Ingolstadt Hospital (Klinikum Ingolstadt) Regional Hospital Improves Patient Care with Better Information Flow Published: October 21, 2003 Solution Overview Company Ingolstadt Hospital (Klinikum Ingolstadt) Partner(s) Siemens Customer Profile Located in southern Bavaria, Germany, Ingolstadt Hospital is a medical center with 1,100 beds that serves a catchment area in the center of Bavaria with a population of approximately 500,000 thousand people. Software and Services C# Microsoft Office Infopath 2003 Microsoft Office Professional Edition 2003 Microsoft Office SharePoint Portal Server 2003 Microsoft Visual C# .NET Microsoft Windows 2000 Server Microsoft Windows XP Tablet PC Edition Web Services Business Situation Staff at Ingolstadt Hospital’s emergency ward manually collected and submitted patient data to hospital systems. Handling paper forms and repetitive data entry took time away from treating patients and impeded efficient communication between hospital staff resulting in increased wait times for patients. Solution Description Ingolstadt Hospital deployed a solution based on Microsoft® Office Professional Edition 2003 and running on Microsoft Windows® XP Tablet PC Edition. The new solution replaces paper documents with XML-based forms created with Microsoft Office InfoPath™ 2003 and stored using Microsoft Office SharePoint™ Portal Server 2003. Fujitsu-Siemens Stylistic Tablet PCs HP LH3000 - 800 MHz - 1 GB RAM Vertical Industries Healthcare and Healthcare Insurance Country/Region Germany Benefits Hardware Is estimated to reduce the time staff spends on admitting patients to the emergency ward by 6,000 hours annually Reduces additional, not accountable costs by stream-lining data flow and waiting times for patients that follows a patient throughout treatment Saves €31,200 in time wasted searching for information Improves patient care by reducing information gaps Audiences Business Decision Makers Developers Information Technology Professionals When Ingolstadt Hospital replaced its paper-based process for emergency ward admission with a solution based on Microsoft Office Professional Edition 2003 and deployed on Tablet PCs, the hospital improved patient care by reducing wait times in the emergency ward because doctors and nurses no longer fill out forms manually. This busy hospital averages 25,000 emergency patient admissions each year, with up to 20 people concurrently receiving care in the emergency ward. Using this solution, Ingolstadt Hospital is saving 15 minutes each time it admits a patient, representing 6,000 hours annually that the staff can devote to providing care instead of handling documentation. With the solution in place, Ingolstadt Hospital expects to improve healthcare outcomes and send people home sooner. Situation Ingolstadt Hospital provides primary-level trauma care to patients either flown in by helicopter or brought to the hospital’s emergency ward by ambulance. As a major regional health facility, Ingolstadt Hospital provides emergency and acute care services, including all major diagnostic procedures, to a catchment area of approximately 500,000 people. Every patient arriving at the hospital brings a unique medical history. Taking that history into account while adding new data as the patient moves through admission, various diagnostic procedures, treatment, and discharge is an essential element of healthcare that provides practitioners with a complete picture of each patient at every stage of his or her hospital stay. Ingolstadt Hospital has long recognized the importance of facilitating the collection and communication of accurate patient data among attending clinicians and practitioners as a means of improving care and accelerating patient treatment. With that goal in mind, the hospital has been employing electronic data transfer to reduce manual, paper-based methods of communication among staff. “The faster the transfer of patient information between all parties involved in a patient’s care, the better healthcare we can provide,” says Professor Johannes Aufenanger, Professor of Laboratory Medicine at Ingolstadt Hospital. “To that end, we have replaced paper order forms for lab services with an electronic order system in which orders are placed directly to the lab from computers on each ward so our analytic devices can start working immediately. Likewise, we can now use a cell phone to transfer critical information like electrocardiogram results to the emergency room while we are transporting a patient by helicopter.” However, the hospital felt that there was room for improvement. Nurses and doctors still had to leave their patients to go to the computer and enter lab orders; the emergency physician attending an accident site still had to relay most information to emergency staff either verbally or by handing over paper forms for staff to enter the data into the hospital’s systems manually. And as the patient progressed through his or her hospital stay, the same information had to be collected several times so that staff filled out the same information in many different forms—for example, every time a patient was transferred to a different doctor’s care. “Anytime there is a transfer of information between individuals, or a staff member has to interpret a written form and enter data into a system, there is a chance of error,” says Dr. Schmutzler, Assistant Director of the Neurosurgical department. “We wanted to reduce these gaps in the flow of information accompanying a patient throughout his or her hospital stay, and we began by looking at automating the collection of patient data at the emergency ward.” Deployed on the ultra-mobile Tablet PC, the Microsoft Office System represents a paradigm shift in our ability to efficiently deliver patient care at Ingolstadt Hospital. Thomas Kleemann CIO, Ingolstadt Hospital Ingolstadt Hospital’s role as a regional trauma center means that its emergency ward is busy, handling some 25,000 patients a year. Although the emergency room would be a challenging test environment for a new system, according to Thomas Kleemann, IT Manager at Ingolstadt Hospital, a successful solution would “fulfill the IT department’s mandate for facilitating the flow of patient information as it follows that person through his or her stay at the hospital, as well as making it available to clinicians whenever and wherever they need it. To help us fulfill this goal, we looked for a technology partner with experience both in the healthcare field and in mobile computing, and we chose Siemens as our technology partner because of our long-term relationship,” he says. Solution Siemens Information and Communication Networks (IC Networks), a leading provider of network technology for enterprises, carriers, and service providers, proposed a solution built using the Microsoft® Office System, including Microsoft Office InfoPath™ 2003 information gathering program and Microsoft Office SharePoint™ Portal Server 2003. It also recommended deploying the solution on Fujitsu-Siemens Computer’s Stylistic Tablet PC running the Microsoft Windows® XP Tablet PC Edition operating system. Hospital staff can carry the lightweight, mobile computers like clipboards and connect the Tablet PCs to the hospital’s wireless local area network. Now, practitioners can carry the Tablet PC with them throughout the hospital and use the pen to enter patient data into the InfoPath forms modeled after the original paper versions. Siemens designed and developed the XML-based forms so that they could communicate with the hospital’s databases through Web services. Web services are small, reusable applications written in XML, a universal language for data exchange. They allow data to be communicated across the Internet (or internal Intranet) between otherwise unconnected sources that are enabled to host or act on them. The solution takes Figure 1: All documentation generated during a patient’s stay at advantage of built-in data Ingolstadt Hospital is handled using electronic InfoPath 2003 validation for the forms, which helps increase the forms, which are stored in SharePoint Portal Server 2003. These accuracy of the patient information collected. Using XML-enabled forms use Web services to communicate with the hospital’s databases and always display the patient’s most upthe Tablet PC and InfoPath forms, doctors and hospital to-date information. Hospital staff use the Tablet PC and a staff can work with the stylus stylus to fill out forms and order tests without having to leave to enter information quickly the patient’s side by connecting to the hospital’s wireless local and easily as they move through hospital corridors area network. and around the emergency ward. The forms can then be stored on a SharePoint Portal Server, where they are processed by a Web service into the hospital’s back-end information systems, including a radiology database, patients’ medical history database and patient’s organizational data. “We were looking for an intelligent tool that would allow us to transmit patient data to and from all hospital systems via XML, and Microsoft Office InfoPath turned out to be the perfect tool for us,” says Kleemann. “Together, Office Professional Edition 2003, XML, InfoPath-based forms, and Web services provide a new software environment for gathering, sharing, and reusing the most up-to-date patient information. Deployed on the Tablet PC, the Microsoft Office System represents a paradigm shift in our ability to efficiently deliver patient care at Ingolstadt Hospital.” Benefits Within the busy atmosphere of Ingolstadt Hospital’s emergency ward, the hospital experienced immediate benefits from its Microsoft Office System solution. Now the first-response physician, who travels with the patient to the hospital, can collect vital information about the patient’s history and the injuries sustained, and complete diagnostic orders such as x-rays, blood tests, or ultrasounds using the Tablet PC and InfoPath forms. “The advantage of the wireless computer and InfoPath intelligent forms is that patient data collected en route can be submitted directly to the hospital’s information systems, bypassing emergency ward paperwork and removing the chance of miscommunication, which could result in treatment delays,” says Dr. Schmutzler. “We often have 20 patients at a time in our emergency ward, yet our Microsoft Office System solution allows us to work more efficiently because our staff can attend to the injured instead of shuffling paper.” With physicians routinely juggling five to seven different forms per patient even for relatively simple procedures, doctors are particularly glad to get paper out of the emergency ward so that they can practice medicine more efficiently. Patients will no longer have to answer the same questions over and over again because once the information is entered into the system it can be easily retrieved via the InfoPath form. “Microsoft Office InfoPath 2003 and the Tablet PC combine to automate the collection and distribution of admission forms in the emergency ward, reducing by an estimated 15 minutes the time it takes to admit a patient,” says Dr. Schmutzler. “Seeing 25,000 patients a year, we expect to save over 6,000 hours annually in handling documentation. That’s 6,000 extra hours we can devote to providing care. The result is that patients are getting treated faster and can leave the hospital sooner.” The hospital is also reducing the risk of misinformation residing in the patient records because InfoPath prohibits the user from entering outdated or redundant data while filling out the digital forms. Eliminating manual data entry and the possibility of errors while improving access to patient data are key benefits for Ingolstadt Hospital. Seamless Data Flow, Shorter Patient Wait Times Waiting for doctors, lab results, nurses, physiotherapists, x-ray technicians—in short for any member of a patient’s care team—can be a frustrating experience. Eliminating these wait times by facilitating the flow of pertinent information among team members and between the lab and any other relevant hospital department will significantly reduce patient wait times, accelerate treatment, and save the hospital money. “We expect to reduce additional, not accountable costs by streamlining data flow and reducing waiting times for patients with the introduction of the Tablet PC and of our Microsoft Office System solution, together with the implementation of the DRG (Diagnosis Related Groups) accounting system,” says Kleemann. “Now we can achieve a positive result for the patient as early as possible. For example, now a nurse can use the Tablet PC to enter notes directly during ward rounds without having to go to the PC terminal and retype data into the system. That nurse can also send a test request to the lab and receive a result before he or she has completed the round. Real-time access to lab-results with this new system facilitates step diagnoses, where the same blood is tested several times a day, so when it might have taken several days to come to a diagnosis based on this test, now it could take only one. That could result in the patient leaving the hospital a day earlier.” The Right Information at the Right Time in the Right Place Previously, clinicians and staff complained that they did not have pertinent patient information when and where they needed it to provide the best medical care. The more time wasted in searching for the right information, the more time the patient waited for treatment. Sometimes staff complained about a plethora of documents that provided more information than required, or that they had to fill out similar content repeatedly. Instead, the Microsoft Office System solution deployed on the Tablet PC helps ensure that the staff has access to the right information at the right time, at the right place so they can spend more time with the patient and less time trying to locate data. “Through the consistent conversion to a system based on electronic patient files and electronic (patient) admission, we expect to eliminate the need for 40,000 scan operations – with each search taking two minutes – per year,” says Kleemann. “By avoiding the transfer from paper to electronic data, the hospital will save 31,200 Euros in material and personal costs.” Now all data is available to the doctors as intelligent electronic forms that include patient information already in the hospital’s records, or that has been collected since his or her admission. “InfoPath in combination with the Tablet PC will help doctors to enter and receive data right while they are with patients, which is where healthcare takes place,” says Kleemann. “Doctors can make necessary decisions directly related to this data right away and get treatment started earlier.” The new solution has benefits that go beyond the emergency ward to affect how patient information is handled throughout the entire hospital. InfoPath makes it possible for clinicians and staff to transfer the data beyond the boundaries of the hospital’s back-end systems to share cumulative, current patient information anytime, anywhere. For example, doctors can receive and review lab results at home, or in the staff room and can communicate with other people on the care team to more easily fine-tune treatment protocols as changes in the patient’s condition arise. The Tablet PC allows doctors and staff to access that information anywhere, anytime, both online and offline. Says Kleemann, “By combining intelligent forms and digital data collection with the Tablet PC we expect to increase our efficiency and productivity, reduce the average length of stay, and improve patient care.” Microsoft Office is the business world’s chosen environment for information work that provides the software, servers, and services that help you succeed by transforming information into impact. For more information about Microsoft Office System, go to: http://www.microsoft.com/office/ For More Information For more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) 426-9400. In Canada, call the Microsoft Canada Information Centre at (877) 568-2495. Customers who are deaf or hard-of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) 892-5234 in the United States or (905) 568-9641 in Canada. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to: http://www.microsoft.com/ About Siemens Siemens Information and Communication Networks (IC Networks) is a leading provider of network technology. Its comprehensive portfolio—HiPath for enterprises, SURPASS for carriers—comprises IPbased convergence solutions for voice and data, a full range of solutions for broadband access, and optical transport networks. The Siemens Group provides complete solutions from a single source for the infrastructure of the Next Generation Network—optimized for a prompt return on investment and to open up new business opportunities for customers. For more information about Siemens AG Abt,. ICN VD GW products and services, visit the Web site at: http://www.siemens.com/ © 2003 Microsoft Corporation. All rights reserved. This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY. Microsoft, InfoPath, SharePoint, Visual C#, and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. The names of actual companies and products mentioned herein may be the trademarks of their respective owners. Press contact: rrt@wagged.com Office SIG Principal