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Reshaping the medical world

“In health there is freedom. Health is the first of all liberties.” The words of Swiss writer Henri Frederic Amiel crystallize mankind’s unique dependence on its most fundamental, life-saving industry: medicine. There is arguably no other field where advances in technology and efficiency can have such a profound effect in terms of human cost. As a result, Norway is working hard to develop new ICT systems to improve all aspects of healthcare, from indoor positioning to simpler ways of sharing and recording patient information.

Norway has been quick to realize the potential that ICT has to revolutionize health care and to structure the handling of the vast amounts of information that need to be at the fingertips of doctors and health care professionals every day. A number of organizations including Abelia, a business association of Norwegian knowledge and technology based enterprises, are working to co-ordinate industry-wide ICT usage in health. “We work across a broad spectrum to influence the health agenda towards increasing the use of ICT in order to solve resource challenges in the health sector,” says Abelia’s Rune Foshaug.

The Tromsø Science Park is home to the National Centre for Telemedicine (NST), which is a key part of the ICT health community, and is one of the organizations behind the forthcoming pHealth 2009 conference in Oslo. © NST

The forthcoming pHealth 2009 conference in Oslo is a demonstration of the national commitment to ICT health solutions. SINTEF, Rikshospitalet and the National Centre for Telemedicine are working together to present discussion forums, the implementation of new technologies in the health system, and special focus areas on advanced research into micro and nano sensors, wearable and implantable systems and technological trends in ICT solutions for patient self management.

Integrating Clinical Systems
Norwegian software company CSAM, has had international success producing software designed to facilitate interaction between hospitals and health care providers over distances. CSAM’s solution involves an interface for different existing systems to operate together. This was initially born out of a pressing practical circumstance: the merger between the university hospitals Rikshospitalet University Hospital HF and the national oncology hospital, Radium Hospitalet. In this case, the software developed allowed the integration of the hospitals’ clinical and administrative systems so that neither hospital was required to change system. Ullevål University Hospital – one of Europe’s largest – has also contributed solution components.

CSAM’s James Ormonde explains. “The issue or problem is that healthcare users need to go in and out of disparate systems to find the clinical information they need,” he says. “Exploiting the unique features of CSAM Plexus means that hospitals can integrate existing applications – within and between the hospitals and health care workers – permitting doctors to keep using familiar tools, while wrapping the whole thing in an easy-to-use web interface.” It could even, in the future, allow patients to access their own records through a secure logon process.

CSAM Plexus is central to the system, transforming and combining information from different sources into a common information model. The system covers all aspects of the health care system, from patient records to clinical specialist applications. Improvements in accuracy, reduced paperwork, and the opportunity for customers to develop their own applications, including an Application Development Platform, are benefits already being enjoyed both nationally and internationally. “Norway is a leader in the eHealth field and integrated and interoperability are essential components of this strategy,” says Ormonde. “The software was first developed in 2005, and is now deployed in the three university hospitals in Oslo – Rikshospitalet, Ullevål University Hospital and Radium Hospital - as well as in Sweden, Russia and China.”

DIPS ASA’s CEO Tor Arne Viksjø says that “So far, the DIPS Paperless EPR concept has been implemented in more than 60% of the hospitals in Norway.”

Electronic Patient Records
Bodø compay DIPS ASA’s paperless EPR (Electronic Patient Records) system has achieved hitherto unrivalled success in Norway, thanks in no small part to the “eHealth revolution.” According to Chief Executive Officer Tor Arne Viksjø, “So far, the DIPS Paperless EPR concept has been implemented in more than 60% of the hospitals in Norway. Similar market penetration by Paperless EPR has not been seen anywhere else in the world.”

Paperless EPR provides a number of benefits – not least environmentally – for improved efficiency. The system uses an EPR-scanning and workflow system designed for doctors, nurses and other healthcare professionals. Current systems are, in Viksjø’s view, inadequate. “Lack of access to critical information is a problem in hospitals with paper patient records. Investigations have shown that about 30% of medical records are in the wrong place when needed, and 1 - 3% of medical records are never found. Treating the patient without the necessary patient record information can reduce the quality of the treatment,” he says. Delays, unnecessary tests and examinations all add to costs.

DIPS’ products cover a wide range of practical applications, including nursing documentation and treatment planning, booking and waiting lists, workflow and process management, prescriptions and operation theatre scheduling.

“One important issue is that relevant parts of the old paper-based patient records have to be scanned into the EPR system as soon as possible,” says Viksjø. “The old patient records are sorted prior to planned visits or as soon as possible in the case of acute visits. It is very important to identify which parts of the paper records are needed for future treatment of the patient. These parts of the paper records are categorised into groups, for example referral letters, discharge notes from other hospitals, anaesthesia records and so on.” DIPS’ system allows the scanning and grouping of documents in context, so that treatment can continue without the paper records.

Friprog – the Norwegian Open Source Competence Centre is one of the key factors behind Norway’s strong reputation within open source software. Utilization of these solutions can help hospitals and health authorities to save money. © Martin Bekkelund | Friprogsentere | CC-BY-SA 3.0

Hospital Technology
Another Norwegian company doing sterling work within medical ICT is Oslo-based Sonitor Technologies AS. The company is a leading provider of Real Time Location Systems (RTLS) designed to track moveable equipment and people with unprecedented accuracy. The use of airborne ultrasound as a communication platform is designed to put an end to wasted time spent searching for relevant equipment or people in a hectic hospital environment. The system is based on Digital Signal Processing Technology.

The Sonitor Indoor Positioning System (IPS) in now being deployed at hospitals across Norway, the United States, Spain, the UK and the Netherlands. Wireless detectors and tags enable the IPS to keep track of important information about the equipment or people being monitored.

Another leading company is Imatis, which has an impressive portfolio of different solutions within the health software and equipment fields. The Imatis software product suite, IMATIS Integrated Healthcare Solutions, is divided into “Communication” and “Clinical” solutions. Integration is a key concept here, as the Imatis suite brings together everything from nurse call and communication systems to surgical equipment and medical imaging technologies.

Amongst Imatis products is the IMATIS Patient Chart, which provides a 360 degree overview of treatment plans, and can be used in connection with diagnosis, medication, observation, treatment and more besides. Other clinical solutions include an ‘electronic whiteboard’ – software which provides an overview of the location of resources and patients as well as other important information such as the status of tests and diagnoses. Imatis has also developed the IMATIS Bedside Portal, a multipurpose touch screen which provides everything clinical information for health care workers to entertainment for the patient.

New ICT technologies that could change everything from patient record management to the monitoring of patient health after medical procedures. © NTNU Info/Rune Petter Ness

An eHealth Community
Researchers and scientists working within eHealth in Norway find themselves well-supported by a network of collaboration and cooperation between hospitals, universities and independent institutions. The Research Council of Norway’s ten-year project, VERDIKT, is based on a vision that, through sharing competence and supporting innovation including strengthening contact with the international research community. VERDIKT – Core Competence and Value Creation in ICT – provides funding for a number of eHealth projects in Norway.

In Norway, the ‘collaboration model’, involving actors from the government, hospitals and vendors, has been an important factor in the success of a diverse and extensive eHealth community. Innovation Norway has played a vital role in providing funding for hospitals and ICT companies involved in innovative projects. ICT-related initiatives from Norway’s four Regional Health Authorities (RHF), Helse Nord, Helse Midt Norge, Helse Vest and Helse Sør-Øst, are built upon a high degree of cooperation and a strong network.

The Simular Research Laboratory AS also conducts high-level research and development projects, and includes the Centre for Biomedical Computing (CBC) - a Norwegian Centre of Excellence (NCE) focussing on open-source, reusable software – an area in which Norway continues to be highly regarded. When hospitals have limited budgets, open source software can function as a highly effective way to save money. Success stories in recent years include Linpro’s Multiframe technology – now part of Redpill Linpro Finland – which allowed hospitals in the Hedmark and Oppland regions to continue using older computers for patient database information and centralized X-ray digitization.

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