DocuLive EPR Norwegian version
A hospital electronic health record system developed by Siemens Medical Systems Norway first version from 1988 and from 1996 as part of the the MEDAKIS project. From 2003 as a independent EPR system. 1 of 2 major EPR solutions in Norway. Installed in several University Hospitals. Some of which have managed the transition to a fully electronic health record.
- 1 Overview & History DocuLive
- 2 Main Functionality
- 2.1 BOS / Order & Result
- 2.2 BOF / Documentflow and Messaging
- 2.3 Multimedia
- 2.4 Nursing
- 2.5 Scanning
- 2.6 Clinical Pathways
- 2.7 Medication
- 2.8 Charting
- 2.9 Digital Dictation w/Speech Recognition
- 2.10 Digital Archive
- 2.11 Web Services
- 2.12 "Doogle" ("DocuLive Google") / Free text search
- 2.13 Document Designer
- 2.14 Document Controller
- 3 Security
- 3.1 .NET
- 3.2 SQL Server
- 3.3 Windows XP
- 3.4 Windows Vista
- 3.5 Windows Word
- 3.6 Mid Norway
- 3.7 Ullevål University Hospital
- 3.8 Rikshospitalet/Radiumhospitalet
- 3.9 West Norway - Bergen
- 3.10 Outside Norway
- 3.11 WEB Services
- 3.12 Service Broker
- 3.13 Event Manager
- 3.14 Context Manager
- 4 Performance
- 5 Criticisms
Overview & History DocuLive
Currently a mix between Norwegian and English documentation
BOS / Order & Result
"Bestilling og Svar" "Order and result"
”Order and findings” enables requisitioning of medical services from radiological departments, clinical chemical, microbiology and pathological departments.
DocuLive is able to handle a twoway communication with radiological departments and clinical chemical, regarding requests and findings. From microbiological and pathological departments the module only receives the findings. The design and the content of the referrals can be set up by the hospital as a XML script, providing individually configurable forms.
X-ray, clinical and chemical requisitions can also be configured to suit the client’s needs. The hospitals can then determine which tests to include.
All incoming results are displayed in a common worklist with clinical replies. The results are available for the requisitioning physician, the requisitioning department, and the ward the patient is admitted to.
Radiological results are presented clearly together with the requisition, which gives the user an excellent overview with everything on one screen. The user can easily follow the attached link to view the images taken. A cross communication with the PACS-system will be activated by clicking the link, and the relevant examination will be displayed.
A close-up view is simply exe-cuted by double-clicking the image displayed on screen. The image is then presented in high resolution and in a larger format for a more detailed study.
BOF / Documentflow and Messaging
"Beskjed og Følgeskriv" "Documentflow and Messaging"
This module contains a useful tool for addressing and calling attention to other users regarding new entries in the patient records. Certain entries must often be evaluated by another clinician or therapist, who must be made aware of the fact that new information is available.
By tying an attachment to a document in the patient record, the user can add comments, information and messages that will become a permanent part of the patient’s record. The response and feedback from other users will be presented chronologically in the same attachment, enabling the clinicians to keep track of the dialog and discussion regarding a specific document in a patient’s record.
The user may respond to attachments by signing, adding comments or entering a reply. When browsing through a health record, documents with attachments are clearly marked. The state of an attachment can be “draft”, “to be signed” and “signed” as for all other DocuLive EPR documents.
The module also makes it possible to communicate more informal messages between users without adding the notifications as a permanent attachment in the patient’s record. These messages are still retrievable in the system and can be retrieved at a later stage as “sent” or “deleted” elements in the users DocuLive mailbox. Informal messages can be relevant both for patients and documentation, and the module therefore provide a possibility to add links to the relevant DocuLive documents in a message. One
Images and multimedia contents are very important parts of a patient’s health record.
The multimedia module in DocuLive provides an excellent opportunity to store sound, images, video and animation files related to a patient’s record. The patient’s disease is then illustrated in a complete and detailed manner, yielding important information to the healthcare personnel to plan the right treatment.
Supported file formats are:
- Images (.tif, .tiff, .bmp, .jpg)
- Audio (.mp3, .wav)
- Video (.mpeg, .mpg, .avi)
The module also supports series of images.
The multimedia elements are stored with information that safeguards:
- Rapid retrieval
- Use for educational purposes
- Safe access control
Images can often offer an important documental value, and they may be of intimate nature. It is therefore important that the access to photos are handled by the same access control routines and traceability as other information in the health record. The safety aspect is well taken care of in DocuLive.
The multimedia module is set up with an convenient workflow so that inserted elements can be sent for approval by the responsible clinician.
In addition to a standard DocuLive-Zoom, it is also possible to view images in a separate window, for a more detailed overview. The images can be marked with keywords, a functionality that provides a searchable photo archive with rapid retrieval. Images can also be edited after being imported in a patient’s health record. The user can set up which type of image editing software to be preferred in DocuLive.
The nursing documentation in DocuLive EPR provides lot of benefits compared to the paper-based nursing documentation. The module displays an overview of a patient’s problems and related nursing interventions. All with the touch of one button.
The solution is highly flexible and supports the nursing routines of the different departments. Problems related to the update of paperbased care plans are eliminated. The electronic care plan in DocuLive is accessible at any time and any place.
The Nursing module consists of:
- Consecutive nursing journalnotes as a structured part of the entire EPR.
- Problems with nursing inter ventions and evaluations
- Nursing discharge summaries,various letters and letters from notes.
It is possible to connect the module with a classification system for nursing. Everything is handled from one dialog box that easily provides an excellent overview of all problem areas, interventions,notes and evaluations.
The Nursing module is fully integrated with the DocuLive Chart module, and relevant nursing data will automatically appear on the right section of the patient’s chart. There is also access to all other relevant documents from the chart’s document section.
DocuLive’s nursing module is focused around the problem-solving part of documentation and the nursing process. This means that you can collect data, define nursing focus areas and goals, define interventions, evaluate problems and write summaries. All nursing documents can be added to the record from an archive of document templates. The nursing focus areas, interventions and evaluations can in addition be added to the record from the treatment plan dialog box and also directly from other nursing documents.
Templates, standard texts, dictionaries and autocorrect functions are available for all document types and can be configured by the customer to fit the document.
The flexible Nursing module takes into consideration many different dependencies, allowing the user to make any number of connections between nursing areas, interventions, evaluations and other documents enabling the nurse to relate several interventions to one problem or several problems to one intervention.
The module displays all actions related to a nursing area, and all areas related to an action. Furthermore you can display:
- All evaluations tied to a nursing area/action.
- All notes tied to a nursing area/action.
- All documentation tied to a nursing area/action.
- All documents of the same type.(for example all admittance notes).
- All documentation tied to a function area.
All documents can be tagged with relevant key words making it easy to get an overview of the relevant nursing documentation structured by key words. For example function areas as “skin” , “nutrition”, “pain” and action areas like “Information”, “training”, “nursing procedure” are searchable.
The Nursing module provides flexible functionality gaining benefits for the hospital and the patients.
The scanning module is an important tool to make a patient’s health record complete. With the scanning module, health care providers can scan paper-based documents and attach them digitally to the patient’s record. A smart workflow makes getting rid of old paper archives simple.
The scanning module is developed to sort and store the document being scanned, in the correct order in the electronic patient record. Scanning works in interaction with the module “Mail and Messages”. The physicians and nurses receive a useful supplement of scanned documents in a fast and efficient manner to support the treatmentprocess.
Scanned documents are embedded in an empty DocuLive document. In this way important functions as classification, access control, audit and prints are safeguarded. A predefined user access must be set to enable the user to scan documents.
The attributes of the document are handed down from DocuLive classes. Input of document type determines where the document will be stored in the record.
The scanning module also offers batch scanning, which means that the user can put several documents at a time in the scanner’s feeder. Batch scanning may be performed centrally for the discharge of large old paper records. The classification of where to store the documents can be done by predetermined separation-sheets. At the end of the process the documents are stored in the patient record and in a separate database. The document title contains the document date, document type, organization unit and/or registered free text.
The storage is often in a separate database server. A pointer will be established from the DocuLive database to the digitalized, scanned documents.
The decentralised scanning of consecutive documents is mainly performed in a ward or a department. The user simply opens the patient record in DocuLive, starts the “scanning module” and places document in the feeder of the scanner. The scanned document is sketched out in a special designed dialogue box where it can be grouped, rotated and sorted and given several parameters. All parameters may be changed at a later time.
With the scanning module you can merge the past with the future.
The Clinical Pathway module provides an effective way of keeping overview of all types of examinations and patient related activities. The module has one common environment where all kinds of activities can be handled and monitored.
Example of activities can be anything from measuring blood pressure, ordering taxi, requisitioning of clergy, X-ray examinations, edication, clinical observations and analysis, treatment plans, notes, discharge summaries and laboratory services.
The module gives an excellent overview over planned, scheduled, pending, ongoing and performed and cancelled activities.
The module includes a flexible administration tool that offers the user the opportunity to predefine and group activities to be available for different types of treatment process. This functionality ensures that the patient receives the correct treatment and follow-up. All acitivities can be approved by the medical person responsible and executed by the staff. These predefined clinical pathways ensures an efficient and safe working routine.
The activities are classified into different categories: • Services implemented as an internal referral both with and without a reply section. • Documents, as for example notes and discharge summaries • Prescription of medications • Nursing related activities • Laboratory analysis in: - Clinical biochemistry - Microbiology - Pathology • X-ray examinations • User-defined examinations
The Clinical Pathway module also supports repeating activities. Weekly, daily, hourly and user-defined patterns can be ordered. All acitivities may also be given a priority.
The graphical interface looks like the one from MS Outlook.
From a patient’s record, the user gets access to the activity overview and available services through a separate icon. From the available services menu the user can find the appropriate activity by searching in register containing predefined templates, all individual activities and the most common acitivities for any given department. The day-plan view displays the daily acitivities in an Outlook-familiar calender.
Information from and to other systems outside DocuLive are easily handled by common interface solutions.
The module is subject to the same access control generally found in DocuLive, and the activities are not active before a user with the necessary authorization signs it.
The Clinical Pathway module functions in close relation with all other modules in DocuLive and in interface with other systems.The module is then able to gather all the patient related activities and presents it all in one common overview.
The Medication module provides complete control of a pasient’s medication, medication mixtures and IV-liquids. The module will reduce the number of errors as cause of wrong medication and most of the problems related to paper prescriptions will be eliminated.
Medicament prescription is available in an easy-to-follow overview. Recommended guidelines and warnings conduct the user to a safe patient treatment. Physicians and nurses can therefore contribute to a safer and more sound patient treatment.
Ordering of drugs is performed in a user-friendly dialog-box. Quantity, hour, duration and a lot of relevant parameters can be managed in several ways.
The module can be used in all wards, doctor’s offices at the hospital and at the bedside.
Medicaments ordered in the medication module, can easily be re-used to make prescriptions. An automatic transfer of all relevant medication data to the discharge summary is also possible.
The Medication module is closely connected to the Clinical Pathway module and the Chart module. For instance, the liquid balance in the Chart module, also includes the total volume of mixtures and IV-liquids from the Medication module. This functionality gives the hospital a uniqe tool to monitor the patient’s intake/output exactly.
A separate overview of a patient’s drug hisitory is easily accessable from the Chart at any time.
A medication order can be established in several ways; From the chart, just by typing the name of the drug or by starting the activitity overview in the Clinical Pathway module. A search for a drug displays the name of the drug, strength, volume, form and other relevant information. It is also possible to configure the system to decide which information to displayed.
The module offers several flexible solutions for dosage types and time frames. The user may order different types of drugs as repeating, once, continuous, schematic, as needed or conditional.
Separate repetition patterns, for example every other day, each Wednesday and Friday etc. are also possible entries. Day dose and day dose per kilo is calculated, and any medication allergies will be shown on screen.
The module has various warnings and guidelines,as for instance medicament allergies and interactions between medications.
The user gets a warning if the dosage given varies from the prescribed dose. A warning will also appear a if the time span since the last dosage is to short t or if the maximum daily dose has been exceeded.
The module offers context sensitive inquiry against Physicians Desk Reference. There is also directly access to the Physicians Desk Reference, and possibility for a context sensitive inquiry against the client’s quality- and procedure system.
The administration of the Medication module is done in a separate work list containing information about the patient, medicaments and the administration guidelines. The list can display an overview of a single patient or of several patients.
The user may state a reason for cessation of medicines in a pre-defined list if wanted. If the user states life threatening and less serious side effects, this information can be transferred to various forms, and to the patient’s list of essential information.
The Medication module is subject to the same strict safety roules as generally found in DocuLive. Orders and prescriptions and are not active until the correct values have been stated, and signed by a user with the necessary access. The users may have reading rights, editing rights or a combination of both, set and customized by the hospital.
Kurvearket har eksistert på papir i lang tid. Dagens kurveark på papir er et viktig redskap i behandlingen av pasientene for flere yrkesgrupper. Det inneholder sammenstilling av nøkkelinformasjon, utvalgte observasjoner, forordninger og kvitteringer. De ulike personellgrupper har forskjellige ønsker og krav til kurven.
Den elektroniske kurven viser nyttig sammenstilling og presentasjon av vesentlig klinisk informasjon om en pasient. Utvalgte deler av informasjonen er presentert på en lineær tidsakse, som viser utviklingen av viktige kliniske parametere.
Samtidig visualiserer kurven også innskriving av ny informasjon. Kurven åpnes fra et ikon på skrivebordet i DocuLive dersom en pasientjournal er åpen på skjermen. Det er også mulig å åpne kurven fra den enkelte pasient i en pasientliste fra hospitaltreet. Det vil således være enkelt å bevege seg fra kurve til kurve på de forskjellige innlagte pasientene på en post.
Enhver seksjon har en overskriftslinje med funksjoner som gjelder seksjonen under ett. For eksempel vil det være mulig å kollapse hele seksjonen ved et enkelt grep, slik at man får plass til å vise de øvrige seksjonene på kurven.
Brukeren kan enkelt bevege seg langs tidsaksen på kurven, både forover og bakover i tid. Klinisk informasjon i alle tidslinjeseksjonene vil dermed oppdateres, og vise innhold svarende til det valgte tidsintervall.
De forskjellige seksjoner på kurven bygges opp av informasjon av forskjellige typer: • Kliniske observasjoner, væskeinformasjon, utstyr etc. • Medisinering • Lab (LKB, Mikro) • Undersøkelser (internhenvisninger, radiologi, patologi, egne undersøkelsesskjema) • Andre dokumenter.
Digital Dictation w/Speech Recognition
Digital dictation in DocuLive EPR contains several advantages compared to ordinary dictation.
Cassettes and distribution of these will become obsolete, and you will thereby save the time-delay from the manual handling of the dictation process.
The module enables the sound file to be automatically stored in the right place in the patient record. Users thereby have access to the clinical information - as a sound file - in the medical record before anything is transcribed, a functionality that may prove very important in critical situations. Health personnel then don’t have to wait for the secretaries to type the text before critical decisions are made.
The logistics are simplified, you save time, the information is found in the right place, and the sound file is available from every workstation that has DocuLive EPR installed.
The module can easily be interfaced to most types of dictation equipment.
The access to use the Dictation module is defined in the users profile and can thereby be restricted to a certain amount of users depending on profession, training, equipment available and hospital routines.
Transcription is organized in different virtual typing pools, where medical secretaries have a tailor made work list for the continuous monitoring and transcription of incoming sound files. These coordinated work lists enable the secretaries to share the workload and to easily process the sound according to the priority set by the “dictator”.
From the secretary’s work list, DocuLive EPR brings up the right sound file and starts the text editor. All in one single mouse-click.
When the secretary has written the dictation, the transcribed document is ready for approval. The author can access the document from his approval list, read through it and (if needed) edit the document. He can also add an additional dictation. When completed, the author easily signs the document off.
When activating the dictation dialogue from the current patients’ record, the user is able to change the appropriate typing pool and priority if the default setting does not apply. Comments can also be entered if necessary precautions are to be made. The author may of course edit the dictate any time during the process, except when the dictate is being typed in by the secretary.
DocuLive.NET exposes webservices on a per module basis, meaning that one webservice corresponds to one DocuLive.NET module. The methods in each webservice corresponds to underlying methods in the DocuLive.NET module.
"Doogle" ("DocuLive Google") / Free text search
The free text search module, “Doogle”, is a search engine where health care personnel can search for a selection of journal documents. Since many users now are used to search on the Internet, it was only natural to adopt simular, advanced search functionality in DocuLive.
In several European countries searchable journal systems are a demand. The functionality is especially useful within the field of research and education where you for example may search for patients with certain diagnosis.
The users can easily retrieve patient records within the same problem area and knowledge in relation to those they are working on. The search can be limited to only patients the users have on their work list.
Scanned documents, containing old paper documents, are also included in the search.
The search function is subject to the same stringent access control and safety as found otherwise in the system. Users only get a hit for elements in the record that they have access to enter.
The search technology being used is developed in Norway and developed to suit systems where the safety must be strict.
The menu to start “Doogle”, is found in the hospital icon. The search phrase must be entered in the search field. Wildcards allowed are: “*” or ”%”. If you only fill in one wildcard, you receive a hit on all records in the whole system, with the last created document displayed first.
The combination of wildcards and search words can be performed both as a prefix and a suffix. Wildcards can be used together with interception possibilities in “Doogle”.
To open a desired document, you simply double-click the entry in the result field. If an update is necessary, the update dialogue is displayed before the actual document.
20 hits are displayed per page. More than 20 hits can be navigated with the use of <<Last page and next page>>.
A yellow triangle icon with an exclamation point indicates that special access rights are needed for accessing.
A circular icon with an exclamation point indicates that the document can not be displayed with the users access level. The module will not strain the server noticeably.
== Technical Platform== see ...
Currently the only EPR system in Norway on this or similar platform. The system is completly .NET based, old and new functionality. SOA based.
C#, C++, TSQL,
SQL Server 2000 SQL Server 2005
Word 2000 Word 2003
==Installations== see ...
Ullevål University Hospital
Norwegians largest hospital - Ullevål University Hospital
DocuLive is integrated with the portal CSAM at the Riks-Radium site.
West Norway - Bergen
Also several installations in Denmark through CSC Scandihealth Denmark and the products OPUS and VITAE. Where DocuLive kernel are the kernel foundation for theese products.
==Support & Maintenance== see ...
==Integration== see ...
The DocuLive Context Manager platform helps enterprise customers to visually integrate medical applications by means of a loosely-coupled messaging system. It provides the backbone to enable having a common context among participating medical applications.
DCM is valuable for our customers because it enhances the overall user experience. Applications are integrated on the user’s desktop which make it possible to work together and trigger events in each other.
Design of the DocuLive Context Manager
The DocuLive Context Manager helps you to integrate medical applications on the client-side. The DocuLive Context Manager includes the following features:
Front-end integration platform for multiple medical applications.
MSMQ based solution.
XML based messaging.
Messaging platform for the enterprise. Applications connect to the DCM message queue and send messages to participating applications.
Routing of messages between participating applications.
Integrating applications using the DocuLive Context Manager
An application wishing to integrate connects to the DCM message queue and sends a message to subscribe to context notifications. The application sends, as part of the message, the address for the message queue where it will listen for context notifications.
Context notifications are delivered to the participant’s message queue and it is up to the receiving application to implement the logic for applying the context change accordingly.
System availability in production sites - 99.99%
Largest site: 19000 Users, at peak hour 2900 simultaniously users
A critical paper by Mikkelsen & Aasly (2001), which examines the transition of a Norwegian University hospital towards all-electronic records, cites DocuLive Medina as the records management software for the electronic record element of the dual format system.
- Mikkelsen, G. & Aasly, J. (2001) "Concordance of information in parallel electronic and paper based patient records",International Journal of Medical Informatics 63, pp.123–131.