information to the mobile paramedic teams. Javad says: The Windows BitLocker Drive Encryption feature of Windows Vista helps paramedics to secure the drives of the tablet PCs. Additionally, through some fairly innovative use of parental control and the protection jointly provided by Internet Explorer 7 and Windows Defender, weve managed to open up the mobile Internet. In the ambulances, paramedics can access remote medical databases with Windows Vista and go to certain Web sites securely. Nelson says: Valentia Technologies also integrates additional applications using Windows Mobile devices. Among the most innovative is a digital pen that writes normal ink on paper while digitising written data and images. Captured data is beamed to a Bluetooth gateway in the ambulance through a Windows Mobile device for real-time transmission by GPRS to a central server.

with Windows, less familiarisation and training will be required. The .NET Framework offers rich programming tools, which were used to create a flexible, secure, visually appealing system. Elimination of Paper-Based Systems The new system will increase the timeliness and accuracy of pre-hospital, emergencycare data capture since each field on the tablet PC or mobile device has built-in logic to ensure paramedics enter relevant data every time. Javad says: Each field entry is checked to ensure the data entered conforms with the expected data format for that field. Use of drop-down menus ensures hospital names and station codes are entered correctly. Also, any problems due to illegible handwriting by paramedics are resolved. Any potential increase in demands on the system can easily be accommodated by the addition of extra servers and modems, if required. This is especially important to the government of Dubai, where the emirates ambulance service is expanding to meet the rapid growth of the city in recent years. The government has developed a state-of-the-art, 140-bed trauma centre capable of handling major medical emergencies not only in Dubai, but throughout the United Arab Emirates. Improved Performance Management The solution, driven by Windows XP, ensures healthcare authorities can use recorded data to generate reports, identify opportunities for improvements in service quality, and contribute to paramedic training and ongoing professional development. Javad says: Paramedics can use features of the system to monitor their in-field work experience for continued professional development purposes. This is made possible by the workflow practices in

Windows XP, which can not only prompt actions, but also monitor compliance in the ambulance. For example, if a paramedic carries out a particular procedure too slowly, the system can flag up the need for further training.

Paramedics can use features of the system to monitor their in-field work experience for continued professional development purposes.
Ahmed Javad, COO, Valentia Technologies

Extendibility for Joined-Up Services The flexibility and interoperability of Microsoft technologies is helping Valentia Technologies develop further enhancements to the system. Nelson says: This includes closing the loop between the ambulance control centre and the pre-hospital emergency care practitioners. This will see the automatic populating of demographic and incident data directly onto the tablet PC from the control centre, giving paramedics more time to treat patients. Valentia Technologies is also defining standards to support integration by ambulance computer aided dispatch systems and with hospital PAS systems. There will also be full integration with vitalsigns monitoring equipment in ambulances to create a wireless ambulance environment.

For More Information

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Windows Vista
Windows Vista can help your organisation use information technology to gain a competitive advantage in todays new world of work. Your people will be able to find and use information more effectively. You will be able to support your mobile work force with better access to shared data and collaboration tools. And your IT staff will have better tools and technologies to enhance corporate IT security, data protection, and more efficient deployment and management. For more information about Windows Vista, go to: www.microsoft.com/windowsvista

For more information about Valentia Technologies products and services, call +353 1 493 7624 or visit the Web site at: www.valentiatech.com

Software and Services

Microsoft Server Product Portfolio Windows Server 2003 Microsoft SQL Server 2005 Windows Vista Windows XP

2007 Microsoft Office System Technologies Microsoft .NET Framework 3.0

This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY. Document published February 2007