Introduction
P. 1
Origin of the Healthcare Quality Improvement Campaign
P. 2
Healthcare Quality Improvement Campaign "Smart Care" Certification Marks and Awards description
P. 3
Chapter1 Smart Hospital Accreditation Marks
Contents
1. Linkou Chang Gung Memorial Hospital
P. 7
2. Taichung Veterans General Hospital
P.13
3. China Medical University Hospital
P.19
4. Mackay Memorial Hospital
P.25
5. Kaohsiung Chang Gung Memorial Hospital
P.31
Chapter2 Selected Prized Works of Smart Medical Treatment 1. Taipei Veterans General Hospital
P.39
2. Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
P.41
3. National Taiwan University Hospital
P.43
4. Shin Kong Wu Ho-Su Memorial Hospital
P.45
5. Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
P.47
6. Kaohsiung Medical University Chung-Ho Memorial Hospital
P.49
7. Chi Mei Hospital 8. Kaohsiung Veterans General Hospital 9. Yuanlin Christian Hospital 10. Taipei Medical University Hospital 11. Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
P.51 P.53 P.55 P.57 P.59
Introduction The Joint Commission of Taiwan (JCT) is an organization that was jointly funded and established in 1999 by the Ministry of Health and Welfare, Taiwan Hospital Association, Taiwan Nongovernmental Hospitals & Clinics Association, and Taiwan Medical Association. Trusted by society for its rigorousness, integrity, and neutrality in conducting accreditations, certifications, and on-site inspection activities, the JCT has become a professional accrediting organization certified by the International Society for Quality in Health Care Ltd. (ISQua). Committed to promoting quality and patient safety concepts, the use of quality management tools, and medical staff training, the JCT has built a resource sharing platform with medical partners, delivering excellent healthcare values and encouraging institutions to persevere with healthcare quality improvements, with the aim of jointly promoting the health and well-being of the people. In recent years, in light of medical technology advances, an increased complexity of disease types, and staff shortages in the medical profession, medical institutions have been gradually utilizing information technology (IT) to assist business, in order to improve efficiency and safety and reduce errors. These IT-based innovations are collectively termed “smart care.” In 2013, the JCT began the “Smart Hospital Simulation Challenge,” a competition to recognize outstanding implementations of smart care technology in hospitals. The hope was that selecting outstanding medical intelligence cases through contests would serve as an aspirational benchmark for medical institutions and motivate technology companies to team up with medical institutions to enhance medical efficiency, quality, and create industrial value.
In 2014 and 2015, a “Smart Care” category and an “Industrial Application” group were respectively added to the Healthcare Quality Improvement Campaign, with a total of 255 information cases submitted by medical institutions and firms to date. The competition has been held for four years, and to date 341 entries across 63 institutions (including medical institutions and IT industry vendors) have participated. Not only have smart medical care certification marks and prizes been awarded for excellent entries but also Smart Hospital certifications have been bestowed according to hospitals’ overall performance, all with the goal of encouraging the comprehensive development of smart technology in hospitals. As of now, there are five medical institutions that have been certified as a "Smart Hospital" throughout the nation. The contest in the Smart Care category not only selects quality smart medical services, but also publicizes excellent MIT health service information solutions. Award-winning cases from 2013 to 2016 were collected in the “Smart Care” category from the medical institutions’ group so that people can see real-world examples of innovative and successful applications of information technology to boost the efficiency, quality, and value of medical services.
Origin of the Healthcare Quality Improvement Campaign Since 2000, the JCT has promoted the Healthcare Quality Improvement Circle (HQIC) Publication and Competition campaign, with the initial focus on HQIC. This campaign encourages frontline medical staff to form a team, select a quality improvement theme, and using the PDCA management cycle as a basis, make continuous improvements through the power of teamwork, big data, and statistics. Based on the notion that quality improvement should entail diverse quality management methods, in 2002, the contest’s third year, quality improvement entries from non-HQICs were invited to participate in the contest. In order to encourage the medical profession to break departmentalism within the unit or professional field, the event scope has been expanding since 2006 (the 7th year), when the competition’s name changed to the Comprehensive Medical Quality Improvement Competition” to better reflect its goals of promoting integrated holistic care, patient safety, evidence-based medicine, and other related issues. The competition structure was readjusted in 2007 (the 8th year), and divided into three categories: themes, systems, and evidencebased medicine. In 2008 (the 9th year), the activity was renamed the Healthcare Quality Improvement Campaign (HQIC) in the expectation of recapturing the original spirit of “continuous improvement,” “management cycle," and "teamwork" for medical quality improvement. To encourage medical institutions, clinics, health centers, and long-term care institutions with a total of 99 beds or fewer each to join the campaign, a Community Healthcare group was added to the Theme category beginning in 2011 (the 12th year).
Furthermore, in 2013 (the 14th year), a Simulated Situation category was added to the contest in an attempt to motivate medical institutions to use simulationbased training to strengthen collaboration and communication skills among medical teams. In 2014 (the 15th year), a “Smart Care” category was listed as a fifth competition category in a bid to enhance the application of information technology within medical institutions. With a view to encouraging newly-recruited medical staff in training to participate in the quality campaign, during the event’s 15th year, a Literature Review Rookie group was added to the Evidence-based Medicine category and an Intensive Care Rookie group was added to the Simulated Situation category. In addition, to stimulate domestic institutions or units to improve medical quality and develop excellent and special medical services through innovative research and development, as of 2016 (the 17th year), a Centers of Excellence group and a Community Organizations of Excellence group were set up in the Systems category. Throughout the 17 years of the campaign, the Continuous Quality Improvement Award, the Innovation Award, the Human Factors Award, and the Happy Workplace Award have been awarded annually without interruption to encourage the medical profession to engage in continuous quality improvement and creative thinking. For the purpose of expanding participation in the competition, the JCT from 2013 (the 13th year) began holding the Cross-strait Medical Quality Promotion and Exchange Competition with the intention of motivating more institutions to continuously carry out quality improvement and benchmarking to achieve the goal of improving medical quality.
- Joint Commission of Taiwan About the 18th Annual Healthcare Quality Improvement Campaign
2017 Clinical Applications of Smart Medical Technology
Healthcare Quality Improvement Campaign "Smart Care" category marks and awards description
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Healthcare Quality Improvement Campaign "Smart Care" Category Certification Marks and Awards Description The competition’s Smart Care category is divided into "medical institutions" and "industrial applications” groups
1. Certification Mark design concept The “S”stands for Smart. The “arrow up on the right” indicates consistent new energy entering the medical industry, with continuously improving smart care for a virtuous circle.
2. Certification Marks and awards for the medical institutions’ group (1) The medical institutions’ group is classified into six major areas, with these areas and marks listed as follows:
Area 1
Outpatient and emergency services
2
In-patient services
3
Community health (including long-term care)
Mark
Smart care：
Smart Research： 4
Teaching & research
5
Administrative management
6
Environmental treatment
Smart Management：
(3) Smart Hospital Certification Mark Eligibility for awards
Mark
The institutions which have met initial requirements for the Smart Hospital mark will be allowed to apply for an on-site review early the following year, with the winner awarded the Smart Hospital mark.
3.The Certification Mark for the Industrial Applications group (1) Enterprises, hospitals and schools that have ever developed medical products may sign up for the contest if the entry has met all of the following conditions: 1. It is an innovative product, service, or holistic solution for smart medical care. 2. It involves practical testing or user experience in medical care or health management. 3. It is potentially commercializable. Note: "Product" includes services or solutions.
(2) Awards: The gold, silver, bronze, and marks are awarded to competitors who have passed Stage 2.
Healthcare Quality Improvement Campaign "Smart Care" category marks and awards description
(2) Awards : 1. Certification Marks: the smart marks in each category are awarded to competitors who have been chosen for and passed Stage 2, an oral presentation. 2. The gold, silver, bronze, and masterpiece are awarded to competitors who have passed Stage 3, an on-site review.
2017 Clinical Applications of Smart Medical Technology
Chapter 1 Smart Hospital Accreditation Marks 7
Linkou Chang Gung Memorial Hospital About the hospital
TEL:+886-3-3281200
Linkou Chang Gung Memorial Hospital since its inception has adhered to three principles, “human-centered care,","patient first," and "affordable medical care.” The spirit of these principles have been applied to provide high-quality medical treatment of patients as a priority. The hospital holds that providing good service means more than just having friendly and patient medical staff; hospital administration, registration, and medical records policies are integrated so as to promote the convenience of medical treatment. When implementing processes and systems, the hospital incorporates "patient first" service into the process or systems’ design. The hospital offers affordable services based on the ideals of diligence and simplicity. It also strives to improve medical quality, such as by introducing a PET-CT scanner, an X-ray angiography system, a brain surgery navigation system, and other stateof the-art devices. In recent years, the hospital has invested in the establishment of the first proton therapy center in Taiwan which will provide the most advanced radiation therapy services for cancer patients. Looking to the future, Linkou Chang Gung Memorial Hospital will uphold the spirit of "absolute perfection" advocated by its founder Mr. Wang by continuously innovating and improving quality. The hospital is forever committed to do its best to serve society and promote the health and welfare of people.
Award-winning Projects The hospital is the first in the nation to receive the "Smart Hospitalcertification mark" Award-winning projects are listed as follows: 1. Electronic interdisciplinary safe blood transfusion system (developed by the hospital) 2. All-in-one integrated smart inspection services (developed by the hospital) 3. Management of acute cerebral apoplexy care indicators with cerebral apoplexy data entered in the information system (developed by the hospital) 4. Application of a mobile healthcare app in healthcare systems (jointly developed by the hospital and the Industrial Technology Research Institute) 5. M e d i c a l s t u d e n t s a n d r e s i d e n t s knowledge and skills documentation information system (developed by the hospital) 6. Convenient and safe multiple payment methods (developed by the hospital)
Experience sharing and implementation results 1. Electronic interdisciplinary blood transfusions safety information system
The hospital is a tertiary medical center that treats severe and complex diseases. In order to treat many of these diseases, doctors need blood to be available for transfusion at any time in response to medical treatment or changes in patients’ conditions. Up to 80,000 blood-related products and 300,000 units of blood are transfused every year. Therefore, we comprehensively examined the critical risk points during the blood transfusion process. We referred to international research literature on improving blood transfusion safety, continued to leverage computer information technology, and built an electronic interdisciplinary safe blood transfusion operating system for preventing mistakes during blood transfusions. The system also standardizes the transfusion process and information-sharing so as to overall improve the safety of blood transfusion, through interdisciplinary and cross-hospital information integration.
Figure 1. Critical risk points during blood transfusions
Figure 3. Effects of the blood transfusion safety information system
Linkou Chang Gung Memorial Hospital
(7) I n n o v a t i v e s m a r t b l o o d t y p e examination and interpretation systems Effective integration into medical (8) information systems
Figure2. E-framework and strategy for an interdisciplinary blood transfusions safety information system
Implementation and effectiveness :
(1) Use of an electronic identification system to reduce human error rates during blood transfusions. (2) Complete establishment of a database of blood subtypes and specific antibodies. (3) Integration of cross-hospital, crossplatform file blood types for effective cost savings. (4) Use of the blood transfusion medical assistance system to provide complete information about doctors’ blood transfusion strategies. (5) Improvement of blood transfusion reaction response rates as a result of immediate warnings. More thorough investigations of blood transfusion reactions. (6) D e c r e a s e d i n c i d e n c e o f b l o o d transfusion reactions.
Figure4. Effects of the blood transfusion safety information system
2. All-in-one integrated smart inspection services Diverse healthcare processes were integrated into one centralized place. Integrated items included scheduling patient appointments and procedures, prescriptions, patient identification operations, radiopharmacy receiving materials,dispensing of medicines, and patient medical records. Centralized and streamlined operations helped to increase the safety of the use of radioactive drugs and the accuracy of medical tests and exams. These changes also boosted efficiency and reduced patients ' wait times.
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Implementation Details and Outcomes (1) Three-in-one confirmation with zero errors: patients (including scheduling and examination history and records), prescriptions (verifying prescriptions), and radioactive drugs (radiopharmacy receiving materials and medication dispensing, and injections verification)
Figure 5. Dispensing radioactive drugs
Figure 6. Scanning a drug label
In an effort to treat acute ischemic stroke immediately, the hospital monitors the time it takes to administer intravenous thrombolysis agent therapy and has used its information system to minimize the time to treatment with rt-PA for acute ischemic stroke. A decision support rule built into the EHR that tells doctors when rt-PA should be administered and can determine any absolute contraindications can improve medical quality and safety for patients with acute ischemic stroke. Recovery rates and quality of sensory and motor functions after acute ischemic stroke were better after implementation of this decision support tool. Implementation Details and Outcomes: (1) When a patient is rushed to the emergency room with suspected acute ischemic stroke, the rt-PA reminder system is launched immediately. (2) A rt-PA administration time reminder is generated to notify physicians when the ideal 60-minute window for giving thrombolytic therapy to the patient ends. (3) The result has been that the entire medical team, from the ER nurses, to the ER physicians, to the specialists, are all immediately aware of the time remaining to give thrombolytic therapy and all on the same page because of this reminder system.
Figure 7. Screenshot of Scanning a Radioactive Drug
(2) The establishment of the integrated smart inspection service system enhanced medication safety and patient identification, with zero-errors so far.
3. Management of acute ischemic stroke care indicators with stroke data entered in the information system 9
Figure 8 Emergency rt-PA information system mechanisms
Since 2009, the hospital has actively pushed child-friendly healthcare, which refers to providing a friendly and safe environment for hospitalized children. A user-friendly mobile healthcare app on a tablet computer has been introduced featuring a cartoon character named Sasemi (the name is derived from a similar pronunciation of thalassemia). The app makes good use of text, sound, pictures, animations, films, and other multimedia. Given childrens’ affinity for games and role-playing (playing house), children watch cartoons and educational videos. They also engage in interactive Q&A programs that can increase childrens’ self-control, decrease hospitalization anxiety, enhance cooperation with invasive therapy, improve treatment compliance, and give them a positive impression towards medical care. Environmental guidance, pain expression, nursing instruction, bookcases, and home health management (see Figure 9) were tailored to be ageappropriate for children.
(2) Alleviated anxiety in children with upcoming transplant surgery, improved their cooperation and compliance. Every child was educated with the app. Home care skills for sick children increased from 35% to 85%. Number of home consult calls after discharge from the hospital decreased from 22 to 6 times per week. (3) C h i l d r e n a n d t h e i r f a m i l y ’ s satisfaction with the medical team increased to more than 90%. (4) The hospital received the 2013 gold award in the nursing care category from the Institute for Biotechnology and Medicine Industry (IBMI) for fulltime care of children with severe thalassemia who have undergone umbilical cord blood transplantation. (5) Transplantation cases ranged from Malaysia, China, Vietnam, and India, bolstering Taiwan’s international healthcare reputation.
Linkou Chang Gung Memorial Hospital
4. A p p l i c a t i o n o f a m o b i l e healthcare app within healthcare systems
5. Medical students and residents knowledge and skills documentation information system Digital medical education training can deliver interactive content that can speed up the rate and effectiveness of learning the skills necessary to become a physician.
Figure9 .Mobile healthcare app care features
Implementation Details and Outcomes (1) Enhanced the effectiveness of pain management. The cartoon app interface and interactive films successfully attracted children’s attention and increased their concentration, reducing pain assessment time from 15 minutes to 4 minutes.
Figure10 . A Diversified Mobile Platform Without the Limitations of Time and Space
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Implementation and effectiveness: (1) Constructed an e-learning database for providing guidance to teachers and students. (2) Integrated various clinical scoring tool system modules and linked them to e-learning platforms. (3) Tracked students’ learning progress (4) Using the interactive teaching platform, teachers gave students feedback in real-time
(5) I m p r o v e d t r a i n i n g i n t e g r i t y a n d immediate feedback rates, as well as increased training progress rates and overall training satisfaction. (6) Lowered manpower costs for training physicians.
Figure 11.Skills Completion Progress Chart for a Sample Student
Figure 12. E-learning Training Schedule
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The hospital discovered that patients desired more convenient and flexible ways of paying for medical services. To meet this need, the following payment methods were introduced.
(1) Outpatient :
The hospital installed payment kiosks to provide patients with a fast and convenient way to pay their clinic bills. In addition, an outpatient expenses payment feature was added to the hospital’s app, “Chang Gung E-click”. Morever, bill payment services at convenience stores were begun for patients who were not near the hospital, thereby reducing wasted travel time and transportation costs. The hospital even added the option to pay bills via one’s MRT EasyCard, a decision that has proven to be extremely popular.
(2) Inpatient
Point-of-service (POS) ATM card payment services were added at the nursing station for each ward, so patients do not need to carry large
amounts of cash nor do they need to go to the counter for payment; an ACH automatic transfer service (ATS) was provided for making recurring payments for nursing home patients, for example. service (ATS) is provided for longterm payment needs of nursing home patients. Implementation effectiveness : (1) For the hospital: reduces the frequency of getting counterfeit notes, cash storage and delivery risks, overand underpayment incidence, petty cash exchange, time and work spent on manual collection of fees and reconciliation. (2) For the public: mitigates the risk of loss or theft of cash and avoids injuries due to overcrowding. (3) For patients: lowered the wait times at cashiers and registration counter by three seconds, adding up to 120,000 hours of time saved per year. (4) The self-service feature can increase the flexibility for staff scheduling and lessen the burden on front desk clerks.
Linkou Chang Gung Memorial Hospital
6. Convenient and Secure Multiple Payment Methods
Figure 13 Multiple Payment Methods—a Self-Service Payment Kiosk
Cooperative Company
Industrial Technology Research Institute (mobile healthcare app) Website：https://www.itri.org.tw/
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Chapter 1 Smart Hospital Accreditation Marks
Taichung Veterans General Hospital About the hospital
TEL:+886-4-23592525
In line with national policy on providing medical care and conducting teaching and research for veterans and their dependents, the Veterans Affairs Council (VAC) with approval by the Executive Yuan on July 1, 1982 established “Veterans General Hospital Taichung Branch.” The hospital opened on September 16, 1982. The hospital was upgraded and changed its named to “Taichung Veterans General Hospital” on July 11, 1988. Since its inception, the hospital has been guided by excellent leaders, including former VAC chairperson Mr. Chao Chu-yu and former hospital supervisor Mr. Lo Kuang-jui. In 1984, the hospital was accredited as a "First Class Teaching Hospital" and in 1988 was named a “Would-Be Medical Center.” Eventually the hospital was recognized as a "Medical Center and Class I Teaching Hospital.” In 2007 and 2011, the hospital was certified with the “New Hospital Accreditation and Teaching Hospital Accreditation.” Composed of 1,534 beds with 6,000 daily outpatient visits, the hospital focuses mainly on acute and severe disease, providing the public with safe, friendly, and high-quality medical services. In addition, the hospital offers a high-quality teaching and training environment, conducts outstanding medical research, and remains devoted to its mission to serve as a “Health Guardian” for the public. ● Mission: to pursue excellence in medical care, teaching, and research to promote the health of veterans, the general public, and all mankind. ● Vision: to wisely treat patients using a holistic medical model. ● Core values: compassion, quality, innovation, and accountability
Award-winning Projects 1. A Smart, Cloud-based Medication Reconciliation System “Medication reconciliation” is the process of verifying which medications a patient should be taking at a point in time. This means synchronizing the medications list with medications at home, medications received in the clinic, in the hospital, and from any other sources such as local pharmacies. This process is needed so as to avoid drug omission, duplication, and negative drug interactions. Medication reconciliation is also an annual measure of medical quality and safety as set by the Ministry of Health and Welfare. The hospital built a smart patient medication reconciliation decision support information platform that was integrated with the National Health Insurance Administration’s (NHIA) PharmaCloud system, the Food and Drug Administration’s drug pharmacological classification ATC code data sets, and the hospital’s own medication reconciliation database. When seeing a doctor, patients are asked for authorization to use their medication records. With automatic medication record downloads, inspections, and comparisons, the patient's medication list is presented on a timeline arranged by drug type and date. Medical use history and the number of days remaining before the next refill can also be shown. This visualization tool provides a simple way for doctors, pharmacists, and nurse to communicate as well as actively notify each other of duplicated medications and drug interactions both inside and outside 13
Experience sharing and implementation results
Create new values of the PharmaCloud system 1. Purposes The PharmaCloud system provided by the National Health Insurance Administration (NHIA) allows for convenient access to a patient’s complete patient medication information and promotes patient-centered medicine reconciliation in collaboration with clinicians, pharmacists, nursing staff, information and medical management personnel. The medication reconciliation process is outlined in (Figure 1).
Taichung Veterans General Hospital
of the hospital. At present, the medication reconciliation system has been used more than 20,445 times and has helped protect patients. PharmaCloud data is downloaded and presented in a time line, and detailed drug information is available for each drug. The Pharmacloud system is embedded directly inside EHR for convenience. The hospital will continue to develop the system and expand it out into surrounding communities in order to increase medication safety.
Figure1. Medication reconciliation decision support information platform functional chart
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2. System Features
1. A Nationally Searchable Medication History Function The inter-hospital medication history is presented completely on a time line using clear, proven visualization techniques. The data is sourced from the NHIA PharmaCloud system (Figure 2 ) . T h e m ed i c at ion s a re a rra n ged according by type and time and presents the dispensing organization and other ancillary information in different colors (e.g., the hospital, other hospitals, time of use, days left before refill). Patient medication history is clear at a glance, allowing medical staff to quickly grasp the patient’s medication situation at home before hospitalization, for the purpose of more effective information communication. The timeline interface provides smart and convenient links to hospital drug handbooks, literature database (Uptodate), Ministry of Health and Welfare Food and Drug Administration package inserts, and drug appearance databases for users to conduct a quick search. Information from the outpatient, emergency, inpatient wards, and hospital pharmacy and other hospitals are consolidated on the same page (Figure 3).
Figure2. Patients'medication history is presented in a time line
Figure3. Patient medication time lines
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(2) A two-way communication platform for pharmacists’ evaluations and physicians ' replies
The medication reconciliation decision support information platform should support inpatient process reengineering and provide the following innovative services and functions: (1) Medication reconciliation before hospitalization The pharmacist records the patient's medication before registration for hospitalization via the PharmaCloud system and faceto-face consultation. A medication reconciliation interface is set up where pharmacists can quickly select, make notes and evaluations via a user interface. Then, clearly presented medication reconciliation records are used as a reference for physicians to prescribe drugs in the medications order entry system. After the patient is hospitalized, medication reconciliation and follow-up are conducted to evaluate the consistency and integrity of the prescriptions before and after hospitalization (Figure 4).
After the pharmacist's reviews medications ordered, the system automatically suggests corrections for prescriptions if there are medication-related problems. The system automatically sends text messages to healthcare team physicians and nursing stations for automatic printing and puts these notifications in the medical order system, which allows prescribing physicians to review changes. (3) Automatic screening of high-risk inpatients, with pharmacists offering drug evaluations The system performs daily 3. automatic screening of high-risk groups that require medication reconciliation, assisting pharmacists by proactively evaluating drugs and making recommendations.
Taichung Veterans General Hospital
2. Network interactive platform for medical, pharmaceutical, and nursing divisions
Outpatient medication reconciliation process reengineering Outpatient medical practice combined with the PharmaCloud system: after the patient registers at the clinic, when the patient’s IC Card and the doctor’s personnel card are inserted, the system will automatically check the patient's consent form, if any, the "batch download value-added application" will be launched to provide doctors with the PharmaCloud time-line. This allows the doctor to look for duplicate medications and check for drug-drug interactions.
Figure 4 Medication reconciliation record interface
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Results
Figure5. List of patient medication
(1) Automatically load PharmaCloud inside the EHR (Figure 5). (2) I n t e l l i g e n t l y s c r e e n h i g h - r i s k outpatients with the medication reconciliation system. Provide multiple medication (3) reconciliation in combination with the case manager. (4) This is the first system that searches for drug interactions and duplicate medications across the entire nation. Medication reconciliation is done based on a drug-drug interactions database. The system gets gets 1306 pairs of interaction rules by making comparisons between ingredient codes (6,790 items) of existing domestic drugs (50,068 types). The database is updated in real time, accurately comparing drug interactions and displaying alerts, with the aim of improving medication safety.
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Taichung Veterans General Hospital has also opened up its medication reconciliation system to its Chiayi and Puli (see Figure 6 for the structure chart). The branch sends patients' consent forms to the general hospital, which then assists in downloading and returning the data to the branch. This model can be extended to the 25 network hospitals contracted with the hospital. Moreover, the medication timeline visualization used by the system will be rolled out by the National Health Insurance Administration for use by all contracted healthcare providers in Taiwan.
Figure 6 Scalability of the Medication reconciliation decision support information platform
1. Medication reconciliation: from Sep. 2014 through Dec. 2016, the hospital was the first in the nation to provide pharmacists with pre-hospitalization medication reconciliation for inpatients. The system was used an average of 454.3 persontimes per month and reconciled 481.2 medications during hospitalization. The number of dubious prescriptions averaged 38.8 per month. Physicians accepted the system’s recommendations 70.8% of the time in 2014, 82.4% of the time in 2015, and 84.7% of the time in 2016. 2. System warnings: in 2015 the hospital set up an interdepartmental duplicate medication and interactions comparison system, alerting physicians every month when prescriptions were duplicated. Over 10,000 duplicate medication alerts and 2,000 drug-drug interaction alerts were sent. The rate of duplicate medications for hypertension, hyperlipidemia, and diabetes dropped more than 50%.
Taichung Veterans General Hospital
The benefits of the PharmaCloud-based medication reconciliation system at the VA hospital
3. Duplicate medications decreased significantly (hypotensive drugs down 56.31%; hypoglycemic drugs down 50.63%; hypolipidemic agents down 55.38%; hypnotics down 28.80%; antipsychotic drugs down 26.51%; antidepressants down 26.03%). 4. Recognition from outside the hospital: the hospital won first place at the Ministry of Health and Welfare’s PharmaCloud system application and creation competition, received the JCT smart hospital competition’s top honor and government service quality award, and was recognized in the Healthcare Quality Improvement Campaign. 5. The medication timeline visualization concept will be rolled out by the National Health Insurance Administration to all medical institutions in Taiwan.
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China Medical University Hospital About the hospital
TEL:+886-4-22052121
Founded in 1980, China Medical University Hospital (CMUH) is Taiwan’s first medical center that combines Chinese medicine and Western medicine. With more than 2,000 rooms, CMUH passed the international medical assessment conducted by the JCI in 2010 and in 2014 and has been recognized as one of the best medical centers in Taiwan in terms of quality of service and quality of equipment. Upholding its core values of being employee-oriented and patient-focused , CMUH has developed a corporate culture of pursuing excellence, efficiency, and humanity in the hope of building a world-class medical center in both Chinese and Western medicine. In recent years, CMUH has moved towards becoming a comprehensive smart hospital by integrating medical care and administration with information technology. Using a comprehensive electronic medical records system, a mobile ward management app, and a patient-facing health portal app, CMUH offers patients continuous care before, during, and after hospitalization. For its achievements in electronic medical records, CMUH has been awarded both a Gold Award and Silver Award by Ministry of Health and Welfare. CMUH also leads the industry by promoting digital signatures for medical consent forms , and the entire hospital plans to go completely paperless by 2017.
Award-winning Projects In recent years, CMUH has drawn a Smart Hospital Information Roadmap and implemented a variety of mobile applications. CMUH won 9 marks across 5 fields in the Smart Hospital category of the 2015 Healthcare Quality Improvement Campaign (HQIC). It was also awarded the Annual Smart Hospital award. In 2016, CMUH won the Gold Award, the Bronze Award, the Merit, and APP Special Award, making it the only hospital that has won the award for two consecutive years. In particular, the CMUH APP, Smart Ward Care, and Smart Health Education Platform were awarded with the APP Special Award, Gold Award, and Bronze Award & Potential Award, respectively. Smart Application
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Features
CMUH APP (2015 Special Award)
Patient appointment reminders, Health Calendar, Patient Participation, Personalized Service, Automated Procedures, Questionnaire Evaluation, and Family Assistance.
Smart Ward Care (2016 Gold Award)
Hospitalization Calendar, Medical Instructions, My Medication and Health Data, Environmental Control, Purchase of Health Equipment and Meal Orders, Contact with Nurses, Recommendations for Health Education, and an Electronic Whiteboard.
Smart Health Education Platform (2016 Bronze Award & Potential Award)
Interactive Information on Health Education and Care before, during, and after Hospitalization; Integrated Health Education Resources, and OnPremise and Cloud Platforms of Health Education Resources
Upholding a patient-focused business philosophy, CMUH offers patients comprehensive medical care and health education before, during, and after hospitalization. Three achievements are described as follows :
1. CMUH APP The comprehensive smart clinical service allows patients to keep a record of health at home before hospitalization. During hospitalization, the record will be integrated with the hospital’s EHR to help doctors understand patients’ health at home. A mobile health management platform offers patients complete and real-time information on medical diagnosis, treatment, and medication after hospitalization. Each function is described as follows : (1) Real-time Patient Appointments : To avoid long wait times, patients may check the queue and clinical information instantly via the APP and set push notifications. In case of any changes in the surgery process. (2) Health Calendar: The calendar contains the schedule of outpatient services, examinations, surgery, and medication refills schedule for chronic diseases. It will send a push notification a day before and the morning of. Locations of examinations, health education, and instructions for surgery or anesthesia are available for inquiries in the calendar.
(3) P a t i e n t P a r t i c i p a t i o n a n d Questionnaire Evaluation : Patients can record their health status, including self-description, blood pressure, heartrate , blood glucose, height and weight, BMI, initial assessment, cancer screening questionnaire, pre-anesthesia assessment, and peritoneal dialysis log at home using the APP. During a clinic visit, the data will be uploaded to the hospital’s medical system to help doctors have a full understanding of patients’ health status. (4) Automated Procedures: At the hospital, automated blood pressure, heartrate, height, weight measuring devices are offered. To manage health subsequently, patients can upload their data to the EHR and Healthcare Manager via IC card or QRcode.
China Medical University Hospital
Experience sharing and implementation results
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2017 Clinical Applications of Smart Medical Technology
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(5) Personalized Services : 1. M y M e d i c a t i o n s ( C h i n e s e a n d Western medicine): Information on medication, such as ingredients, appearance, indications, administration, side effects, taboos, principles of storage, and instructions for use, is provided for users to understand the administration and safety of medicine. 2. My Examinations: Patients can search for the exam results and view trends for a better understanding of their health status. 3. My Health Education: A variety of health education videos and documents are offered for quick inquiries. Patients may add them to their favorites list based on their diagnosis or push notification preferences. (6) Family Assistance : For those who are unable to operate smartphones by themselves, such as seniors and children, they can authorize or set a list of family dependents via APP to receive a reminder for registration, medication, health education, medical treatment, and health examination on their behalf.
2. Smart Ward Care
Patient-focused smart wards are built to offer inpatient services integrated into tablets. The medical information system, the dosage checkup system, the video and communication system, and the health education video streaming system are integrated with mobile devices, wireless health measurement devices, the energysaving and environmental control system, electronic head cards, and electronic whiteboards to offer comprehensive smart ward care. Each function is described as follows :
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(1) Hospitalization Calendar and Medical Instructions: Combining information on the doctor's advice, examination, and surgery, a graphic calendar is easy to read and inquire instantly by patients. Instructions are also connected for patients and family dependents' repeated access. (2) My Medication : The medicine visual identification system allows patients to check their medicine by picture and barcode and to understand the purpose of their medicine and any side effects. This frees up the pharmacists and nurses and improves medication safety. (3) Environmental Control: Based on the concept of a green building, wards are equipped with energy-saving lights, digital temperature control, and
(6) Bedside Medicine : The instrument data network (blood pressure, blood oxygen, blood glucose, body temperature, and electrocardiogram) uploads the data directly to hospital information system and the nursing information system without manual input, which saves time and reduces data entry errors. Patients and doctors receive the results of measurements in realtime, which facilitates two-way communication instantly and further improves patients’ awareness and promotes self-care. (7) Electronic Whiteboard : The digital ward management system clearly labels ten common precautions that need to be taken for patients (bed isolation and the reason, critical illness, high fall risk, DNR, surgery, examination, dialysis, and risk of suicide) and visually depicts the entire flow of patients within the ward. (8) Electronic Signature of Consent : After doctors explain the reasons and risks and benefits of surgery and other examinations to patients, patients sign electronic informed consent forms by tablet, eliminating a significant source of paper waste for the hospital.paperless medical records across the hospital.
China Medical University Hospital
window control panels, creating a comfortable, energy-saving, and cost-effective environment. Six models of lights are offered. Patients can switch their preferred lighting at the touch of a button. (4) Health Education Resources : Personalized health education videos are selected automatically based on the patient’s reason for hospitalization. Through push notifications, information from the tablet can be transmitted to the digital TV in the ward. The administrator can record the time of access to the videos to understand how much the patient has learned about their diagnosis and tailor discussions appropriately. (5) Contact with Nurses : Pictures of common needs (such as adding drips, feeling pain, and replacing sheets) are set on the tablet. If a patient need a nurse’s assistance, the request will be transmitted to the responsible nurse’s mobile phone directly; patients may also talk to nurses directly by tablet, which improves communication and saves time. communication and saves time efficiently.
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Chapter 1 Smart Hospital Accreditation Marks 23
3. S m a r t H e a l t h E d u c a t i o n Platform The hospital has set up a patientfocused mobile learning platform that contains electronic health education, health knowledge, an integrated database, websites, and APP. To understand the needs of patients, the hospital also collects their feedback through various social media sites and has further developed a mobile learning platform in line with patients’ expectations. Each function is described as follows: (1) Professional Knowledge : The medical professionals of the hospital summarize the contents of current advance in medical care as well as write new articles about health knowledge. These contents and articles are digitalized and classified within the smart health education platform. (2) Comprehensive Health Education : Patients are privately provided health knowledge before, during, and after visits based on the procedures for visits.
(3) Mobile Learning on the Go : Patients are able to receive health education and health knowledge by mobile devices, such as mobile phone, APP, tablet, electronic signage, and guide, inside and outside the hospital.ion Resources : A variety of health education resources are offered, including nearly 4,000 articles, 500 videos, and 700 pictures. (4) Diverse Health Education Resources: A variety of health education resources are offered, including nearly 4,000 articles, 500 videos, and 700 pictures. (5) Personal and Group Health Education: Personalized health education is offered by CMUH APP based on the patient’s diagnosis. An exclusive APP was also designed to meet the needs of different groups, such as children, seniors, eye care, the overweight, and those in labor. (6) Consultations via Social Media : Patients can view videos and articles about health education and share them with family members. They can also interact with nurses via YouTube, Line@ and Facebook. As of today, there have been 210,000 clicks on YouTube, 3,120,000 clicks on health education videos, 27,000 people on FB per month, and 19,000 people on Line per month.
China Medical University Hospital
(7) Integrated Resources : Health education resources are integrated with the medical system and broadcast in the lobby, in smart wards, via mobile phone (mobile leaflets), and on social media platforms for patients to access at any time.
Smart applications of the hospital are all built to offer patient-focused medical services. In addition to complete care inside the hospital, records of health status at home are integrated with the hospital’s medical system, allowing patients to receive medical service nonstop regardless of time and location, further improving the quality of medical service.
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2017 Clinical Applications of Smart Medical Technology
Chapter 1 Smart Hospital Accreditation Marks
Mackay Memorial Hospital About the hospital
TEL:+886-2-25433535
In recent years, Mackay Memorial Hospital (M.M.H.) has faced an increasing complex medical environment, lack of resources and increasing demand, and an aging population. With the introduction of new technology, M.M.H. has adopted ICT to improve patients’ safety, quality of medical service, and operating efficiency, transforming itself into a smart hospital that offers new value. M.M.H. offers patients holistic treatment based on a cross-disciplinary care team and strives for safe and quality medical care. Resources are integrated and gradually spread to communities, remote areas, offshore or international regions; high-end medical lean production is also introduced and combined with cloud information to improve the efficiency and capacity of medical services. All of these achievements have been highly praised.
Figure 1. M.M.H. Smart Hospital Mark
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Since 2013, M.M.H. has participated in the Healthcare Quality Improvement Campaign (HQIC) organized by the Joint Commission of Taiwan (the JCT). In 2016, among 21 participants, M.M.H. won 7 marks across 5 fields in the HQIC and was awarded the Smart Hospital Mark (see Figure 1). The award-winning project (see Figure 2) contains the “High-alarm/High-risk Medication Reminder System” and “Nursing Aids Shift System” in the field of medical care; the “Wiki Platform” in the field of quality indicators; the “Cloudbased Decision-making Support System” in the field of cost-effectiveness; the “Medical Education Platform” in the field of research and teaching; and the “Medical Equipment Maintenance APP” and the “Doctor-on-duty Notification System” in the field of integrated projects/administration in the HQIC organized by the JCT.
Mackay Memorial Hospital
Award-winning Projects
Figure 2. M.M.H. Smart Hospital Mark Award-winning Project
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2017 Clinical Applications of Smart Medical Technology
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Experience sharing and implementation results 1. Improving the safety of medication - High-alarm/High-risk Medication Reminder System Developed by the Information Office of M.M.H. using NB.NET and ORACLE9i, the High-alarm/High-risk Medication Reminder System combines the existing BCMA, a medicine dispensation system, and links with LIS to offer up-to-date information at any time. Achievements and Evaluation: Increased nurses and pharmacists’ correct perception of high-alarm/high-risk medicine reactions, reduced possibility of major injuries caused by negligence of high-alarm/high-risk medications, improved reaction time and complete evaluations of medicines, and decreased labor costs.
2. Zero tolerance of crashes – Automated Nursing Aids Shift System 1. Handover data are automatically aggregated and cleanly displayed full-page on the screen. 2. Detailed data can still be inquired if necessary. 3. Data within 24 hours and in the future are retained. 4. Automatically aggregated data includes 90% of patient information. 5. In case of a crash or blocked network connection, the system can automatically right itself using its last hourly backup.
Achievements and Evaluation : 1. The patient handover time was shortened by one minute on average. 2. The completeness rate of nurse handover increased from 70.0% to 92.0%, reducing mistakes and further maintaining patient safety. 3. The satisfaction rate for nurse handovers increased from 74% to 93%.
3. Anesthetic Indicator Cloud-based Management System 1. Quality Indicator Management System: This software was self-developed to provide indicators collected, reports, and the statistical process control (SPC) flowchart. 2. File Management System: An internet server is used to provide more convenient file synchronization and sharing. 3. Knowledge Management System: A content management platform was used to build a Wiki Platform that has developed into an invaluable knowledge management system. 27
To improve the utilization of data, M.M.H. built the business intelligence technology analysis platform using EHR data and internet of things devices’ data. The data is published internally. Excel and Power BI are used to build the database and the dashboard. Analyzer training programs are provided to improve the capacity for system building, deployment, management, and evaluation. US$55,183 was spent to build the system over the first two years. From 2013 to 2015, 148 metrics were developed, including hospital administration, financial management, medical quality (see the figure right below), and patient safety and medical research; system efficiency benefits are listed below :
Mackay Memorial Hospital
4. Cloud-based Decision-making Support System – Self-occupied smart business model
1. Utilization: 463 website searches per month (with an annual increase of 5.6%). 2. Functions: Usage of information technology and data quality and safety were up to expected standards. 3. Process Improvement: US$166,400 was saved per year. 4. Clinical Benefits: Days of hospitalization, re-hospitalization, and days of antibiotic usage were reduced.
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5. Medical Education Platform The Medical Education Department of M.M.H. established the teaching platform task force to apply web technology to build a learning platform that could be accessed via mobile devices. The platform’s architecture and features were determined by a cross-disciplinary team made up of doctors from 14 medical specialties. Applications features include course management templates, electronic teaching assessment tools, diverse management functions, and an integrated learning history and feedback section.
6. Improving medical equipment maintenance via mobile device Complete information on medical equipment can be inquired through an app to improve the efficiency and convenience of maintenance. After the app and new procedures were developed, clinical units and medical staff reduced the time it took to troubleshoot equipment. User satisfaction increased from 77% to 97% and maintenance time was reduced by 20%. In addition, use of the app has increased by 71%. Due to the success of the app, M.M.H. has been invited by other hospitals to share their experience.
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1. 2. 3. 4.
5.
This app is currently available for iOS and android devices. It has the following features : Inquire about shifts (day, night, notification) by division, nursing station, and date. Online requests for and consents to change shifts. Online paging: Push a single button to contact the staff member on duty immediately and to reduce mistakes. Inquire about personal shifts and changes in shifts: Dates and locations on duty every month can be listed for doctors to make arrangements. Look up work hours reports: Reports with regard to the compliance with 88-hour work week law, average working hours/week, and the percentage of working hours exceeding work hours restrictions can be inquired; the Mobile Doctoron-duty Notification System is combined with the electronic whiteboard at the nursing station to offer more complete information on shifts instantly.
Mackay Memorial Hospital
7. A u t o m a t e d D o c t o r - o n - d u t y Notification System
M.M.H. will continue to apply new information technology to improve its medical care quality.
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2017 Clinical Applications of Smart Medical Technology
Chapter 1 Smart Hospital Accreditation Marks
Kaohsiung Chang Gung Memorial Hospital About the hospital
TEL:+886-7-7317123
Founded on January 1, 1986, Kaohsiung Chang Gung Memorial Hospital (Kaohsiung CGMH) currently has 2,686 wards, more than 5,800 employees, 7,300 outpatients, and 360 emergency patients per day. As a member of the Chang Gung Medical Foundation, Kaohsiung CGMH is recognized by the Ministry of Health and Welfare as an excellent medical center with 81 specialties and sub-specialties. In addition to providing state-of-the-art medical care, the hospital is also active in medical education and clinical research. With a focus on the interdepartmental integration, Kaohsiung CGMH uses a treatment model that results in a compassionate and safe environment where the rights and interests of patients are maintained. Through strong leadership that listens to its staff, the hospital adopts new medical technology and improves the quality of medical services. In pursuit of medical excellence, Kaohsiung CGMH has continuously introduced new medical technology to benefit patients in southern Taiwan; in addition, the hospital develops digital teaching and assessment tools to improve the learning effectiveness of employees and trainees. Various medical research centers have been built to advance fundamental medical research. Since 2014, Kaohsiung CGMH has participated in the HQIC organized by the JCT. For three consecutive years, Kaohsiung CGMH has won 9 marks across 5 fields competing against 23 participating institution. In 2016, Kaohsiung CGMH was awarded the smart Hospital Mark.
Award-winning Projects (Pharmacy Department) As the organizer of the Joint Training on Pharmacy OSCE in Teaching Hospitals, S o ut h T ai wa n, t he Depa rtmen t of Pharmacy at Kaohsiung CGMH has built the OSCE Platform (Online Smart Communication & Education Platform), which is a remote teaching and work platform designed for OSCE. Functions include the Online Contribution and Reliability and Validity Analysis of 31
New Teaching Plans, Computer-selected Examination Questions, Pre-test Online Teaching, Result Announcements, Questionnaires, and two-way TeacherStudent Interaction; in addition, the Department of Pharmacy also works with the Department of Medicine and the Department of Medical Education to introduce the Electronic Grading System. After grading the tests by mobile
Experience sharing and implementation results The Objective Structured Clinical Examination (OSCE) is an important teaching and assessment tool for clinical beginners. Since 2012, the Department of Pharmacy at Kaohsiung CGMH has acted as the organizer of the Joint Training on Pharmacy OSCE in Teaching Hospitals, South Taiwan, to provide the training required by 13 teaching hospitals in South Taiwan. Challenges are as follows : (1) Preparations: The hospital expected more participation from reputable teachers but failed due to time, labor, and budget concerns. (2) OSCE: Manually selected examination questions lacked fairness; time for paper review was insufficient; examiners were unable to receive the overall results instantly and thus failed to give group feedback. (3) E x a m i n e e s : T i m e f o r p r e - t e s t learning and post-test feedback was insufficient; external examiners and examinees were unable to provide and participate in post-test guidance. (4) Forms consume a lot of paper and need to be input in the computer, which expends money and time. As a result, the Department of Pharmacy began working with the Department of Medicine and the Department of Medical Education to set up the OSCE Platform and to introduce the Electronic Grading System.
1. OSCE Platform Based on standard of HTML5, the website relies on Javascript (jQuery) and the CSS framework Bootstrap to build a responsive website that adapts to the size of the device’s screen that is being used to access the site. The website encrypts its database and all transmissions to ensure information security. Each user is given an account and a password which expires after a certain period of time. After login, users can only browse certain pages that are authorized; The main functions of the platform are as follows :
Online Contribution of New Teaching Plans : The OSCE teaching plan contribution system is built on the platform to offer an open channel for contributions of teaching content. Pharmacists from participating hospitals are encouraged to contribute teaching plans based on practical experience. After receiving contributions, two experts will be assigned to evaluate the appropriateness of the contributions and give comments.
Kaohsiung Chang Gung Memorial Hospital
device, examiners send the results back to server for statistical analysis and group feedback. Implementing the OSCE Platform and the Electronic Grading System has resulted in the Department of Pharmacy achieving the goal of pharmacy OSCE and teaching effectiveness while significantly reducing the work hours and costs of OSCE-related operations.
Reliability and Validity Analysis of New Teaching Plans : Teaching plans need to go through the reliability and validity analysis. Experts from participating hospitals grade the teaching plans on the platform, which will summarize the results of all examiners and conduct a reliability and validity analysis. Examiners can work online completely without being subject to time and space; administrators can also view the results of examinations without conducting additional analyses. Before, examiners had to visit each hospital in person to participate in reliability and validity analyses of new teaching plans. Now it can be done entirely online, saving time and money. 32
2017 Clinical Applications of Smart Medical Technology
Chapter 1 Smart Hospital Accreditation Marks
Computer-selected Examination Questions :
Post-test Online Teacher-Student Interaction:
The chief examiner will choose a basic template for the OSCE assignment and the number of examination questions first. Then, the system will select suitable examination questions randomly from the question database for the chief examiner to choose from.
In response to the recommendation for individual feedback, a TeacherStudent Interaction area is set up on the platform to prolong the time for twoway interaction between teachers and students after the test. If examinees have any questions or recommendations after the test, they can send a message to examiners on the platform. Examiners can also get into private conversation with examinees. Such conversations can only be browsed by both parties. Once a message is sent by a party, the system will inform the other party of a reply via email. To access the teacher-student interaction area, the personal account and password are required. Feedback is private and not subject to the day of examination. This can facilitate immediate feedback and encourage trainees who are afraid to speak in front of the public to ask questions. As this is not an immediate response, examiners have enough time to prepare data and respond to examinees more completely. Through teacher-student interaction, the percentage of external examiners guiding examinees and the percentage of external examinees receiving guidance has increased from 0% to 100%.
Pre-test Online Teaching : Based on the concept of “flipped classroom�, the Pre-test Online Teaching Platform will record lectures. Before class, students can learn by themselves online; in class, interactive teaching will be performed, such as practices, problem solving or discussions, to improve the learning effectiveness. Lectures are recorded using PowerCam software for examinees. On the day of the test, teachers and students are able to discuss the parts that need clarification in class.
Post-test Result Announcement and Questionnaire: After each test, examinees can search for personal results and comments. Various forms and satisfaction questionnaires can be filled in by examiners, examinees, and standard patients online, the results of which will guide future feature requests and teaching content development.
Figure 1 OSCE Platform
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2. Electronic Grading System:
P r e- t es t E xamine r Grad ing Consensus Meeting :
Before the grading consensus m eet i n g, t h e r equired da ta a re downloaded to examiners’ mobile devices. After grading, results will be sent back to the system for instant browsing. Examiners only have to discuss the parts in dispute, which can shorten the meeting time by 50% compared to following itemized discussion lists in the past.
OSCE Grading :
Before the OSCE test, information on examinees and grading are downloaded to examiners’ mobile devices. After examinees enter the examination room, examiners may start grading examinees by selecting their codes. Grades will be sent back to the system directly for statistical analysis. Compared to paper, examiners have more time for grading examinees and giving comments.
Post-test Group Feedback :
After the test, examiners will give group feedback since grades will be sent back to examiners’ mobile devices immediately after the test. In the past, examiners gave feedback manually; with the statistics provided by the system, now examiners can give more individualized and contextualized feedback that is based on all examinees’ performance and emphasize questions that need special attention. With the introduction of the OSCE Platform and the Electronic Grading System, the team can achieve the goal of pharmacy OSCE and teaching effectiveness, while having teaching hospitals in southern Taiwan participate in the OSCE training together.
Award-winning Projects (Department of Medical Education) 1. M o d e r n m e d i c a l e d u c a t i o n h a s evolved to emphasize convenience and interactivity. To provide medical staff and trainees a more convenient way of learning, the Department of Medical Education has introduced customized ebooks. Teachers can compile digital books by combining text, interactive multimedia through an easy to use interface. This turns one-way teaching to a two-way learning model, further improving trainees’ participation and problemsolving abilities. 2. The hospital has an online ebook library that trainees can search for using their mobile devices. Trainees can search for information on topics that they need help on instantly. Teachers can also improve the contents of the ebooks based on students’ comprehension and feedback. 3. In addition to text and pictures, interactive ebooks also contain music, videos and clinical presentations that promote health education for patients, contributing to primary prevention and improving patients’ quality of life.
Kaohsiung Chang Gung Memorial Hospital
The Electronic Grading System collects grades provided by examiners on a mobile device. After grading, the devices will automatically send the grades back to the system, which then sends the grades back instantly and automatically generates an electronic file based on each business need. Multiple encryption methods are adopted to protect all data in the system’s database. If authentication fails, users are unable to access testrelated information or upload grades; in addition, the test environment is a closed network to avoid attack; the app is not available in the iOS or android app stores, so the general public can not install the app. This system can be used for the following :
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Experience sharing and implementation results With changing technology and the rapid rise of the digital age, the hospital has had to change and adopt a new way of providing continuing medical education. Electronic books feature interactive functions and simulations, which not only improves trainees’ participation, but also stimulates diverse thinking and clinical skills. Compared to traditional teaching methods, e-learning has many advantages. According to the comments on e-learning, learners prefer using simple technology or tools. With the combination of multimedia and interactive materials and mobile devices, learners are able to learn a diverse set of content at any time, which improves learning efficiency, problem-solving ability, and user satisfaction.
1.Interactive electronic books A set of simple editing software is offered to authors. Authors can import PDF, PPT, video files, and animations to create ebooks without any programming skills. With the use of ebook editing software, clinical teachers are able to develop more digital materials creatively, allowing readers to interact with ebooks and take mock exams, further increasing readers’ participation and motivation to learn. eBook, the name for the electronic library of medical education content, features categorized ebooks, analysis of learning and test results, and control of mobile devices which trainees can access at any time. For teachers, usage data can facilitate paper review and improve the contents of ebooks based on trainees ' feedback.
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2. Electronic book compilation training and promotion 1. Hospital-wide training on ebook compilation Since 2014, the Teacher Training Center has organized a seminar on interactive digital book compilation every year. The seminar is included in the teacher training certification credits. Participants are specialists and medical clinical teachers. Professional instructors are invited to lecture on ebook design through hands-on practice in the hope of cultivating ebook teachers. Seminars are divided into fundamental and advanced classes based on the needs and goals of teachers.
2. Ebook competition
To promote ebook compilation, a contest named Ebook Contest is held. Eight experts, including experts in ebook software, the staff from the materials office, doctors from the Teaching Training Center, and the medical committee, are invited to review entries and grade the books’ design, compilation skills, applicability, and creativity.
1. Doctors Ebooks for each specialty have been created and used for training medical residents. Each book contains disease introductions, clinical skills, equipment operation, group diagnosis, and evidence-based medicine. A total of 81 ebooks on clinical skills have been designed and been made available to medical students and interns from from Chang Gung University, Kaohsiung Medical University, China Medical University, Taipei Medical University and Chung Shan Medical University. 2. Medical staff The hospital organizes the annual training programs for the medical staff working in the fields of nursing, pharmacy, medical examination, respiratory therapy, clinical psychology, functional therapy, physiotherapy, medical radiology, hearing therapy, audiology and speech therapy, and nutrition. Ebooks are part of the priorities for teaching material development. A few teachers from each department are trained on ebook creation and create them for trainees to read. 3. Patients Health education can help prevent diseases and improve patients’ quality of life. The convenience and interactivity of ebooks through music, videos, and clinical presentations can further enhance health education for patients.
3. Achievements Through eBook, teachers can uphold ebooks to the online library where trainees can download them to mobile devices. Learning and test results of clerks, interns, PGY, residents, and other medical staff are collected for statistical analysis and feedback to improve learning effectiveness, teaching, and ultimately the quality of medical services. Achievements in interactive ebooks are as follows : (1) From 2014 to 2016, 102 teachers were trained to compile 150 ebooks with regard to different levels of teaching of doctors and the medical staff. (2) The Evidence-based Medicine Center introduced interactive ebooks in both Chinese and English to implement evidence-based medicine (EBM) education, where clinical cases were combined to increase trainees’ interest in learning and clinical skills. In the 2015-2016 HQIC Evidence-based Medicine Contest held by the JCT, the hospital won 2 gold, 2 silver, and 2 bronze medals. (3) A total of 81 ebooks designed for essential clinical skills for medical students have been compiled. Through ebook teaching, the test results of trainees have increased significantly (by 12.6 points on average), thus demonstrating the effectiveness of ebooks in certain situations. (4) The hospital’s achievements in ebook teaching were accepted to be published in the 2014-2015 Association for Medical Education in Europe (AMEE) and BMC Medical Education journals.
Kaohsiung Chang Gung Memorial Hospital
3. Ebook promotion
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2017 Clinical Applications of Smart Medical Technology
Chapter 2 Selected Prized Works of Smart Medical Treatment
Topic : Online Nursing Device and Applications
Taipei Veterans General Hospital About the hospital
TEL:+886-2-28712121
Taipei Veterans General Hospital began clinic services on July 1, 1958 and emergency services in March 1959, and officially opened on November 1, 1959. It contains the Chung-Cheng buildings, Shih-Yuan Building, Evergreen Building, Chih-De Building, Nerve Regeneration Center, Medical Science & Technology Building, and other major buildings. The hospital has 3030 beds. In the Hospital, medical teams composed of 6213 employees provide accurate medical treatments with advanced equipment. Over the past sixty years, the hospital has prided itself on providing patientoriented service. It devotes itself to using innovative medical technology to improve the quality of care. It is committed to providing physiological, psychological, and spiritual medical care. It also develops original health care innovations by integrating information technology and that increases quality and safety.
Award-winning Projects
The nursing department manages the nursing information system. It has converted many of its functions to a mobile friendly format by creating smartphone apps. The e-Nursing APP and Nursing Communication system are examples. They have increased the efficiency, flexibility, and availability of nurses and enhanced nurse to nurse communication.
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The e-Nursing app developed by the hospital includes two major features: nursing assessments and brief medicine supply. The other members of the health care team can receive the results immediately and provide medical treatments soon. The brief medicine supply is connected to the pharmacy order system.
Cooperative Company
In addition to vital signs assessment, the e-Nursing app also supports pain assessment, pressure sore risk assessment, and 21 other nursing assessment interfaces. Nursing personnel can perform professional clinical assessments and provide it to physicians for medical reference. When physicians are immediately aware of what the nurses observe, problems can be avoided. The brief medication supply is connected to the pharmacy order system so that the nursing personnel can comprehend the content of pharmacy orders throughout the hospital. This feature improves the timeliness of medication delivery. The Nursing Communication system is constructed with simple dialing and routing rules. This makes it easy for anyone to reach the nurse on duty without having to look at the day’s work schedules. This system can enhance the correctness and timeliness of communication between staff. In addition, each hospitalized patient can find and directly communicate with the on-duty nurse using this system. The Hospital has leveraged information technology to protect patients’ safety, to simplify nursing workflows, and raise operating efficiency. The hospital plans to further develop the apps in the future.
Taipei Veterans General Hospital
Experience sharing and implementation results
Far EasTone Telecommunications Co., Ltd. Website：https://www.fetnet.net/home/ Cornerstone Technology Co., Ltd. Website：http://www.cs-ehealth.com/
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2017 Clinical Applications of Smart Medical Technology
Chapter 2 Selected Prized Works of Smart Medical Treatment
Topic : Safety at Home – A High-Quality, Highly-Accessible Home Hospice Program Enabled by Telemedicine
Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation About the hospital
TEL:+886-3-8561825
【Business Concept】 Objective : Humanistic Medicine and Respect for Life Mission : Protecting Life, Health and Love. 【Goal】 1. Strengthen sustainable operation and management and combine medical technology and information applications to be the model of hospital management. 2. Cultivate talents and implement medical humanism to be international medical education center. 3. Raise expertise and integrate services to provide patient-oriented holistic care quality. 4. Establish excellent research environment to enhance the innovative researches and developments for contribution to human beings. 5. Take care of disadvantaged groups and practice health promotion to implement social responsibilities. 【Vision】 To become a patient-oriented international hospital. 【Heart Lotus Hospice Ward】 The concept of Heart Lotus Hospice Ward is life respect. On August 8, 1996, it constructed the first palliative ward on the east coast of Taiwan. Heart Lotus, named by Dharma Master Cheng Yen, means the heart is like a bloomed lotus, hoping that patients can face illnesses and life respectfully. Heart Lotus. It is the specialized training hospital for hospice and palliative medical treatments. It consists of 15 beds in total. Patients and their families will be provided with patient-oriented medical treatments by health care workers, social workers, psychologists, volunteers and religious clergy for psychological, social and spiritual care.
Award-winning Projects Safety at Home – High-Quality and High-Accessibility Home Care for Patients in the Terminal Stage of Illness with Cloud Technology The concept of the cloud Heart Lotus hospice palliative service uses an internet connection to deliver humanoriented medical treatments rather than illness-oriented ones while lowering costs and improving access to care. The design focuses on the development of a home hospice care platform integrating care models, assistive devices, 41
multilingual care instructions and realtime communication with systematic and digitalized methods. The technology also allows coordination of care for hospice services between the clinic, hospital, and home. Through the remote interactions with the hospice palliative team, patients in the terminal stage of their disease can be supported with efficient and personalized care services at home. In addition, the system also monitors the quality of information of hospice services for future improvement.
The features of the integrated care information platform for cross-culture hospice home cares were built as follows: 1 .Provide multimedia and multilingual health education information for caregivers: The hospice health education models compiles 8 versions of hospice health education information, videos, and an e-book supporting different languages. These data will provide professional knowledge and related assistance for self-learning for indigenous people, foreign caretakers and principal caregivers. 2 .C o n s t r u c t t h e d o c t o r - p a t i e n t interaction system: The health care team interacts with patients and their families with videochat at any time. It can monitor patients’ heartbeat, breathing, blood pressure, oximetry and other physiological indicators through the cloud technology. Through the support network, patients and their families can share experiences and encourage others, and they are also supported by the professional team with psychological, social and spiritual advice.
Cooperative Company
Hualien Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation
Experience sharing and implementation results
3 .Integrate community resources and coordinate the rental and information of home medical supplies: The system provides assistive devices, health care institutes, fundamental hospitals, health care supplies, life services, and other life supports. Nowadays, it has completed online information, map and contact windows of 1867 community life suppliers. 4 .Establish a hospice nursing system: The system can convert written records to electronic records to reduce the time of nursing personnel spent writing, and support inquiring and recording patients’ status at any time. Moreover, it has integrated with the hospital’s EHR so that patients’ inspection, image, diagnosis, disease progress and other records can be shown on the platform. With the support of these four features, patients in the terminal stage of their disease and their caregivers will be supported with high-quality end of life care. 5 .The hospice palliative team also supports the mission of the hospice palliative education training in Hualien and Taitung. It not only offers hospice education for medical and nursing students at the Tzu Chi University, but also supports level two hospice and palliative care training for the Public Health Bureau and longterm care institutes. In addition, it also supports palliative medical treatments and advance care planning in communities to spread the hospice concept.
Figure 1. First management system integrating patient medical records information and palliative care services for patients in the terminal stage of their disease in Taiwan
Chyun Huei Commercial Technologies Inc Website：https://www.chci.com.tw/Introduction.aspx
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2017 Clinical Applications of Smart Medical Technology
Chapter 2 Selected Prized Works of Smart Medical Treatment 43
Topic : Applying Information Technology to Improve Acute Ward Management
National Taiwan University Hospital About the hospital
TEL:+886-2-23123456 New Health Care Models for Hospital Medicine: Establishing an Integrated Health Care Model to Meet Taiwan’s Future Medical Needs At National Taiwan University Hospital (NTUH), the Department of Complementary and Integrated Medicine (CIM) was set up in October 2009 in order to better treat complicated patients with multiple medical problems. The department was set up after finding various deficiencies in the care processes of the hospital. Modeled after hospital medicine programs in the USA, NTU started hiring hospitalists, physicians who only took care of inpatients. These hospitalists, in coordination with nurse practitioners, project managers, hospice caretakers, pharmacists, nutritionists, physiotherapists, and other healthcare professionals communicated with each other to promote smoother handoffs in care both during and after hospitalization. The teamwork also strengthened patient safety, increased medical treatment quality, efficiency, and satisfaction. It also demonstrated the value of integrating teams. To comply with the plans of the Ministry of Health and Welfare and to promote the field of hospital medicine nationally, CIM constructed the Taiwan Society of Hospital Medicine in November 2015. The goal is to make integrated inpatient care between hospitalists and specialists. The care is to be continuous, integrated between outpatient and inpatient centers, serve as a model for future medical care in Taiwan, especially as society ages.
Award-winning Projects Digital Revolution of Hospital Medicine based on the Electronic Board – Clinic Information System of Integrated Medicine
The solution was accomplished by a team of attending physicians, nurse practitioners, project managers, and electrical engineers in NTUH’s CIM. Applying principles from operations research and queueing theory to ward management, the team streamlined and coordinated common inpatient care processes and merged disparate hospital information systems and data sources such that they could be shown on one “Big Board.” The fact that there was only one board mounted in a centralized location made it easy for all medical personnel to see real-time ward status, available beds, patient discharge plans, and who the physician
and nurse of record were at all times for each patient. Physician and nurse work schedules were also available. This “big board” has laid the foundation for future development of advanced inhospital communication systems. The system includes the major features as follows : 1 .Graphical interface: using a touchbased interface, the system presents clear icons for common hospital tasks and hyperlinks to patient information, which enhances data accuracy. 2 .Real-time statistical analysis: Based on the complete service records and quantification data, the system can efficiently present the health care performance through the service quantity statistics and tendency charts, process the statistical analysis depended on the service items and support the drawing functions.
A Specialized Clinical Information System for Hospital Medicine: Providing integrated and innovative medical services and enhancing service and management efficiency In 2010, NTHU’s CIM constructed the Centralized Ward Electronic Board and Clinical Information System of Integrated Medicine which shall be the creation around the world. The major feature of the integrated medical platform is to provide a delicate, userfriendly and efficient interface based on the electronic board set in the center of wards to support patientoriented medical treatments. The system integrates existing information systems and optimizes procedures. Through brief operation modes, health care workers can communicate with each other easily. All related health care workers can comprehend and management a patient’s status with various devices in the medical system everywhere. The information platform assists clinic personnel to support medical treatments, seamless handover of medical treatments, and promotes interdisciplinary, team-based care. Therefore, it helps to reduce length of hospitalizations and raises the hospital’s efficiency. In addition, the big board enhances ward service quality and its image to patients and their families by building a culture of strong medical quality. The system is not only referred to by many domestic medical centers who have brought representatives to learn from NTUH, but has now been implemented in all wards at NTUH.
Figure 1. The Centralized Ward Electronic Board and Clinical Information System in 2010.
National Taiwan University Hospital
Experience sharing and implementation results
Figure 2. (Left) Dr. Lin Yu-Feng, the author, gave a speech at WHO Society of Hospital Medicine in 2012 with the topic, Innovative Reconstruction of an IT Smart Ward. (Center) The NTUH CIM won the Smart Medical Integrated Project Award at the 15th Healthcare Quality Improvement Campaign of Joint Commission in Taiwan with the topic, Applying Information Technology Improve Ward Management and Procedure Reconstruction. (Right) The NTUH CIM received the SNQ certificate (Guo Pin Tzu A01268) in 2013.
Figure 3. Group picture, NTUH CIM
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Shin Kong Wu Ho-Su Memorial Hospital Topic：IRON MAN– e - Nursing System About the hospital
TEL:+886-2-28332211
Shin Kong Wu Ho-Su Memorial Hospital was founded in 1992. Former Chairman Wu Ho-Su said: “not progressing is regressing.” In July 2001, the hospital passed the assessment of Department of Health and upgraded to a Medical Center officially. The hospital operates 817 beds. Moreover, it constructed a new building with 7 stories above ground and 2 stories underground and set the dialysis care, dentistry and rehabilitation areas there in Oct 2011. The Hospital is the medical core of the Shilin, Beitou, Sanchong and Luzhou districts for emergency and critical medicine treatment and preventive medicine. Using the 3Hs (Health, Hope and Happiness) as core values, according to superintendent Hou Sheng-Mou, the hospital will become the best hospital it can be. Specifically, the hospital will raise medical quality, promote doctor-patient communication, and preserve patient privacy. By providing a high-quality healthcare environment and promoting the health of communities, it expects to become the leading medical center in the Shilin area.
Award-winning Projects The system was desgiend to do the following : 1 .Generate nursing records automatically during nursing operation: the system can generate nursing records automatically to present consistent, complete and efficient data. It saves documentation time, simplifies the nursing procedure, and strengthens healthcare quality and raises patient safety. 2 .E n h a n c e s a f e t y w i t h p a t i e n t oriented design of human body graphics: With vector graphics the system provides visual and easy-toidentify information by integrating pipelines, pressure sores, wounds, pain and body parts. It maps the data to actual and correct patient information. It reduces handover time and raises patient safety. 3 .Provide decision support and work scheduling with timetables: The nursing database is established based on nursing assessment correlations in order to actively provide references in accordance with the nursing circumstances. In terms of work scheduling, the
system uses timetables to provide the works to be implemented during the period depended on the configured frequency. After health care workers input data, the system will link it to corresponding nursing statements or records.
Experience sharing and implementation results 1. Generate descriptive nursing records automatically to reduce documentation time.
2. Integrate care data to reduce handover time and strengthen patient safety.1 3. Configure parameters that trigger decision support to avoid near misses caused by typos.
Shin Kong Wu Ho-Su Memorial Hospital
4 . Construct indexes (benchmarks) of nursing quality from clinical notes and databases: With structured indexes, the system directly transfers nursing records to corresponding nursing indexes for consistent index collection.
4. Support references for decision making to reduce the load for nursing personnel and to provide guidance for training of new employees. 5. Transfer data which are true, complete and correct nursing indexes from clinical operations with the integrated system automatically to simplify data entry for nursing personnel. 6. Share healthcare information for healthcare teams to better understand patients and to investigate healthcare approaches, in order to raise operating performance and to keep patient safety and healthcare quality. 7. Simplify operation procedures to reduce time-consuming nursing processes and to increase the time to take care about patients so that the nursing service satisfaction reached to 72.5% 8. State 17 electronic disease progresses to reduce written copies, storage space and transmission time for environmental protection.
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Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation Topic : E-learning – Tzu Chi Learning Management System
About the hospital
TEL:+886-5-2648000
In the past, the lack of medical treatment in the Yunlin and Chiayi area has been problematic. Dharma Master Cheng Yen had a compassionate heart and convened people around the world to contribute to the Dalin Tzu Chi Hospital, which would be constructed based on truth, goodness, and beautiful human nature. The Hospital is located in a village with a population of less than 30,000 and began protecting the health of people 16 years ago. The Hospital occupies roughly a 40,000-ping total area and operates about 1,000 acute and chronic beds in total. Based on patient-centered principles, the Hospital not only devotes itself to modern medical treatment but also focuses on providing humanistic care. Every day, more than 120 volunteers support warm and friendly medical cares anyone who comes to the hospital from the 1,000,000 people in the area. Moreover, the Hospital provides holistic medicine assisted using the latest technologies.
Award-winning Projects In 2003, the Department of Education at Dalin Tzu Chi Hospital introduced the e-learning and constructed diverse integrated learning environment actively. With the courses, the functions of the e-learning platform are promoted to the Hospital and each Tzu Chi vocation. In 2009, the Tzu Chi E-learning platform was launched officially and offered about 2,700 courses at the end of June 2017. It promotes educational training from employees through course offerings, reports, and by integrating actual courses with employees’ training records. Moreover, the Tzu Chi lecture platform was established to record outstanding speeches in each specialty. At the end of 2010, the e-Portfolio platform was launched to organize physicians’ learning processes using specialized courses. The 10,000 employees in each field can access these online systems with a single account and password. In addition, the Health OK website provides more than 160 health education courses for people through android and iOS apps. Based on the integrated online platforms, Tzu Chi e-learning has constructed a high-
quality, efficient and interactive online learning environment continuously.
Experience sharing and implementation results In practice, a hospital is not only a place for patient treatment but also an essential educational institution. Moreover, it is a specialized institute which needs cross-disciplinary cooperation and up to date knowledge at all times. A wide range of educational and training activities are undertaken by interns, professional health care workers, administrative personnel, and patients. Thus, there are four major educational items, including higher education which covers intern education and teacher education, on the job training, and continuing professional education for teacher education, as well as adult health education for patients and the community.
Four Learning Disciplines of Medical Institute
1 . Convenient System for Students : For students, the progress system lists all required programs clearly. The progress of each program is shown with indicators. When the indicator is pointed at by the mouse, completed courses and selectable courses will be presented automatically and rapidly. The system also supports complete study records, registration records and scores. In addition, the clear and convenient course selection system allows students to select required courses quickly. Students can learn all courses in every department of their field. Hospital equipment can be reserved through the equipment reservation system to achieve a high usage rate.
2 .Convenient System for Teachers : For teachers, the system provides convenient course offerings and an email notification system, online course applications system, instruction progress system and student analysis system. Teachers can view students’ satisfaction and feedback and scores in time. Also, they can interact with students on the platform to understand students’ acceptance and practice some examinations.
The Hospital adopts virtualization technology for effective and quick troubleshooting on system hardware. The technology is used to backup the system and to reduce users’ waiting time by practicing system porting. Comparing to other hospitals, it has 3 dedicated system engineers in charge of the update, maintenance and expansion of the e-learning platform to expand functionality and increase system reliability. In terms of personal privacy, each user's learning progress is protected with a password. Only the teacher and the direct supervisor can access the data. Except for specific requirements, the e-learning platform only provides the collection, process and use of students’ learning progresses for teaching or academic requirements. Moreover, the e-learning platform does not provide detailed personal information. Employees have been notified about the regulations when they are hired. For isolated purposes, detailed information will be provided by request and only after careful review and approval by the hospital president.
Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
3 . Reliable and Secure System Tzu Chi e-learning platform uses a single sign-on system by integrating the required data from the human resource database in six departments. Each one of the about 10,000 employees can sign into the platform.
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Topic : New iCKD Healthcare Technology Platform
Kaohsiung Medical University ChungHo Memorial Hospital About the hospital
TEL:+886-7-3121101
Kaohsiung Medical University Chung-Ho Memorial Hospital was constructed in Kaohsiung City in 1957. Since its establishment, the Hospital has solved a number of internal and external challenges and has been praised by both community and government agencies for its medical service and research achievements. In addition, the hospital’s care network has been extended to the Kaohsiung Municipal Siaogang Hospital, Kaohsiung Municipal Ta-Tung Hospital, and Kaohsiung Municipal Cijin Hospital. Also, the Ministry of Health and Welfare in February 2015 approved the hospital to build Kaohsiung Municipal Ganshan Hospital in order to develop a more efficient medical system and to provide more comprehensive clinical services. Moreover, the Hospital has continually introduced new technology and medical equipment to deliver cutting edge medical care. In April 2016, the Hospital passed the JCI International Hospital Accreditation, becoming the first medical center in southern Taiwan to do so. In June 2016, the Hospital won the International Medical Model Prize. It hopes and expects to become one of the top university hospital in the world.
Award-winning Projects Improve prevention, control and care of chronic kidney disease through digital learning and information services. The new iCKD Healthcare Technology Platform aims to increase service quality with the two major features as follows : 1. iCKD health management app: Promote the self-management of health for patients through 10 major features, including physiological signal measurement at home, health education for disease, nutrition analysis, medication reminder, alarms and warning, etc. 2. Cross-team management platform: Analyze and monitor patients’ home health management with visual data on the personal dashboard. The healthcare quality indicators automatically support the related healthcare teams to comprehend disease progress and provide feedback in time with online reminders.
Before Launched and Services
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Kaohsiung Medical University Chung-Ho Memorial Hospital
Experience sharing and implementation results
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National Center for High-performance Computing (NCHC), Website：https://www.nchc.org.tw/tw/
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Topic : A Secure, Real-time Communication App for Medical Professionals
Chi Mei Hospital About the hospital
TEL:+886-6-2812811
Chi Mei Hospital, formerly named Father Fox Foundation Hospital, was founded in 1968 and changed its name to Chi Mei Hospital in November 2010. It operates 843 emergency beds and 1278 beds in total, has 24 medical departments and about 3,500 personnel. With the objectives of care, professionalism and efficiency, the Hospital is patient-oriented to provide high-quality and a full range of healthcare. The main mission of the Hospital is to provide safe and excellent medical care to promote the health of people and employees and to cultivate healthcare talent. While keeping outstanding medical quality and protecting the safety and benefits of patients, it aims to develop medical professionalism, integrate medical teams, meet the requirements of patients and the community and create a good organizational culture for sustainable operation and development.
Award-winning Projects The project aims to explore the applications of a real-time messaging system for critical medical results, including biochemistry, blood tests, blood bank, microbiological reports, image reports, inspection reports, pathologic reports, etc. The app is similar to the LINE messaging app, but adds crucial clinical medicinespecific features: HIPAA compliant security, chat history, search features, message tracing, advanced message reply settings, and integration with hospital software. Therefore, CMedLine was developed to solve these issues. Traditional Message Shortcoming Pure text presentation Limited transmitted word number No attached file Single color One-way message transmission No group communication No indication of read message Difficult reply confirmation
Defects of LINE Medical professionalism transmission Read message treatment Historical record storage Message search function Highlighted message presentation Team member control Huge message traceability Secure internal introduction
Experience sharing and implementation results The CMedLine solved these clinical issues using six features: 1. Access Control: User accounts and passwords are synchronized with the information system in the Hospital.
51
2. M e s s a g e M a n a g e m e n t : t h e CMedLineApp receiver will show read messages, unread messages and historical messages. It also can connect to the mobile system in the hospital to view patients’ data to better understand the context of critical results and make better decisions.
Chi Mei Hospital
5. Risk degree identification: critical and less critical alerts are shown with different colors and flash so that they can be identified by clinic health care workers easily.
6. Messages are synced with a central server and the HIS system: Replied messages issued from not only a PC but also the app will be synchronized to the app of other members.
3. Unlimited message length with colors for identification: CMedLine will provide complete messages to receivers.
New and old system comparisons : 4. C o m m u n i c a t i o n b e t w e e n t h e message sender and receivers: When transmitting the message to current health care workers, the message sender knows the group members clearly and can communicate with them by phone.
Author : Deputy Director, Center for Quality Management Officer, Center for Quality Management Senior System Analyst, Information Systems Office Senior System Analyst, Information Systems Office Section Chief, Information Systems Office Section Chief, Information Systems Office Director, Information Systems Office First Medical Deputy Superintendent
The smart medical era is coming. The hospital full intends to continue delivering cutting edge medical care that is increasingly convenient, efficient, and effective. This project has the full support of the hospital and will lead to even more applications in the future.
Tan Che-Kim Kuo Ya-Wei Lin Ching-Chia Hsu, Yu-Chi Wang Chung-An Chen Chia-Jung Lin Chen-Tung Lin Ching-Yih
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Topic : Hospitalization Service – Automatic Early Warning System for Critical Illness
Kaohsiung Veterans General Hospital About the hospital
TEL:+886-7-3422121
In order to strengthen the healthcare for people in southern Taiwan and to raise medical quality, Kaohsiung Veterans General Hospital was constructed on October 31, 2003. It is the only one public Medical Center in Kaohsiung and Pingtung. In compliance with the Government, the hospital aims to promote health and medical policies and to provide the high-quality healthcare services. Due to the importance of emergency medical services, the hospital constructed the Emergency Building in August 2003 to improve services for patients with emergent or critical illnesses. Also, in compliance with the Ministry of Health and Welfare’s order to enhance the competence of emergency medical network in Kaohsiung and Pingtung, it constructed the Emergency Operations Center (EOC) in the area. To comply with the national elderly care policy to provide integrated healthcare for elders, the hospital constructed the Building for Geriatrics and Geriatric medicine in November 2014. It not only provides the elderly with integrated clinic and hospitalization services, but also support geriatric medical education, research, and other functions. Moreover, the hospital plans to build a Healthcare Building to provide more high-quality healthcare services for people in Kaohsiung and Pingtung.
Award-winning Projects The system is constructed by the Critical Care Center, Department of Internal Medicine, Department of Emergency, Department of Nursing, Information Management Office, Cardiovascular Center, and Quality Management Center jointly. The system database collects blood pressure, heartbeat, body temperature, oxygen consumption, degree of blood-oxygen saturation and GCS. Based on the nursing information system, a series of developments and changes of patients will be presented in the medical information system to support clinical decision making for frontline health care workers. The system won the 17th Golden Award and Creative Award of Healthcare Quality Improvement Campaign and the Sliver Award of Smart Healthcare of the Joint Commission of Taiwan, the 199th Excellence Award in Taiwan Convention on QC Circles,
the 1st grade of thesis presentation in the annual conference of Society of Emergency & Critical Care Medicine, Taiwan, R.O.C., the 1st grade of thesis presentation in the annual conference of Taiwan Society of Emergency Medicine, Outstanding Award (Patient Safety) of health promotion creative project of Health Promotion Administration, Ministry of Health and Welfare, and Golden Award and Creative Award of Healthcare Quality Competition of the Joint Commission of Taiwan.
Experience sharing and implementation results
Based on literature review, 70% of unexpected in-hospital cardiac arrests (referred to as IHCA hereunder) present some symptoms 6 to 8 hours before the time of cardiac arrest. The Automatic Early Warning System created and developed by the Hospital
The system successfully improved 13 indicators, including the average number of IHCA per month, frequency and occurrence rate of hospitalized adults, night shift and weekend IHCA frequency, survival and discharge rates for IHCA patients who had Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT) in the their first heart rate records, the survival rate 48 hours for patients after IHCA, the survival and discharge rates for IHCA patients, discharged rate of survival patients 48 hours after IHCA and the in-hospital death frequency and rate of IHCA patients. On average, it can assist in saving 47 patients’ lives Due to the excellent efficiency, the Hospital is invited for oral presentation by the European Society of Intensive Care Medicine, American Heart Association, European Society of Cardiology, and other international conferences. The quality management and the construction of Early Warning System are not only praised around the world but also applied to improve clinic efficiency and to save patients’ lives. The hospital believes that quality management strengthens medical quality for emergent and critical patients.
Kaohsiung Veterans General Hospital
can detect illness exacerbation early for in-time treatments to reduce first aid requirements and mortality of hospitalized patients. Innovative polices have led to expansion of a complete National Early Warning System (NEWS) to the hospital. Users can configure warning signals for the one with the highest score with 7 levels of severity. Continuous reminders in the Physician Management, Illness Progress Record and Hospitalization systems highlight the names of highrisk patients in the Clinic Nursing System. A dynamic board with early warning system capability is placed in in the wards. Screen savers also display the early warning system to physicians.
Author : Dr. Huang Wei-Chun, Dr. Wann Shue-Ren, Dr. Chen Yao-Shen, Dr, Juang Wang-Chuan, Dr. Kuo ShuHung, Dr. Lin Sheng-Zhe, Dr. Hong Wan-Ting, Dr. Lin Kun-Chang, Information Analyzer Hsu, MingHsia, Associate Information Engineer Tseng An-Li, Dr. Lin Po-Hsiang, Dr. Hou Te-Sheng, Medical Management Personnel Huang Chien-Ling, Dr. Cheng Chin-Chang, Supervisor Lin Li-Ying, Head Nurse Lu, Ya-Mei, Head Nurse Chung, Hsing-Chih, Dr. Ku, Yen-Chiu KSVGH Critical Care Center, Department of Internal Medicine, Department of Emergency, Department of Nursing, Information Management Office and Cardiovascular Center,
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TopicďźšGold LEED Certificated Green Smart Management Efficiency and Integration
Yuanlin Christian Hospital About the hospital
TEL:+886-4-8381456
Yuanlin Christian Hospital was established to provide emergency and critical care services for local people. For the medical treatment in Changhua area, Mr. Guo Shou-Jen, the Superintendent of Changhua Christian Hospital has a vision of Changhua is a medical city. Changhua Christian Hospital, Lukang Christian Hospital, and Yuanlin Christian Hospital can be linked as a medical network. His philosophy is to bring healthcare workers to where the patients are instead of vice versa. By constructing each hospital branch to provide local services as advanced as those in a large medical center, the issues derived from patient transfers and congested operating rooms and the intensive care units can be reduced.
Award-winning Projects Yuanlin Christian Hospital cares deeply about delivering medical care in an environmentally-friendly and sustainable way. As such, it aims to develop an international reputation as a smart and low-carbon hospital, which is important in Taiwan where pollution exceeds WHO recommendations. In order to reach these goals, the hospital approaches construction materials, power consumption, and local raw materials with the consideration of protecting the environment. It has introduced the optimal design of electromechanical air-conditioning and heat pump and ice storage systems, the cool gas recovery of liquid-oxygen evaporator, the solar water heater system, and other powersaving facilities. In September 2015, the Hospital received gold certificate of Leadership in Energy and Environment Design (LEED) issued by the U.S. Green Building Council. It is the first comprehensive medical building to receive a gold certificate within the Greater China area, including the Northeast Asia. This new milestone for sustainable development and environmental protection will serve as an aspiration for other new medical buildings to achieve in Taiwan.
Experience sharing and implementation results Yunlin Christian Hospital develops green, smart and low-carbon environment by contributing to the environmental protection without consideration of profit. It aims to reach the low-carbon goals and environmental protection and raise the image of hospital. After introducing the LEED design concepts of U.S. Green Building Council, it has become the leading hospital of Changhua Christian medical system, and expects to become one of the leading hospitals in Taiwan.
1. Energy Management System: The system provides power consumption of each systems in the Hospital by integrating related information. Historical data recorded by the system can also be applied for analysis and regulating the optimum mode for power saving. 2. Indoor Air Quality Monitoring System: CO2 sensors are set on each floor of the Hospital to transmit data to the central control room continuously. In case the CO2 is higher than 1,000 ppm, the connected air conditioning system will inflow the outdoor air for air quality improvement. 3. Fire Alarm System: The Hospital applies the addressable firm alarm sensors to show the accurate location on the central host for fire. The message will be synchronized to the engineers’ mobile phones for rapid treatments. 4. Refrigerator Temperature Monitoring System: The temperature of each refrigerator storing medicines and specimens are recorded continuously for safety. Each department which needs to access these contents can inquire the historical temperature records of the corresponding refrigerator via Internet. 5. E n e r g y - s a v i n g A c h i e v e m e n t 1 : Comparing the similar buildings of the Hospital with those described in the report of the U.S. Green Building Council, the Hospital saves about 2,300,000-degree power per year which is enough to supply Taipei 101 for 40 days, and about 12,500,000 NTD per year approximately.
6. E n e r g y - s a v i n g A c h i e v e m e n t 2 : The Hospital applies the energy management system on power usage regulation for load management, in order to reduce the peak load and to save the electricity bill. 7. P e a k l o a d : A b o u t 6 0 % p o w e r consumption saved in 2016 summer by comparing with this in the same period of 2015. 8. Electricity bill: About 785,000 NTD saved in August and September 2016 by comparing with this in the same period of 2015.
Yuanlin Christian Hospital
Smart Management System Construction :
Figure 1. LEED Certification Press Conference
Figure 2. LEED Medal
Cooperative Company
GO-IN Engineering Co.,Ltd. Website：http://www.goin.com.tw/ Ingenious Engineering Corp. Website：http://www.iecme.com.tw/ Advantech Co., Ltd. Website：http://www.advantech.tw/
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Topic: Cloud Care System for Hospitalized Patients – Safety, Efficiency and Integration
Taipei Medical University Hospital About the hospital
TEL:+886-2-27372181
Taipei Medical University Hospital, founded in 1976, is the first affiliated hospital of Taipei Medical University and is the basis for the two-way exchange of clinical services and educational research for the medical system of Taipei Medical University. The Hospital established the 2nd medical building in 1994 and the 3rd medical building in 2007 to develop a full range of medical services. It extended the Cancer Center to the Cancer Medical Building in 2010 to develop personal medical treatment. At present there are 800 beds and 2,000 personnel in the hospital, making it one of the leading hospitals in eastern Taipei.
Award-winning Projects Product Function/Feature Description : The product supports applications in clinic medical care on hospitalized patients and provides the latest information about them, such as physiologic measurement data, medical orders, various type of reports and cross-team medical care records. Moreover, it strengthens communication between physicians and nurses and other team members and presents a complete medical record reports on patients during hospitalization. Also, it uses push notifications to provide real-time crossdisciplinary information and illness review notifications.
To achieve a paperless medical care environment, mobile devices are used to raise the quality of medical services. Taipei Medical University Hospital developed the Cloud Care System for rounding on the wards. Physicians can record and transmit real-time physiologic measurements of patients through the medical IoT mechanism. Physicians and nurses can check their iPad to inquire and browse the latest data of crossdepartment reports and records and patients’ information in the imaging system, including medication orders or nursing records. Moreover, other clinical nursing personnel team members, such as dietitians and respiratory therapists, can also check patient records depended on their clearance level. The System supports clinic alerts with push notification functionality so that physicians can receive emergency notifications immediately and provide aid. In addition, at the teaching hospital, attending physicians can review and complete each note recorded by resident physicians and interns through the system at any time. Introduction of the system has improved patient safety and raised the efficiency of medical treatment services and the quality of integrated medical care. The system will be integrated with the ISBAR and handover of crosscovering teams in the future, in order to eliminate any gaps to delivering holistic medical care.
Taipei Medical University Hospital
Experience sharing and implementation results
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Topic : Applications of Cloud Smart Call Bell on Medical Care System
Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundatio About the hospital
TEL:+886-4-36060666
Taichung Tzu Chi Hospital (referred to as the Hospital hereafter) was constructed in January 2007, and the new district was completed and constructed in August 2011. According to the population statistics in the end of 2012 provided by the Ministry of the Interior, the population of Taichung City is about 2.68 million and the elderly population ratio is 9.1%. There is a mountainous area near the hospital that is medically underserved, so one reason the hospital was built was to meet the local medical needs for the locals who live in this area of the city. The Hospital is located in the central area of Taichung City and aims to serve the people in the Taichung City mainly. Most of patients come from the Beitun District, Tanzi District, Fengyuan District, Taiping District and Dali District. The Hospital is expected not only to provide complete and convenient medical treatment for people in the surrounding areas, but also to connect the medical vocations by constructing complete and dense Tzu Chi medical network with the Tzu Chi hospitals in the north, the middle, the south and the east.
Award-winning Projects Nowadays, all medical institutes suffer from a shortage of nurses. The Hospital actively introduces information technology to strengthen the organization management and operational procedures. Originally, communication was improved by receiving calls with a mobile phone or a nursing trolley instead of the host in the nursing station. Based on the integration of cloud information technology and the medical care services, the Cloud Smart Call Bell System was introduced to assist with the reconstruction of medical care processes for nursing personnel. To create forward-looking smart nursing care, the Hospital expects to reach the achievements as follows : 1. Reducing the waiting time since a patient calls nursing personnel for help, 2. Reducing the time to notify nursing personnel for abnormal of medicine receipts, 3. Reducing the time to notify nursing personnel for abnormal blood tests, and 4. Enhance the satisfaction of health care workers and patients.
Figure 1. Friendly and Rapid Services
Experience sharing and implementation results To decrease the waiting time for patient calls, reduce the time consumption of communications between nursing personnel and medical technologists, pharmacists and enhance the satisfactions of health care workers and patients, the Hospital develops the Cloud Smart Call Bell System. It adopts the VoIP (Voice over Internet Protocol) technology which converts traditional speech signals to IP packet format, transmits packets to the destination via Internet and converts these packets to speech and signals for output, and integrates the system and nursing trolleys with the host, control units, plural call devices and an Internet
Achievements and Effectiveness Assessment (1) Improve communication between patients and nursing personnel by decreasing the waiting time since a patient calls nursing personnel for help. (2) Improve communication between nursing personnel and medical technologists, pharmacists, and other personnel to strengthen the medical care for patients. (3) Enhance the satisfaction of health care workers and patients to raise the quality and competitiveness of medical care services. (4) Performance management. (5) Other benefits: 1. Reduce the cost of information for medical institutions: The cost of traditional analog call beds is higher and the construction cost is about 10,000 NTD per bed. The cost of cloud smart call bed is lower and about 6,875 NTD per bed can be saved. 2. Reduce personnel errors: The system can ensure medical care safety for patients by preventing errors due to nursing personnel missing calls. After the project was implemented, the missing rate of principal nursing personnel receiving patients’ calls was 0%. (6) Patent application scope: The patent certificate in Taiwan and the patent gazette in China have been received for the specific implementations and technical principles of the innovation.
Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
Protocol-Private Branch Exchange (IPPBX). After a patient pushes the button of the call bell, the system will automatically trigger a signal to the nursing station and respond to the phone on the nursing trolley and the mobile phone of the nurse on duty. The principal nurse can communicate with the patient immediately by mobile phone or the phone on the nursing trolley, and then provide required services. In addition, to find the principal nurse, each hospitalized patient for medical technologists, pharmacists, and other personnel with the Cloud Smart Call Bell System, the shift arrangement of nursing personnel in the nursing station has been integrated with the System. Medical technologists, pharmacists, and other personnel can call the corresponding principal nurse by dialling the bed number of patient, and they can then communicate through the mobile phone of the System directly to save time. Through the Cloud Smart Call Bell System developed by the Hospital, nursing personnel can receive and respond patients’ calls more rapidly and timely with the rings of the host, the nursing trolley and the mobile phone. Moreover, based on the integration of the System and the shift arrangement of nursing personnel, other personnel can communicate with the principal nurse directly. The System provides more benefits than traditional analog call bells.
號碼管理 •床號、分機號碼整合、個人簡碼
識別化 •藥局、檢驗科、護理值勤人員、護理站、床號都能 易於識別化
習慣的改變 •行動通訊取代桌機、數位化帶來的多功運用、
Figure 2. Automatic Message Receiving/ Sending
Figure 3. Selected Features of the Cloud Smart Call Bell
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2017 Clinical Applications of Smart Medical Technology
Chapter 1 Smart Hospital Accreditation Marks