Research on Electronic Medical/Health Record System suited for Developing Countries Environment (Indonesia) Medic-One Private Emergency Medical Service Study Case http://www.medic-one.org 15 May 2009 Seagaia Meeting 2009, Okinawa Yunan Satria Waseda University - GITS 1
Current Fact & Situation In developing country like Indonesia, Emergency Medical Services (prehospitalization) is soon expected to have a more sophisticated and efficient way to manage information flow among each expertise. Critical locations of Urgent Care Point Facility, Alarm Call Center and Fleet of Paramedics are located in different area within the city. Current electronic medical records are created and stored within Urgent Care Point Facility and unfortunately still in Word Document format, and can only be accessed locally for printout. Alarm Call Center and Fleets of Paramedics needs to access patient medical/health information. Fleet of Paramedics currently use only Emergency TRIAGE for standard guidelines in emergency medical situation without knowing the patient past medical history. 2
Current Fact & Situation Figure 1. Jakarta City Map (modified) Source: Google maps Figure 2. Medic-One Operational System Source: Self Designed 3
Problem Description Now Patient Health Data is only accessible locally within the Urgent Care Point facility and it is also in the Word Document is not a flexible format for Electronic Health Record, and it cannot be a future standards for Electronic Health Record Alarm Call Center Team and Fleet of Emergency Paramedics also need to access Patient Health Data for a better medical judgment to rescue, not only based on TRIAGE standards. Cost and affordability issue remains as the main problem in deploying proprietary Electronic Medical/Health Records Software 4
Research Objective To develop an Open Standards (flexibility & interoperability) of Web based (ubiquitous) Electronic Health/Medical Records to help the Alarm Call Center Team and Fleet of Emergency Paramedics to easily access patient health information before and during medical emergency cases. Open Standards mean not only the application is built from an open source based programs and it is free (does not mean free of cost), but also the application will allow to create a dynamic space for users to write their own description/preference that can be kept locally or shared with other users. To evaluate the efficiency and cost benefits (lowest cost possible) of Open Standards EMR/EHR to support the Emergency Medical Service Operation compared to the existing Solution of the manual Emergency Medical Service Operation 5
Pre-Hospital Emergency Service Operation Alarm Call Center, Fleet Paramedics and Urgent Care Point Facility Patient Call Alarm Call Center Wireless Internet Access To Receive Patient Health Info Pre arrival Instruction to paramedics using Analog Radio Communication Telecommunicator SMO Dispatcher Fleet of Paramedics Open Standards EMR/EHR internet Urgent Care Point Facility Web Hosting Figure 3. EMS Information 6System Source: Self Designed
Patient s Management in Medical Emergency Situation 3 Telecommunicator inform Dispatcher of : 1 2 Telecommunicator must able to recognize signs and symptoms of Emergency situation (Medical or Trauma) Confirm HOT CALL Press Alert Tone Patient s location Contact number Chief Complaints Name of the caller Level of Consciousness Breathing status Call status Name of the patient Patient s Age Patient s Sex Patient s Allergy Past Medical / Trauma History Figure.4 Patient s management Source: Emergency Medical Service Standards Requirements For Emergency Patient Medical Data Additional : Last meal Last activity 7
Research Methodology How to build an Open standards EMR/EHR? OpenEHR Archetype Editor (Max Clinical Sets of Data that is Globally shared) OpenEHR Knowledge Manager (Search Engine of Globally shared Archetypes Data Available) Extracting Basic Archetype Data from ADL/XML format into Java Environment (JDK and JRE). Constructing Web based Java Environment EMR/EHR Application from Open EHR Archetypes Data structures by using Eclipse Software. Creating mysql Database for storing medical/health data format. Exporting database into an XML language format for better options in mobile users/remote pc access (HTML). 8
Research Methodology Why is OpenEHR? It is an open standards medical data structures and features that provide not only standard interoperability solution, but flexibility as well in constructing data layer in EMR/EHR. It contains Maximum Set of Globally Common Clinical Concept as Archetype Data Set. Common medical/health parameters and tags are set to global standards. 9
Research Methodology Why built over Java Environment? Java can be implemented over independent platform, which means it is a free platform based language It is more sophisticated because it is most commonly used as a community based language; therefore, it is more promising in provides interoperability for long term future. Java language provide flexibility and compatibility in different computer & server platforms from Unix, Windows, Linux and etc. It is an open source and free language provided by sun micro system corporation. 10
Research Methodology Why use MySQL database? MySQL has easy learning curve for database MySQL provides best compatibility with java language environment since both now acquired by sun micro system. Best interoperability as well for a small database but can provide high performance on any server such as Apache server (mostly used in the world). It is free database provided by sun micro system corporation. 11
Research Methodology Why use XML data format? Most of mobile browser interface now is using x-html, c-html, or the original html format; therefore, exporting data into xml format will allow the data to be mapped easily and rule based into a mobile web browser environment by using XSLT as an xml processor XML Data format provide faster real time functionality with a more simple codes to use compared to database format. XML Data format will also give more possibility to be extracted into different technology. 12
Research Methodology Construction of Open Standards EHR/EMR Application for Emergency Medical Services OpenEHR Archetypes ECLIPSE (Front End) Web Browser Template (Input Method) Text Based View (Output Method) ADL / XML based Language Data Java Environment Application Design (Java Programming) Execute Web Browser based EMR/EHR Application Export/Save XML Data in File System (rule based) Extracted OpenEHR Data Structures Ocean Informatics Import Figure 4. OpenEHR Construction Source: Self Designed Mapping Java Environment Application Design & OpenEHR Data Structures Application Developer Patient Demographic & Medical Data (Common & Special Health) Save/Edit Save/Edit (MySQL Database Format) Care Point Clinician & Doctor XSLT (XML processor) Remote PC/Mobile Environment Patient EMR/EHR Health will be displayed in HTML browser format interface Alarm Call Centre & 13 Fleet of Paramedics
Research Methodology Open Standards EHR Database Application on Java Environment Main Clinic for Urgent Care Facility Alarm Call Center/other Clinics PC User (web browser) Mobile Client User (web browser) Data will be viewed in HTML Format INTERNET Wide Area Network Fleets of Paramedics Figure 5. Application Layer Source: Self Design from Java MVC Modelling Request data in HTML Format Produce data in HTML Format JAVA Servlet <CONTROL> JAVA Server Page <VIEW> XML XSLT (MVC) OpenEHR Data MySQL Database <MANAGE> File System XML Data Open Standard EHR Server Application on Java Environment Mirror Web Server App 14
Research Methodology Simple Use Case Diagram <User Log in> User ID Password JAVA Servlet <User Search Client> <User Input Data> Request Java Servlet Transfer to JSP (Extraction) Request Java Servlet Transfer to JSP (Extraction) XML DATA XML DATA XSLT TRANSFORM XSLT TRANSFORM TOOL TOOL Response HTML Figure 6. Use Case Source: Self Designed Response HTML 15
Research Target Open Standards EHR/EMR Prototype Application (Static) for the Emergency Medical Service Patient. 16
Research Conclusion Social and Economic Evaluation over Open Standards EMR/EHR Application compared to Proprietary EMR/EHR Application. 17
Further Research Study Link to Dolphin Server Environment Project. (MML Format Conversion). Dynamic java based openehr application with all the 200+ archetypes data structures included within the system. 18