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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
Yunan SatriaWaseda University - GITS
1
15 May 2009Seagaia Meeting 2009, Okinawa
Current Fact & Situation• In developing country like Indonesia, Emergency Medical Services (pre-
hospitalization) 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.
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Current Fact & Situation
Figure 1. Jakarta City Map (modified)Source: Google maps
Figure 2. Medic-One Operational SystemSource: 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
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Pre-Hospital Emergency Service OperationAlarm Call Center, Fleet Paramedics and Urgent Care Point Facility
Urgent Care PointFacility
Dispatcher
Pre arrival Instruction to paramedics using
Analog Radio Communication
Wireless Internet AccessTo Receive
Patient Health Info
Telecommunicator
internet
SMO
Web Hosting
Fleet of Paramedics
Open StandardsEMR/EHR
Patient Call Alarm Call Center
Figure 3. EMS Information SystemSource: Self Designed
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Patient’s Management in Medical Emergency Situation
Telecommunicator must able to recognize signs and
symptoms of Emergency situation
(Medical or Trauma)
Telecommunicator inform Dispatcher of :
Patient’s locationContact numberChief Complaints
Name of the callerLevel of Consciousness
Breathing statusCall status
Name of the patientPatient’s AgePatient’s Sex
Patient’s Allergy Past Medical / Trauma History
Additional :Last meal
Last activity
Confirm HOT CALLPress Alert
Tone
1 2
3
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Figure.4 Patient’s managementSource: Emergency Medical Service Standards Requirements
For Emergency Patient Medical Data
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).
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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.
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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.
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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.
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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.
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Research MethodologyConstruction 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)
Web Browser based EMR/EHR
Application
XML Data in File System
(rule based)
Extracted
OpenEHR Data Structures
Java Environment Application Design
&OpenEHR
Data Structures
Mapping
Execute Export/Save
Patient Demographic
&Medical Data(Common &
Special Health)
Save/Edit(MySQL Database
Format)Ocean Informatics Application
Developer Care Point Clinician & Doctor Alarm Call Centre
&Fleet of Paramedics
Patient EMR/EHR Health will be displayed in
HTML browser format interface
Save/Edit
Import
Remote PC/Mobile Environment
Figure 4. OpenEHR ConstructionSource: Self Designed
XSLT(XML processor)
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Research MethodologyOpen Standards EHR Database Application on Java Environment
PC User (web browser)
Dat
a w
ill b
e vi
ewed
in
HTM
L Fo
rmat
File System
XML Data
Open Standard EHR Server Application on Java Environment
OpenEHR Data MySQL Database
Mir
ror
JAVA Servlet
XML
XSLT
JAVA Server Page
<CONTROL>
<VIEW>
<MANAGE>
INTERNETWide Area Network
Fleets of Paramedics
Mobile Client User (web browser)
Alarm Call Center/other
Clinics
Main Clinic for Urgent Care Facility
(MVC)Pr
oduc
e da
ta in
H
TML
Form
atRe
ques
t dat
a in
H
TML
Form
at
Figure 5. Application LayerSource: Self Design from Java MVC Modelling
Web Server App
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Research MethodologySimple Use Case Diagram
Figure 6. Use Case Source: Self Designed
<User Log in>
<User Search Client> <User Input Data>
JAVA Servlet
User IDPassword
DATA
TRANSFORM
TOOL
Java Servlet
XML
XSLT
HTML
Request
DATA
TRANSFORM
TOOL
Java Servlet
XML
XSLT
HTML
Request
Response Response
Transfer to JSP(Extraction)
Transfer to JSP(Extraction)
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