The patient status information tool
The patient status information tool aggregates the entire information gathered on a patient during his emergency management. It starts collecting the information from the moment of the first physical encounter, which is usually Triage 1 in large scale emergencies. Of course, if the first physical encounter occurs without Triage 1, i.e. if it starts directly with a patient assessment (which includes Triage 2), the tool initiates the collection of the patient information at that point of first encounter. This design allows the flexibility required to manage patients from any one starting point, as it reflects the breadth of options of what could happen in real-life situations. The patient status information tool collects the following information: triage 1, location, ID, vital signs (see Rescue application), gender, estimated age, medical assessment, interventions and treatment and needs for further management. It is the equivalent of an aggregated electronic pre-hospital patient care record (ePCR), which is already implemented at various stages of completeness in some health systems. However, the patient information tool goes well beyond current ePCRs in that it enables the provision of information on patients who are currently not monitored at all or not monitored to the point of safe practice. In addition, it provides the information via the field application to an aggregated map or table view of all patients encountered and tagged in an incident, no matter where they are and at what stage of their treatment they are, up until they have been handed over to a hospital. Even after hospital handover the patient information is still visible if the incident space is open, to allow accounting for all patients and tracing what happened to them. Of course, after the incident is closed, this information is retrievable for auditing purposes as well. The patient e-form allows an easy and complete handover of the entire patient information to the receiving hospital and of course it also allows a prior view of the patient information, before the patient has arrived in the hospital.
The innovative design of the patient summary table for the COncORDE system enables the complete overview in a very easy to oversee and intuitive to navigate way, both in a table view as well as in a map view.
The patient status information tool is designed to function without identifiable patient data, since it is normal in emergencies that patients are treated without any information of their background and personal data. So, it only collects gender and estimated age and even without entering these data, the patients can be managed with this tool. It allows the flexibility of entering only as many data as has been collected in the rush of an emergency, i.e. it does not block the user from entering information if some items have not been entered. In other words, the user enters what he deems necessary and is not held up with having to enter information, which he does not have. This layout of the tool is designed by partners CUH and HRT and the tool is developed by partner ESRI, in combination with partner NCSR and by itself, it is a valuable ePCR product for commercialisation. There is a potential to link in the future this tool to other existing products on the market, which deal with the provision and protection of patient information, such as personal data and past medical history, which products are commonly referred to as ePHR (electronic personal health record or personal health card). Such linking would require work on security and data protection issues, e.g. decisions how to make the information securely available only to the responder who is currently treating the patient, but keep the information otherwise out of the common incident space. At present this is well out of scope of the COncORDE project, but this further development opportunity has already been seen to attract significant stakeholder interest of companies that develop ePHRs, because via a system such as COncORDE, they would be able to place their product across a very wide user community.
The patient needs screen of the patient e-form provides information (referral diagnosis) to the semantic engine (partner VTT), which supports the system suggestions for suitable hospitals. Again – here is a link to the hospital information tool developed by partner KT. The patient needs screen also provides information (referral diagnosis, priority as time to hospital) to the DSS (partner UCY, VTT) for hospital allocation, evacuation and allocation to transport.
The patient status information tool is developed by ESRI, it is linked to geo-location and the relevant data collected are stored securely in the database.
The Rescue application (for the patient monitoring tool – ID, location, triage1, vital signs)
The Field application
The rescue application and the field application are two connected applications developed by partner NCSR. Partners CUH and HRT have provided knowhow for the requirements of the innovative UI design and for the requirements of what this application should do. The rescue application combines the provision of an anonymous ID to a patient upon first encounter, along with a location signal, output from a wearable vital signs monitor and triage1 information data. The triage1 information is inputted on a screen of the size of a smart watch and for this reason the layout of the original triage1 card (SIEVE) could not be adopted directly. The innovation from the screen design point of view was the conversion of the triage1 steps to be visible on a small screen and to allow both full workup of the steps as well as a shortcut and choice of triage colour at any one time. This design decision would allow for the triage1 to be done under different types of time pressure, as in real practice, e.g. there are extreme cases where only triage colour is selected, as well as cases where all steps are taken to obtain triage result – which is best practice of course. Thus, the system allows the responder who performs the triage to act differently, in line with his specific instructions for the situation issued by the field commander.
Activation of the ID of this application initiates the creation of the patient e-form in the system and allows all the information gathered on a specific patient to be channelled to the right patient form. The location signal provides real time location of the patient, which allows tracking him at any one time. The location signal is displayed on the COncORDE map.
The field application allows the data gathered by the rescue application to be displayed on the field map in different views. The application also enables the data from the real time vital signs monitoring device to continue to be provided to the patient e-form and to the patient summary table.
The rescue application and the field application are products that can be commercialised separately outside the COncORDE system. Given that the COncORDE project does not have a dedicated device that could provide the combination of functionalities, but at the same time the application addresses real needs of the market, a take-up of the project output by designers is expected, to work on the design of a multifunctional wearable device. This would then be referred to as the COncORDE patient monitoring tool. Within the project this tool is simulated via available devices.