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Title and Description
Integrated Prehospital Health Emergency Services in the Region of Crete
Reviewed/ candidate case
Quality reviewed case
Short description
An integrated pre-hospital health emergency management system was developed to provide advanced technological support through the use of intelligent eHealth tools and services for the optimal response management of pre-hospital health emergencies.
Objectives and purpose
The primary objective of the solution is to improve the quality of emergency care at a regional level by: - enabling fast and correct assessment of the type and gravity of emergencies, - providing speedy and accurate information exchange between on-site medical and paramedical staff with their medical personnel at the emergency coordination centre, - optimizing, through the use of ICT, the whole chain of pre-hospital health emergency management.
Detailed description
In Crete, approximately 65% of pre-hospital health emergency episodes are managed by paramedics. Given that the first 60 minutes are the most critical regarding long term outcome (with patients), the ability to optimize response management, dispatch the appropriate resources for each type of emergency and subsequently remotely monitor the patient calls for access to specialist care. It also significantly improves the quality of care delivered.
The pre-hospital health emergency management system (EMS) is an integrated information and communication system enabling optimal response management and treatment of pre-hospital emergencies. The main modules of the solution are briefly described below:
Operator/Dispatcher application: Evaluating the type and gravity of emergency is crucial for dispatching the appropriate mobile units (mobile ICU or normal ambulance, staffed with trained emergency physicians or paramedics, re-scheduling of already dispatched units, use of ICUs equipped with real time telemedicine technology, etc). The corresponding software allows the creation, completion and continuous management of an electronic `Incident Card’. Based on intelligent triage algorithms, it supports incident severity estimations and selection of the most appropriate ambulances. The application keeps track of all incidents being dispatched or waiting to be dispatched by displaying them in a list.
Mobile Intensive Care Units (MICUs) are equipped with technology to obtain and transmit vital signs and ECGs directly to a physician at the dispatching centre, allowing for `remote monitoring and management’ of the patient inside the ambulance.
Using the `Clinical Evaluation Card’, the doctor may record all relevant details of the patient’s condition and therapeutic actions. The application within the mobile unit almost automatically acquires and transmits vital signs and ECG requiring minimum crew involvement thereby allowing the crew to fully concentrate on caring for patient. The telematics subsystem stores all vital signs and ECGs handled by a Mobile Unit in the on-board computer. It periodically synchronizes with the central database located at the Health Emergency Coordination Center (HECC). As a result, a complete emergency episode folder is maintained.
For `administrative decisions support’ like hiring, training and scheduling, as well as acquisition of specific equipment, a software system provides statistics of the emergency incident archive.
The dispatching centre operates a `GPS/GIS-based system’ that depicts the exact position of mobile resources. It thus allows dispatchers to locate the exact position and status of all mobile units and facilitates better coordination of their movement. Today, most of the ambulances are equipped with such GPS’ transmitting their location data through GPRS.
Funding
The technology has evolved from a series of EU-funded projects (e.g. HECTOR, JUST) and national funding for the implementation of the RHIN of Crete. Subsequently, and following initial evaluation, the Regional Health Care Authority has financed the introduction of the required eHealth technology in all mobile ICUs of the region. Currently, maintenance and support cost for the system is undertaken by the central administration of the National Centre for Emergency Care.
Interoperability and standards
A range of healthcare specific standards have been used in the implementation of technological solutions (HL7, ICD-10, Glasgow Coma Scale and Hector Emergency Score, SCP-ECG standard, 2.5 and 3G wireless communications). Software interface modules that allow easy interchange of structured documents with the HIS of hospitals have been implemented. In doing so, the HL7 Clinical Document Architecture (CDA) is utilized, and data for each emergency episode is transformed into a CDA document for communication with the hospital’s HIS.
Timescale
Start of planning
1996
1st milestone
In January 1998, the integrated system (excluding GIS/GPS) functionality was piloted. Full scale productive operations begun in 1999.
2nd milestone
By the end of 2004, the system was extended with GIS/GPS functionality. Additionally, advanced IT tools have been used for continuous education of personnel with emphasis on `skills retention’.
Start of routine operation
2000
Evaluation
Ongoing
Characteristic of the application
Country
Greece
Part in the healthcare chain
Diagnosis
Administration/ Management
Professional education and training
Level of Implementation
Regional
Technology
Bespoke/ locally build solutions
Details on Technology
Internet-based technologies are the basis for the implementation of various information systems. 2.5 G wireless communications (i.e. GPRS) are employed for the communication of mobile units with the HECC, with the purpose of transferring location-based information as well as for real time transfer of ECG data and other vital signs from the (patient) ambulance to the HECC. Intelligent algorithms are a part of various algorithms, enabling fast and efficient incidence evaluation and response management.
Results
Outcomes
Significant reduction of time for response management: Between 2000 and 2006 the following reductions in average times have been achieved: a) Dispatch time: From 5 to 1 minute b) Time to arrive: From 12 minutes to 5 minutes c) Time at the scene: From 12 minutes to 5 minutes d) Time to transfer: From 18 minutes to 14 minutes e) Time at the AED: From 18 minutes to 4 minutes.
Substantial contribution to the quality of care delivered, due to:
(i) Protocol-based (triage) classification of emergency cases allows for dispatching of the most appropriate resources for each type of emergency. Based on objective data acquired at the scene of the emergency episode after arrival of the dispatched resources, the initial decision made by the dispatcher (after applying the appropriate protocols) has been shown to be correct in 82% of all cases recorded during 2004 and 2005 (approximately 40,000 each year).This percentage represents a substantial improvement compared to the accuracy of decisions made prior to the introduction of the described systems and services.
Wider impact
A culture of `technologically-induced’ innovation has been developed by the professionals involved in pre-hospital health emergencies. This has wider implications on the effectiveness of the organisation. Improved performance within the sector(s) is expected to have `spill over’ effects on the main economy of the region, i.e. tourism, through an increase in confidence about the quality of healthcare services delivered. Innovations in this sector are expected to gradually set standards for `best practice’ in the remaining healthcare sector, which is slow in adopting ICT-based innovations and new service delivery models.
Results expected?
Expectations do not differ from the outcomes.
Success factors
- Pragmatic approach to achieving long-term objectives: o Step-by-step advancement. o Setting achievable goals at every stage of the implementation plan. o Emphasis on the application being in routine operation, with frequent review of the fit with long-term goals. - Leadership: o Presence of an internal `champion’ with the ability to influence people, set goals and mobilize the organisation. - Technical Excellence: o A high quality core implementation team capable of achieving complex change in a complex setting. - Continuous, solution-based support from recognised technology experts.
Failure factors
- The main barrier has been securing uninterruptible financial support during the long stint between system/service conception up to the point where detailed data exists with the benefits obtained. - The process of the organisation’s adaptation to new methods of work is also a significant struggle. Without an `internal champion’ in a position to influence change, the system may face difficulties working in a routine mode.
References
References and dissemination
Some indicative references are listed below: A. Kouroubali, et al, "Evaluation strategy in the Pre-hospital Emergency Care Coordination Centre in Crete", 15th World Congress on Disaster and Emergency Medicine, May 13-16, 2007, Amsterdam. D. Vourvahakis, et al, "Traffic Accidents in Crete (1996-2006): the role of EKAB-Crete", 15th World Congress on Disaster and Emergency Medicine,13-16 May 2007, Amsterdam. D. Vourvahakis, et al, "Emergency Coordination Center of EKAB-Crete: Protocol based incident classification and its implication for the operation of the Coordination center", 9th National Conf. on Anesthesiology and Intensive Care, Chalkidiki, September 2006.
Languages
English
Greek
Organisation implementing
Title
Dr.
Forename
Dimitris
Surname
Vourvahakis
Organisation
National Center for Emergency Care (EKAB) - Division of Crete
Department
Occupational background
Address of organisation
EKAB Crete University Hospital of Heraklion Voutes Heraklion, Crete, Greece
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