LED electronica ltd.

Michael Culina MS.A.E.

Business Development Manager

Savska 102a, 10310 Ivanić Grad, Croatia

www.led-elektronika.hr

OIB: 84566292432

Tel: +385 (99)6233322

E-mail: michael.culina@led-elektronika.hr

PatroHR

Summary

LED Elektronika d.o.o.

30.1.2015.

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1. Introduction

PatroHR is integrated software solution designed to implement central information system

of Croatian National Visiting Nurse Service. It was developed by LED Elektronika ltd for

Croatian Health Insurance Fund (HZZO) and supports the visiting nurse activities with a goal

to provide more efficient delivery of health care to all residents of the Republic of Croatia.

The system achieves following goals:

Optimization of visiting nurses’ business processes (work flows) using electronic

recording of the nursing documentation (medical eRecords)

Increases the efficiency of visiting nurse teams (planning and optimization of

schedule)

Significant reduction of direct and indirect healthcare costs

Connection with other health care information systems which results in better

patient monitoring and reporting

Collecting structured data about patients

Simplified training/education and work

Automated reporting

Prevention (primary – healthy population; secondary – chronic)

Collaboration – elementary functions between all actors included in the process

2. Visiting nurse activities

The visiting nurse activities can be classified in the following areas (depending on the patient

group types):

Home care visits for pregnant woman from week 12

Home care visits for newborn babies and their moms

Preschool and school age children monitoring, according to the pediatrician’s needs

Monitoring of chronic patients

Monitoring of disabled patients

Monitoring of elderly patients

Monitoring of healthy persons

Individual and group consulting of the target groups (education, prevention)

Telephone consulting

The main steps of every activity are basically the same. The type of the patient defines the

type of interaction and the scope. In the next table we explain each step of an usual visiting

nurse activity.

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3 PatroHR - Summary

Step Description Data Examples

Registration

(making

request for

health care

activity)

Each activity starts with

the request for activity.

The request can be done

by any actor (user of the

system) via request form.

Standardized collection of data

(personal data, attachment,

description of requested

activity)

Nurse registers patient after

telephone consulting; ;

Hospital reports a newborn;

Nurse from the hospital

registers a chronic patient

that needs a visit; Neighbor

registers a disabled patient;

Periodic group consulting

for specific patient groups

(i.e. pregnant women);

Planning Planning day and week

activities depending on

level of urgency, location

and patient group type

Date and time, location, level

of urgency, patient group type

Daily route planning (with

route optimization);

Planning ahead (few days or

more)

Health care

activity (visit)

Providing visiting nurse

services to the patient

and collect data through

examination, evaluation

and review of existing

documentation;

Cooperation with other

health professionals,

institutions or associates;

Activity data –

time(duration)and location of

activity, participant (actors

involved in the activity),

provided services,

transportation details (means

of transport to the location);

Patient data – Personal data,

household details, medical

diagnosis, nurse diagnosis,

medication therapy,

treatments, physical exam,

vital functions, nutrition

monitoring, fluids, activities,

mobility, pain, sensory

functions, cognitive functions,

other details;

Standardized reports - patient

summary report;

Nurse is visiting patient at home. Examination and evaluation is done. New data associated with the patient, household members and the associated actors (guardian, health professionals, institutions, associates) is added or existing edited. Activity is monitored and recorded in the system so calculation of expenses can be done.

Reporting Reporting on performed

work (monitoring of

efficiency and expenses)

Reporting on patient

status

Cumulative data Periodical statistics based

on location and amount for

payment needs; Periodically

statistics for efficiency

tracking; Various custom

statistics;

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4 PatroHR - Summary

The system is in accordance with the following guidelines and documents:

Guidelines for the conducting of health care activities in the Visiting Nurse Service,

Croatian Chamber of Nurses, 2013

Nursing documentation, Croatian Chamber of Nurses, 2014

Specification of the standard security mechanisms, Croatian national eHealth

platform, 2014

Typical use case

A half disabled patient is released from the hospital for home treatment. He lives

alone with his wife. He has a wound on his stomach.

A nurse at the hospital writes the discharge letter on the day of discharge and

registers the patient on the central PatroHR system

Next day, the visiting nurse inspects new registrations(request), contacts the patients

and schedules activities in her time plan

Visiting nurse visits the patient on the planed time, reviews the existing

documentation and conducts the examination and evaluation. She assesses that

patient needs health care at home four times per week. She saves all collected data

and diagnoses via the PatroHR user application.

o If this is the first time visit for the household, she examines and evaluates the

other household members too.

The visiting nurse has to visit him in 2 weeks to track the recovery progress so she

makes another request in the system to get reminded when the time comes

The patient’s primary healthcare doctors get notified about all provided services and

the entered data of the health visitor

3. Application overview

The system provides support to the nurses in all segments of their workflow mentioned in

the last paragraph. The interface (Web application for direct use, Web services for 3th party

systems) can be divided in three main parts.

Activity

Every activity is recorded with a defined collection of properties which unifies planning and

reporting regardless of the service that has to be provided. Every system user/medical nurse

has his/her planning desk where all registrations come in. Through this kind of separation

the system enables the following list of functionalities:

Planning visits (from daily to weekly schedules)

Standardized activity tracking regardless of the activity type (individual, group) and

provided services

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Auto generate activity statistics (by amount, services, area, time, patient group type,

health team type)

Person

The person metadata collection consists of administrative data, medical data and

associations to other persons (patients, guardians, health professionals, institutions,

associates). Every entered data is associated with one activity so everything can be

qualitatively and quantitatively tracked. The main functionalities associated with a person

are listed below:

Search/filter by patient name, patient group type (i.e. pregnancy, elderly), home

assistance use, age, ...

Collecting data from the field (medical, administrative, prevention)

Auto generated visit evaluation summary

View visit history

Fill/auto generate standardized reports (nursing and care plans, visit reports,

management reports)

Manage patients associations

View entered measurement data in standardized interactive graphs with edge and

percentile values (i.e. head circumference)

Figure 1 Body mass index graph

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Figure 2 Entering medical data

Household

Households are separate objects in the system and have its one metadata collection. Every

patient is bound to one main household. This architecture enables the following

functionalities:

Search/filter by geographically parameters

Easy navigation to household members

Associate household with health professionals, institutions or associates

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Figure 3 Administrative person data

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4. Integration

The concept of data sharing is of great importance in the National eHealth platform as so in

this system too. The system enables integration at all levels from source data to cumulative

statistics. It’s integrated with the following actors.

Actor Description Integration type

CEZIH (National eHealth platform)

Real time synchronization of source data

System service

HZJZ (Public Health Institute)

Monthly statistics (on demand, monthly eMail) – statistics based on the patient group types

Web user interface, Web service, system service

HZZO (National health insurance provider)

Monthly statistics (on demand, monthly eMail) – statistics based on location and amount

Web service, system service

Hospital information systems

Forwarding information needed for visits

Web user interface, Web service

Primary healthcare doctors View entered patient and activity data, forwarding information needed for visits

Web user interface, Web service

Patient portal View and edit of personal information and measurements (for future use)

Web user interface, Web service

5. Technical details

The system is based on the Microsoft ecosystem. Its architecture is horizontally and

vertically structurally partitioned so it enables simple system scale up and maintenance and

also high availability and disaster recovery depending on the costumers needs.

Description System part

Operating system MS Windows server 2012 Application server, Database server Data base MS SQL server 2014 Relational database management

system Application hosting MS IIS Web application servers Service hosting MS IIS Web service servers User interface Internet browser (MS IE,

Google Chrome, Mozilla Firefox)

Web application

Security MS IIS or custom Authentication and authorization

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The system software is developed in C# programming language and it’s based on the

following technologies:

RESTfull web services

ASP.NET MVC

Razor Markup

Entity framework

The user interface is a Web application witch runs on almost every computer or tablet. It’s

based on the following technologies:

Responsive design

HTML 5

CSS 3

jQuery

Bootstrap

Angular

Sencha Ext JS

D3