Windows Vista
Customer Solution Case Study
Paramedics Use Tablet PCs to Send Patient
Information to Hospitals During “Golden Hour”
Overview
Country or Region: Ireland
Industry: Healthcare
Customer Profile
Valentia Technologies, a Microsoft® Gold
Certified Partner, is a leading independent
software vendor specialising in mobile and
wireless technologies that directly
contribute to improvements in patient care.
Business Situation
The Pre-Hospital Emergency Care Council
in Ireland wanted to use public mobile
networks to transmit patient data from
ambulances for real-time display in
hospital emergency departments.
Solution
Valentia Technologies’ patient-care
reporting system uses Microsoft
technologies, and a proof of concept for
enhanced features uses Windows Vista™
and the Microsoft .NET Framework.
Benefits
 Improved “golden hour” patient care.
 Greater data-transmission reliability.
 Elimination of paper systems.
 Improved paramedic management.
 Extendable to other services.
“In addition to its ability to help paramedics find and
organise information, we’re equally impressed by the
enhanced security of Windows Vista.”
Peter Nelson, Chief Executive Officer, Valentia Technologies
Healthcare authorities in Ireland and Dubai are commissioning
mobile solutions in ambulances to help optimise use of the “golden
hour” after paramedics collect patients. Valentia Technologies has
been commissioned by the Pre-Hospital Emergency Care Council of
Ireland and the Dubai Ambulance Centre to deploy a solution for
the real-time transmission of patient data from ambulances to
hospitals. Using “ruggedised” mobile tablet PCs and the Windows®
XP operating system, the solution works both on standard public
mobile networks and TETRA. The solution gives emergency
departments more visibility of inbound patients prior to arrival.
Paramedics are relieved of the burden of paper records and receive
a more structured patient-care workflow. Healthcare authorities can
use the standardised data on pre-hospital emergency care practice
for analysis and evaluation.
Situation
Healthcare authorities worldwide are seeking
ways of using evidence-based practice to
drive efficiencies and improvements in “prehospital emergency care,” starting after the
patient first comes into contact with
emergency healthcare practitioners, mostly
ambulance paramedics. Appropriate prehospital emergency care administered before
and during transit to hospital greatly affects
the clinical outcome following a patient’s
arrival in the emergency department.
According to the “golden hour” principle, a
critically injured patient should be in
definitive care—an operating theatre—within
60 minutes of injury for optimal survival.
Prospects for survival are improved even
more if information about the inbound
patient’s condition can be sent in real time
from the ambulance to the hospital. This
helps emergency department clinicians to be
better prepared for the patient’s arrival.
In traditional paper-based systems,
carbonised standard forms are used by
paramedics to manually record patient
details and interventions administered during
the care episode. Where possible, this data is
written during transit, but it often involves
follow-up by paramedics where details are
incomplete. Originals of the forms are handed
to the emergency department upon patient
handover. At the end of the ambulance shift,
the copies are returned to the ambulance
depot, where they are aggregated for
electronic data entry either by scanning or
manual input.
This is often time-consuming and problematic
because of incomplete or inaccurate data,
illegible handwriting, or damaged forms.
When entered, the electronic data is used by
healthcare authorities for various analyses,
including healthcare service delivery,
ambulance deployment and operations, and
paramedic in-field experience. But the ability
to perform these analyses is dependent on
the timeliness, completeness, and accuracy
of the data originally recorded.
Among those healthcare organisations taking
a lead in the field of pre-hospital Electronic
Patient Care Reporting (ePCR) are the PreHospital Emergency Care Council (PHECC) in
Ireland and the Dubai Ambulance Centre
(DAC).
As the statutory regulator of pre-hospital
emergency care in Ireland, the PHECC has
commissioned the deployment of a
“ruggedised” mobile tablet PC solution. It
records and transmits pre-hospital
emergency care patient and incident data in
real time from point-of-patient contact to
emergency departments.
The solution uses standard public cellular
networks composed of a combination of
general packet radio services (GPRS) and
short message service. Most geographical
areas in Ireland have a reasonably good
global system for mobile communications
coverage, but GPRS is not universally
available. Also, there is currently no
countrywide data-transmission server for
emergency services, such as the Terrestrial
Trunked Radio (TETRA) system.
The PHECC also wanted an electronic
solution flexible enough to incorporate its
existing hard-copy Patient Care Report
standard dataset design and recording
system. Further requirements included the
ability to undertake detailed analyses and
evaluation of standardised data on prehospital emergency care practice, improving
patient care through the implementation of
best practice, competency monitoring, and
clinical audit.
Additionally, the PHECC also wished to ensure
the solution’s ease of use by paramedics to
facilitate enhanced care delivery during
patient transit, as well as to improve
professional development and job
satisfaction. The solution was also required to
be open-ended to facilitate interoperability
with third-party systems such as ambulance
Computer Aided Dispatch systems and
hospital Patient Administration Systems.
Similar considerations and requirements
existed for the DAC, which has commissioned
deployment of the solution across an
installed TETRA system used throughout the
emirates.
“We had a choice to use
open source
technologies, but,
because of the issues
surrounding future
development support,
cost, and easy
interoperability with
other systems, we opted
for Microsoft operating
systems.”
Peter Nelson, CEO, Valentia Technologies
Solution
Valentia Technologies, a Microsoft® Gold
Certified Partner and independent software
vendor (ISV), was a natural choice for the
PHECC and DAC because of its considerable
mobile healthcare experience. It has a strong
focus on using public mobile networks for the
transmission of clinical information.
Peter Nelson, Chief Executive Officer, Valentia
Technologies, says: “In addition to our mobile
technologies experience, we also have
healthcare informatics professionals with
considerable development experience with
mobile clinical applications.”
The Valentia Technologies ePCR system,
called the CareMonX ePCR Suite, is designed
on services-oriented architecture using the
C#® object oriented language, the Microsoft
.NET Framework version 3.0, Windows® XP,
Windows Server® 2003 for the back end,
Microsoft SQL Server™ 2005 as the
database, and Windows Mobile®.
“We had a choice to use open source
technologies, but, because of the issues
surrounding future development support,
cost, and easy interoperability with other
systems, we opted for Microsoft operating
systems and the .NET Framework,” Nelson
says. “Also, it was easier to support a tablet
PC environment with Microsoft as opposed to
other operating systems.”
The first users in the process are paramedics
who use either a mobile tablet PC or a digital
pen device to capture pre-hospital patent
care data into the system from the patient’s
side—whether roadside, in the ambulance, or
at the patient’s home or workplace. The data
is sent in real time to a central database in
the hospital and is immediately available to
other healthcare professionals. Data is also
provided for integration with the hospital
Patient Administration System through an
XML interface to ensure a seamless transfer
of patient information.
The Valentia Technologies ePCR system has
been designed to optimise accurate and
reliable data capture without compromising
care delivery. Ahmed Javad, Chief Operating
Officer, Valentia Technologies, says: “It also
offers an important additional care
dimension: real-time transmission of in-field
patient data to emergency departments,
thereby enhancing use of the ‘golden hour’
and improving the prioritisation of patient
management or triage. This extends the
continuum of care for patients.”
Robert Burke, Developer Evangelist,
Microsoft Ireland, says: “In addition to its
existing Windows XP-based production
version, Valentia Technologies has integrated
Windows Vista-era technologies into its
system to develop a new proof of concept for
its ePCR system. Running Windows Vista on
its mobile tablet PCs offers Valentia
Technologies immediate benefits for its prehospital patient care system, including
improvements to security, reliability, and
management. Its developers have used the
.NET Framework version 3.0 to visualise and
report emergency care information in much
richer ways. And innovative features of
Windows Vista have helped Valentia
Technologies to securely provide more
detailed, up-to-date information to in-field
paramedics.”
The rich functionality of Windows Vista offers
several advantages that enhance the value of
the solution, including its workflow integration
and graphical user interface, with its
transparency and capability for 3D
visualisation. Emergency care technicians
can indicate much richer information to
clinicians about a patient’s condition.
“With prior information
about patients, A&E
units can prepare
properly to meet the
special needs of any
patient and prioritise
patients correctly
depending on the
severity of their
symptoms.”
Peter Nelson, CEO, Valentia Technologies
Nelson says: “In addition to its ability to help
paramedics find and organise information,
we are equally impressed by the enhanced
security of Windows Vista. It provides new
techniques for protecting highly confidential
patient information in the mobile
environment, helps us to conform to strict
regulations, and even provides new
information to the mobile paramedic teams.”
Javad says: “The Windows BitLocker™ Drive
Encryption feature of Windows Vista helps
paramedics to secure the drives of the tablet
PCs. Additionally, through some fairly
innovative use of parental control and the
protection jointly provided by Internet
Explorer 7 and Windows Defender, we’ve
managed to open up the mobile Internet. In
the ambulances, paramedics can access
remote medical databases with Windows
Vista and go to certain Web sites securely.”
Nelson says: “Valentia Technologies also
integrates additional applications using
Windows Mobile devices. Among the most
innovative is a digital pen that writes normal
ink on paper while digitising written data and
images. Captured data is beamed to a
Bluetooth gateway in the ambulance through
a Windows Mobile device for real-time
transmission by GPRS to a central server.”
Benefits
The robust Microsoft operating system
ensures paramedics can communicate
patient care data seamlessly to a hospital
emergency department after making contact
with a casualty. Because clinicians have prior
information about incoming patients,
treatment can begin as soon as the patient
arrives.
Improved Patient Care in “Golden Hour”
The quality of patient care will improve in
Ireland and Dubai once the new mobile
solution for reporting patient data is
implemented in 2007. With the current
system, information entered on the paper
PCR is unavailable to the accident and
emergency (A&E) units in both countries until
patients arrive in their respective hospitals.
Nelson says: “With prior information about
patients, A&E units can prepare properly to
meet the special needs of any patient and
prioritise patients correctly depending on the
severity of their symptoms. This is essential in
critical cases, where optimum use of the
‘golden hour’ can massively boost the
chances of a patient surviving trauma.”
Reliable Transmission of Patient Data
By using Microsoft technology with tablet PCs,
the ambulance services have overcome many
of the challenges associated with real-time
data transfer. Valentia Technologies has
made negligible use of third-party tools, and
the development environment is 100 per
cent .NET technologies, ensuring high
reliability.
Nelson says: “Since the system was designed
to be used in the time-critical field of prehospital emergency care, it was essential it
run on a robust operating environment, with
Windows XP running the .NET Framework and
Windows Server 2003 as the server. Since
most users are familiar with Windows, less
familiarisation and training will be required.
The .NET Framework offers rich programming
tools, which were used to create a flexible,
secure, visually appealing system.”
Elimination of Paper-Based Systems
The new system will increase the timeliness
and accuracy of pre-hospital, emergency-care
data capture since each field on the tablet PC
or mobile device has built-in logic to ensure
paramedics enter relevant data every time.
“Paramedics can use
features of the system
to monitor their in-field
work experience for
continued professional
development purposes.”
Javad says: “Each field entry is checked to
ensure the data entered conforms with the
expected data format for that field. Use of
drop-down menus ensures hospital names
and station codes are entered correctly. Also,
any problems due to illegible handwriting by
paramedics are resolved. Any potential
increase in demands on the system can
easily be accommodated by the addition of
extra servers and modems, if required.”
This is especially important to the
government of Dubai, where the emirate’s
ambulance service is expanding to meet the
rapid growth of the city in recent years. The
government has developed a state-of-the-art,
140-bed trauma centre capable of handling
major medical emergencies not only in Dubai,
but throughout the United Arab Emirates.
Ahmed Javad, COO, Valentia Technologies
Improved Performance Management
The solution, driven by Windows XP, ensures
healthcare authorities can use recorded data
to generate reports, identify opportunities for
improvements in service quality, and
contribute to paramedic training and ongoing
professional development.
Javad says: “Paramedics can use features of
the system to monitor their in-field work
experience for continued professional
development purposes. This is made possible
by the workflow practices in Windows XP,
which can not only prompt actions, but also
monitor compliance in the ambulance. For
example, if a paramedic carries out a
particular procedure too slowly, the system
can flag up the need for further training.”
Extendibility for Joined-Up Services
The flexibility and interoperability of Microsoft
technologies is helping Valentia Technologies
develop further enhancements to the system.
Nelson says: “This includes closing the loop
between the ambulance control centre and
the pre-hospital emergency care
practitioners. This will see the automatic
populating of demographic and incident data
directly onto the tablet PC from the control
centre, giving paramedics more time to treat
patients.”
Valentia Technologies is also defining
standards to support integration by
ambulance computer aided dispatch systems
and with hospital PAS systems. There will also
be full integration with vital-signs monitoring
equipment in ambulances to create a
“wireless ambulance” environment.
For More Information
Windows Vista
For more information about Microsoft
products and services, call the Microsoft
Sales Information Center at (800) 4269400. In Canada, call the Microsoft
Canada Information Centre at (877) 5682495. Customers who are deaf or hard-ofhearing 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:
www.microsoft.com
Windows Vista can help your organisation use
information technology to gain a competitive
advantage in today’s new world of work. Your
people will be able to find and use
information more effectively. You will be able
to support your mobile work force with better
access to shared data and collaboration
tools. And your IT staff will have better tools
and technologies to enhance corporate IT
security, data protection, and more efficient
deployment and management.
For more information about Windows Vista,
go to:
www.microsoft.com/windowsvista
For more information about the Microsoft
Emerging Business Team and engagement
strategies for start-ups please visit
www.microsoftstartupzone.com.
For more information about Valentia
Technologies products and services, call
+353 1 493 7624 or visit the Web site at:
www.valentiatech.com
Software and Services

This case study is for informational purposes only. MICROSOFT
MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS
SUMMARY.
Document published February 2007
Microsoft Server Product Portfolio
− Windows Server 2003
− Microsoft SQL Server 2005

Windows Vista

Windows XP

2007 Microsoft Office System

Technologies
− Microsoft .NET Framework 3.0