Overview

InterSystems TrakCare™ software is a Web-based, patient-centric healthcare information system used by leading healthcare organisations around the world. It is comprised of a comprehensive portfolio of application modules, including patient administration, clinicals, departmental, and community solutions. Any of these modules may be quickly implemented to solve immediate, pressing problems, or modules can be adopted as an integrated portfolio to serve more expansive needs.

At the heart of TrakCare sits the electronic Patient Record (EPR), which captures the continuum of clinical and administrative information about a patient, and the Patient Master Index (PMI). The PMI can be run as a standalone product within a hospital or may be part of a larger state or national system.

What sets TrakCare apart from other hospital information systems (HIS) is its unique design, advanced underlying technologies, and “FastTrak to EPR” architecture and methodologies. This combination ensures that TrakCare offers unparalleled flexibility and speed-to-results, with rich EPR benefits available from the very first TrakCare module implemented. TrakCare can effortlessly encompass EPR information from a variety of systems, including legacy systems and non-TrakCare systems.

TrakCare is built on InterSystems Ensemble®, an innovative rapid integration platform. InterSystems Ensemble® shares core technology with InterSystems Caché®, which is the leading database for clinical applications worldwide. Because TrakCare is uniquely built on a powerful integration platform rather than on a traditional rigid database and the fixed technologies of the past, TrakCare modules easily and seamlessly connect to a broad array of patient information from across departments, institutions, regions, nations, and the world.

From its inception, TrakCare was built to meet the needs of the international marketplace. The TrakCare system provides multi-language support, and customers can readily customise layouts to support local language text. Unlike many hospital information systems that have evolved to become Web-enabled, TrakCare was designed from the ground up as a Web-based solution that allows ubiquitous and secure access to patient information, regardless of the healthcare professional’s location. Since it is Web-based, TrakCare also offers the hardware cost-benefits of a thin client while minimising the IT and administrative overhead costs associated with software upgrades in the traditional client/server environment.

The rigidity of most HIS systems requires healthcare professionals to either adapt processes to mirror their system, or face a lengthy and costly custom implementation project. Laborious specifications detailing phases notoriously delay HIS implementations. If everything is not defined perfectly, or when specifications change, these systems are frustratingly difficult to modify. At InterSystems, we understand your desire for a hospital information system that works the way you do.

With TrakCare, customers can be up and running quickly, armed with powerful tools to readily tailor the solution as and when they choose – a future-proof solution that can rapidly address changes in technology, administration, and healthcare policies without expensive, lengthy recoding.

Our Workflow Manager tool facilitates business process flow in an automatic way. It establishes a desired sequence for tasks to be performed depending upon conditions and functions required by the user as well as secondary processes such as print jobs, alerts, and messages.

The built-in Layout Editor allows users to configure all screens to suit not only the function being performed, but also the unique needs of individuals and groups performing those functions. Menus, driven by workflows, can be defined for an individual user or for groups of users. Every module includes a variety of easy-to-identify icons and colours to highlight patient conditions. All icons are interactive and selectable, and provide an overview of the patient at a glance as well as the ability to drill down into the data.

TrakCare is Synonymous with Interoperability

With TrakCare’s FastTrak to EPR you can quickly achieve the benefits of a patient-centric EPR by integrating current applications with TrakCare and then implementing new functionality or replacing existing functionality over time. Installation of discrete modules streamlines the implementation period. Since TrakCare modules are preconfigured with automated installation routines and supporting installation/ setup and training documentation, these modules can be deployed in achievable stages. TrakCare’s FastTrak to EPR is a proven path to exceptionally fast, successful project outcomes. Perhaps the best example of fast results was when TrakCare was chosen to run the Olympic Polyclinic at the 2004 Athens Games. In just nine days, the team installed TrakCare, transferred demographic and medical data on thousands of athletes to its database, trained volunteer personnel, and went live on schedule.

FastTrak to EPR

Section 1: TrakCare System Management Tools

At InterSystems, we understand that users want their hospital information systems to mirror the way they work. To provide unparalleled flexibility in meeting the unique needs of specific geographies and clients, TrakCare comes with a series of powerful tools that allow clients to configure the system around their specific workflows and to manage access to applications and data. Tools available include:

• Menu Manager
• Workflow Manage
• Layout Editor and Column Editor
• Language Support
• Security
• User-Defined Help Text
• Questionnaires
• Custom Development
  • User-Defined Functions
  • Custom Scripts
• Report Generation and Printing

Menu Manager allows menus to be defined for an individual user or for groups of users. Each menu is defined by its start page, which is usually a presentation of the patient data that best suits the user. This may be a patient list for a desired ward, a floor plan for a patient’s desired location, a clinic list for some or all outpatient appointments scheduled for the day, a theatre list specific to a location for a day, or a sample collection list for a pathology collector. These are configurable to the user’s security group.

The start page allows the user to identify the patient either by selecting the patient from a list or by searching for the patient, and then perform the desired function. A main menu header consists of the most frequently used menu options that the user requires in a day. These menus within the main menu headers may be module-specific or may cross modules as required. TrakCare distributes a standard set of main menu headers, but each site can customise these as desired. Each TrakCare menu drives and initiates a workflow.

Example Start Page: Foor Plan

Example Start Page: Main Ward List

Workflow Manager allows users to establish a desired sequence of tasks to be performed depending upon conditions and functions required by the user as well as secondary processes such as print jobs, alerts, and messages.

Workflow Manager is an intuitive tool that creates tailored step-bystep prompts for the processes and tasks required of each staff member. Containing up to 90% of an employee’s workflow on a single personalised screen, it ensures consistency of quality and processes throughout the facility. The highly visible documented workflow has also proven to be instrumental in reducing staff training time.

Example: Emergency Scenario

1. Patient presents to the Emergency department
2. Patient fills out an admission form:
   • Receptionist searches the database for the patient to see if he has been admitted to the hospital on a previous occasion
   • Receptionist updates the patient’s demographics
   • Receptionist enters next of kin details
   • Receptionist enters other address details
   • Receptionist completes admission details
   • Condition – if the admission is a traffic accident presentation, receptionist enters traffic accident details
   • Receptionist starts the process again for the next patient

To automate the previous scenario, the following screen shot outlines the suggested workflow for each individual step in the process.

Example: Workflow

Layout Editor allows all activity in TrakCare to be conducted using a standard keyboard and/or mouse. Layout Editor is one of the key tools that makes TrakCare so intuitive for users.

Layout Editor enables staff to tailor screens to suit their requirements after the application has gone live. This means that less adaptation is required in advance, so TrakCare can be up and running in less time. It also allows screens to be changed as job functions change.

Tailoring can be as diverse as assigning default values and mandatory fields to speed the input process to assigning user preferences for screen sizes, which may range from a small format mobile device screen to a large plasma screen.

Functions include:

• View Toolbox
• Move a Field
• Delete a Field
• Add a Field
• Make a Field “Mandatory”
• Make a Field “Display Only”
• Show Properties
• Change Field Names
• Hyperlinks
• Field Tab Sequence

When a list of records is displayed on the screen, Column Editor allows the hospital to define the characteristics of the list including:

• What columns will appear on the list, including column width and wrap details
• The sequence in which the columns will appear
• The default sequence in which the records will display
• Columns by which the list can then be sorted
• The number of records per screen to be displayed
• Whether the list may be printed

Language Support in TrakCare’s Translation Engine enables clients to readily translate all screens, captions, messages, and error messages, to provide user interface in other languages. Translations can be carried out globally across the system or locally to a specific screen. Language preference can also be set for each user, and when the user logs on, the system will automatically default to the preferred language.

In Indonesian hospitals for example, TrakCare can not only display a set of results to doctors in either Bahasa Indonesia or English depending on preferences, but the same results can also be viewed on a split screen showing both languages at the same time.

Dual-language formats for names are also accepted, as shown below.

Example: Dual-Language

In addition TrakCare offers support for a variety of:

• Languages (Arabic shown above)
• Unknown/estimated dates of birth (denoted by ?? as above)
• Date formats including the Hijri and Christian calendars
  (Hijri dates denoted in brackets as below)
• Patient confidentiality features (Anonymous is triggered via an optional flag)

Example: Patient Banner

Security details located in Section 3.1 (TrakCare Technical Features).

User-Defined Help Text includes a contextual online help feature at both the function and field levels. By selecting the F2 key, help for the function being executed is displayed. Hospitals are encouraged to refine the Help documentation to include details of the work practices within the hospital. Similarly, by moving the cursor over a user-enterable data item, a tool-tip field can be displayed.

Example: Typical User-Defined Help Screen

Questionnaires offers an intuitive assessment and information-gathering tool that can be defined by a clinical speciality to suit his individual requirements. Questionnaires can be entered directly from the EPR or defined as an integral part of a clinical workflow to ensure that all required information is collected. Current processes that include Questionnaires are: order entry, order administration, diagnosis, clinical pathways, and patient assessment. All completed questionnaires are Page 8 available in the EPR for review and can be defined against the patient’s episode of care or an individual order item. Questionnaires can also be used to record results against an order (e.g., a consultation order). These completed questionnaires can be seen as results.

Example: Questionnaires

Custom Development includes a User- Defined Function (UDF) that allows site-specific coding to be added that can be used to:

• Make changes to the database for noncore functionality
• Print labels
• Define barcode formats
• Generate nonstandard internal numbers

Custom Scripts allows site-specific changes to screen functionality, such as making certain fields conditionally mandatory or changing the application that will open a document.

Custom Report Writer and Printing Capabilities includes custom reports that can be defined and produced through Business Objects Crystal Reports. Printing for these reports can be defined to allow production or on-demand printing to a network printer. In addition, the reports can be created in an Adobe PDF or RTF file that can be e-mailed.

Section 2: TrakCare Modules

2.1 TrakCare Core Components

TrakCare is based upon the core software components supporting the Electronic Patient Record and the Patient Master Index. In addition, TrakCare provides application functionality to support the needs of the healthcare information system across clinical, administrative, and departmental requirements.

2.1.1 Electronic Patient Record (EPR)

The EPR within TrakCare is designed to capture the continuum of clinical and administrative information about a patient. The record contains patient demographics, medical history, previous admission information, previous surgery information, and obstetric history. Patient information can be captured from legacy systems linked through the TrakCare Integration Platform, or the information can be obtained directly from the full set of TrakCare applications.

To access the EPR, the patient is identified by number, or name, or from an optional favourites list if he is seen often by the clinician. The EPR provides a visual display of all information that has been collected.

The EPR includes:

• Patient History allows healthcare professionals to view, amend, or add to the patient’s past medical, social, and family history.
• Allergies and Alerts allows healthcare professionals to view previously recorded allergies and alerts as well as add those newly identified. In addition to notifying clinicians of potential risk to the patient, information about the nature and severity of allergic reactions is also available if it has been captured. The severity can be colour-coded to provide a visual display of allergic sensitivities.
• Results and Order History presents the results and order history of diagnostic and investigative procedures. Results can be sent from the departmental system to the EPR via the TrakCare Integration Platform. This gives healthcare professionals access to results within the EPR view. Results can be displayed in a singular or cumulative format and are presented with clinical indicators, including abnormal results, reference ranges, and criticality status where applicable. System-based highlights and icons act as alerts to abnormal as well as new results.
• Diagnosis Entry allows the input of multiple diagnoses and diagnosis status for each patient episode, including admitting diagnosis, suspected diagnosis, final diagnosis, and discharge diagnosis. The diagnoses may be based on ICD-10 or a similar coding system.
• Patient Notes Entry allows the clinician to enter and view patients’ conditions. Notes Entry tools include strikethrough to view modifications to notes and coded text entry, facilitating the quick entry of standard phrases and comments.
• Clinical Summary History, also referred to as discharge summary, allows the clinician to view previous discharge summaries generated for a patient. This can be viewed in text or tabular format.
• Time Line graphically displays the patient’s EPR. It also allows healthcare professionals to select one or more episodes to view patient data concurrently in the format of the defined EPR charts.

2.1.2 Patient Master Index (PMI)

The PMI is the cornerstone of the TrakCare system, supporting the patient-centric EPR. As well as being able to run the PMI functions independently, these functions are an integral part of each TrakCare module (e.g., when a patient is admitted to the hospital, the PMI Search and Registration functions can be included as part of the workflow for the admission process).

The PMI can be run as a stand-alone within the hospital (or group of hospitals) or can be part of a larger state or national system. In the latter situation, a patient may have a local identifier as well as a state or national identifier. The TrakCare system allows for this identifier to be assigned by the appropriate provider.

A unique hospital identifier differentiates each patient. The format of this identifier is definable by the hospital and may be purely numeric or a combination of alpha and numeric characters. The hospital identifier can be automatically assigned to the patient or manually entered at registration time.

The TrakCare PMI provides healthcare facilities with the ability to record extensive information about a patient. The details displayed can be configured by the hospital using the TrakCare Layout Editor.

Typically, this screen would contain:

• Fields for entering a patient’s socio-demographic details to defining mandatory fields (e.g., patient title, surname, given name, sex, date of birth, address, language spoken, country of birth, etc.)
• Links to other screens for entering:
  • Other address details (e.g., previous addresses, postal address, and mailing address)
  • Contact details (e.g., next of kin, nearest relative, or guarantor)
  • Alerts (e.g., medical, administrative, and clinical)
  • Alias details (e.g., names, sex, date of birth)
  • General practitioner details (or viewing these details)
  • Family doctor history
  • Links (e.g., family, mother/baby)
  • Audit details, such as who last updated the record, all changes made to the record, and details of who has viewed the record Other functionality within the PMI includes:
  • Specific edit restraints set for each field
  • If the patient’s name, sex, or date of birth fields are changed, the user is asked whether to create an alias of the old details
  • If the address or phone number information of the patient is changed, a history of previous addresses/phone is maintained
  • When the suburb is entered, a postcode search facility is available
  • If the patient’s exact date of birth is unknown, an estimated date can be recorded and a flag can be set to indicate this

2.1.3 Application Integration Platform

TrakCare derives much of its power from the fact that it has been built on InterSystems Ensemble®, a rapid integration platform. Designed with today’s Web and service-oriented architectures in mind, TrakCare excels at quickly creating and deploying new business solutions that leverage the functionality of existing applications, orchestrate new business processes, and integrate data from across the entire hospital, outsourced service providers, and community health services.

2.1.4 Healthcare Applications

TrakCare offers a comprehensive set of application modules that assist in the smooth functioning of healthcare facilities. By design, the system focuses on the patient, managing both clinical and administrative information via the EPR. Modules include:

• TrakCare Clinicals
• TrakCare Patient Administration System
• TrakCare Community
• TrakCare Emergency Management
• TrakCare Laboratory

TrakCare supports the entire continuum of care, providing the right information to the right healthcare professional at the right time.

TrakCare Supports the Continuum of Care

2.2 TrakCare Clinicals (CIS)

Consider the problems that arise when an elderly, confused patient presents for treatment and is unable to recall his past medical experiences. Imagine if the doctor could immediately access that patient’s complete medical history at that facility, all from a single screen. Diagnosis and treatment could be carried out much faster and far more accurately. This is what TrakCare Clinicals offers.

All TrakCare functionality is built on the Electronic Patient Record (EPR) and allows the capture, display, and analysis of patient-centric information, facilitating better patient care.

TrakCare Clinicals provides functionality to review and document patient care, and as a by-product automates the ordering of treatment and procedures. TrakCare Clinicals can be implemented as a stand-alone product integrated with existing systems, or in parallel with one or more modules of TrakCare.

TrakCare Clinicals allows authorised healthcare professionals to document care and enter treatment, exploratories, and procedures directly into the patient’s EPR using a connected computer located in a ward, clinic, consulting room, home, or office. Orders can be sent to the provider of the service electronically, by e-mail or fax, or they can be printed to enable the clinician to sign and verify an order if required.

Functionality

All clinical functionality starts with the TrakCare Clinicals – Foundation module. The following add-on modules can be implemented in parallel with TrakCare Clinicals – Foundation or as part of a phased implementation plan:

• Nurses Workbench
• Clinicians Workbench
• Prescribing
• Pharmacy Workbench
• Radiology or Departmental Workbench
• Active Decision Support

Clinical Applications

2.2.1 TrakCare Clinicals - Foundation

In addition to the TrakCare Core Components (see previous section), TrakCare Clinicals – Foundation includes the following components:

• Patient Lists
• Questionnaires
• Orders
• Clinical Summary

Example: EPR

• Patient Lists includes:
  • Patient and Patient Episode allows healthcare professionals to define a list of regularly accessed patients or specific, regularly accessed patient episodes.
  • Care Provider Patient List allows clinicians to build lists of current patients according to their specifications based on various filtering criteria, such as specialty, care provider, patient type, and patient location.
• Questionnaires allows healthcare providers to capture assessment or other relevant information about the patient. Features include:
  • Intuitive Assessment and Information-Gathering Process can be defined by the clinical speciality to suit individual requirements and attached to workflows in the system. Answers from previously completed questionnaires can be used as defaults for faster entry.
  • Unique Decision-Tree Assessment Tools are triggered by the selection of a category of consultation generating decision-tree questions that can result in the selection of the appropriate clinical pathway/care plan.
  • Flexibility of Workflow Location allows questionnaires to be entered directly from the EPR or defined as an integral part of a clinical workflow, allowing healthcare professionals access at the right time and ensuring all required information is collected. Current processes with Questionnaires include: order entry, order administration, diagnosis, clinical pathways, and patient assessment.
  • EPR View makes all completed questionnaires available in the EPR for review and can be defined against the patient’s episode of care or an individual order item.

• Orders provides the foundation for recording and communicating information about the tests, results, and treatments for each patient. Features include:
  • Order Entry
  • Frequently Requested Items can be set up by healthcare professionals to enable these items to be quickly selected.
  • Questions can be defined for display at various points in the order entry workflow, ensuring relevant clinical information is collected.
  • Order Sets enables healthcare professionals to quickly order a group of order items, rather than selecting each item individually.
  • Order Entry Alerts are triggered for combinations of events.
  • Security Restrictions are a standard feature throughout TrakCare. Security group restrictions limit the user’s ability to order items and view sensitive orders and results.
• Clinical Summary provides a summary of clinical and administrative activity when a patient is discharged or transferred to another service. This document is used to communicate to consulting physicians and other caregivers involved in the patient’s treatment. Clinical Summary is comprised of the following features:
  • Configurable Format and Content can be designed (using Business Objects Crystal Reports or Microsoft Word) to meet a range of clinical settings. Patient information provided in the report can include principal diagnosis, other conditions and complications, procedures, medications, clinical opinion, and management plan. • Multiple Document Types supports different types of summaries. For example, an inpatient discharge summary, an inpatient or aged-care transfer, or a nursing discharge summary.
  • Multiple Episode Summaries can be produced for one or more episodes, including nondischarged episodes, statistical discharges, and statistical readmissions. Episodes can also be identified as not requiring a summary.
  • Automated Distribution of the Clinical Summary supports electronic transfer, automatic faxing, printing, and e-mailing to the recipients selected by the user. The distribution list can include external healthcare professionals or organisations.
  • Security Features ensure only authorised users can modify the Clinical Summary. Flexibility exists to retain previously created discharge/transfer/ clinical summaries and produce a new version, which can then be updated.

2.2.2 TrakCare Nurses Workbench

In addition to the clinical functionality available in TrakCare Clinicals – Foundation, TrakCare Nurses Workbench helps nurses track and manage their daily workload, improving their task efficiency and patient care.

TrakCare Nurses Workbench includes the following functionality:

• Workload Tracking enables nurses to build patient-centric worklists according to various filtering criteria such as specialty, care provider, patient type, patient location, orders and results status, and priority.
• Scanning and Image Association allows document and image files to be placed directly against a patient’s episode of care or selected order items.

Nurses Workbench clearly defines the daily nursing interventions and tasks, facilitating the recording of information such as:

• Drug Administration makes medication and fluid that are ordered for the patient visible in the Nurses Workbench. The workbench displays what is required to be administered to the patient and then provides a streamlined process to register the administration of those medications.
• Observations allows the recording of a patient’s clinical observations throughout the episode of care. TrakCare allows clinicians to enter patient measurements such as weight, heart rate, and blood pressure directly into the EPR. Measurements can be graphed to show changes over a period of time and can be printed for inclusion in the patient’s record. Abnormal results can be highlighted when they fall outside hospital-determined reference ranges. The observations may be defined to suit the clinical requirements of the site or users and can be accessed from the EPR or from the nurses’ worklist or other functional workflow.
• Specimen Collection allows the viewing and collecting of specimens as required for ordered laboratory tests.
• Clinical Pathways allows the clinician to define the tasks required for the care of a patient with a particular admission diagnosis or referral reason.
• Care Plans supports the planning of care tailored for the individual. Interventions derived as a result of care planning are matched and scheduled into the clinician’s diary. Standard Care Planning templates can be created.

2.2.3 TrakCare Clinicians Workbench

TrakCare Clinicians Workbench provides further advanced functionality to locate and view patient details and manage the electronic charting of the patient’s progress. It allows authorised healthcare professionals to document care and enter treatment and investigational requests directly into the patient’s EPR.

TrakCare Clinicians Workbench includes:

• Doctor’s Patient List allows healthcare professionals to define a list of regularly accessed patients or specific, regularly accessed patient episodes.
• Orders and Results Worklists deliver current laboratory, radiology, and medication data to the point of care. The worklist allows the clinician to access a list of patients’ results online and review orders according to specified defaults and sort criteria. A clinician’s own specific defaults and preferences can be defined and saved.
• Patient Assessments and Consultation includes:
  • Patient History
  • Subjective Findings for the entry of chief complaint and additional easy lookup fields
  • Objective Findings for the entry of observations and questionnaires
  • Assessment for the entry of diagnosis and clinical notes
  • Plan for the generation of orders
• Clinical Pathways allows the clinician to define the tasks required for the care of a patient with a particular admission diagnosis or referral reason.

Example: Clinicians Workbench

2.2.4 TrakCare Prescribing

The addition of the Prescribing module to TrakCare’s core functionality provides healthcare professionals with the additional safety of a clinical review system that offers medication checks and patient alerts when generating and capturing medication management plans.

With TrakCare Prescribing, the EPR includes the Medication Profile as well as standard EPR functionality.

Prescribing includes the following functionality:

• Generic or Brand
• Frequently Requested Items can be setup by healthcare professionals to enable these items to be quickly selected.
• Priority Assignment
• Questions can be defined for display at various points in the order entry workflow, ensuring relevant clinical information is collected.
• Order Sets enables prescribers to quickly order a group of items, rather than selecting each item individually.
• Prescribing Checks and Alerts are integrated into the prescribing process. TrakCare can be integrated with a third-party pharmaceutical drug knowledge database to provide checks and alerts for concerns including:
  • Allergies provides an alert when current medications prescribed have the potential to create an allergic reaction. The patient’s allergy history can be viewed showing the severity and the nature of the reaction recorded. Where a previous severe reaction was recorded, a mandatory override can be configured as part of the ordering process. Medication allergies can be configured to provide the following alerts:
    • Ordering of the same brand
    • Ordering an item that includes an allergy-related ingredient
    • Ordering an item from the same generic group
    • Ordering an item from the same allergy group (e.g., penicillin)
    • Ordering an item from an allergy group likely to give a cross-sensitivity reaction (e.g., cephasporins)
  • Duplicate Checking is available at a number of levels including:
    • Therapeutic Duplication Alerts
    • Order Item Duplication Alerts
• Interaction Alerts display when current prescribed medications interact.
• Drug Information can be displayed as an order entry message or links provided to thirdparty online or offline drug monographs.
• Therapeutic Substitution creates sets of medications or single medications to recommend to clinicians as alternatives to the placed orders.
• Formulary Management designates medications as formulary or nonformulary items. Ordering can then be restricted via security group dependent on formulary status.
• Security Restrictions are a standard feature throughout TrakCare. Security group restrictions limit the user’s ability to order items and view sensitive orders.

2.2.5 TrakCare Pharmacy Workbench

TrakCare Pharmacy manages safe prescription dispensing and inpatient dispensing. Additional tools are available to support clinical pharmacist activities such as medication review, patient counselling, and education.

Pharmacy Workbench includes the following functionality:

• Dispensing Workbench
• Electronic Format receives pharmacy prescriptions in electronic format, directly into the dispensing system.
• Full Prescription Dispensing
• Unit Dose Dispensing
• Configurable Dispensing Process
• Queuing of Medication Orders with verification, dispensing, and dose reconciliation
• Clear Display of prioritised patient lists with current clinical information
• Patient Alerts
• Drug Manufacture records the manufacturing process and the product formula, specifies the quantity for manufacture, and deducts the quantity of items used automatically when the process is started. The product is also added to the inventory at the conclusion of the manufacturing process.
• Medication Review Reporting includes the following features:
  • Configurable Format and Content can be designed (using Business Objects Crystal Reports or Microsoft Word) to meet a range of clinical settings. Patient information provided in the report can include principal diagnosis, other conditions and complications, procedures, medications, clinical opinion, and management plan.
  • Multiple Document Types can be configured to support different types of medication review reports.
  • Automated Distribution of the medication review reports summary can be carried out by electronic transfer, automatic faxing, printing, and e-mailing to the recipients selected by the user. The distribution list can include external healthcare professionals or organisations.
• Pharmacist Clinical Workbench includes the following features:
  • Prioritised Worklist
  • Single Entry, including therapy notes
  • Review and Actioning
  • Access to all relevant patient information and results
• Security Features ensure only authorised users can modify the medication review reports. Flexibility exists to retain previously created medication review reports and produce a new version, which can then be updated.

Example: Patient Alerts

2.2.6 TrakCare Radiology/Departmental Workbench

TrakCare Radiology/Departmental Workbench streamlines the entire work process of the medical imaging department, allowing for easy and efficient order placement, authorisation, and scheduling. The module can also be used to support other departments, including physical therapy and cardiology.

The capture of pre- and post-examination data and integrated dictation, transcription, and result verification functionality completes the Imaging Facility functionality. Authorised healthcare professionals can review treatment and investigational requests, documenting care/results directly into the patient’s EPR. Results can be sent electronically, printed, e-mailed, or faxed to the requesting healthcare professional.

With TrakCare Radiology/Departmental Workbench, the EPR includes basic workbench functionality including:

• Scanning and Image Association and the recording of patients’ clinical observations are available throughout the episode of care. The observations can be defined to suit the clinical requirements of the site or users and can be accessed from the EPR or from the nurses’ worklist or other functional workflow.
• Appointment Management allows authorised staff to schedule an appointment, place the patient on a waiting list, or perform a procedure immediately once an order has been approved. The system provides the facility to display available time slots at a resource or departmental level, making the task of scheduling both simple and efficient.
• Departmental Workload Manager provides a prioritised worklist of patients and orders, displaying the essential clinical and administrative information for efficient workload management. This is available in standard, diary, and split screen views.
  • Order Authorisation allows authorised staff to review, authorise, or reject requests. Request information or procedures can be updated or changed by authorised staff when required.
• EPR View makes all completed questionnaires available in the EPR for review. They can be defined against the patient’s episode of care or an individual order item.

Radiology Workbench comprises the following additional functionality:

• Pre- and Post-Examination Details allows authorised staff to record more information on the execution of investigations, including material used and the degree and intensity of the investigation.
• Result Reporting (Dictation, Transcribing, and Verification) allows results of investigations to be recorded through simple entry by authorised staff. Alternatively, results can be entered in discrete steps from digital dictation to transcription to result verification.
• Images can be accessed and annotated directly from the Departmental Workbench or through the EPR via the TrakCare Clinical Viewer or an interfaced third-party viewer.

2.2.7 TrakCare Active Decision Support

TrakCare Active Decision Support provides targeted information about critical patient risk factors to assist clinicians in decision making. In addition to the Active Decision Support messages provided in TrakCare Clinicals, such as interaction and duplicate checking, this module provides the unique functionality of creating user-defined rules that drive decision support actions.

Actions can be as diverse as sending a pop-up message to the user, sending an e-mail or fax to the referring doctor, sending an internal message to the laboratory, or even changing the status of an order to “On-hold,” or a waiting list status to “Cancelled.”

The rules can be set across the conventional therapy and patient condition (e.g., issuing an alert if warfarin is ordered for a patient who is just three days out of post-op).

Designed with uncluttered screens, TrakCare Active Decision Support ensures that the desired information is readily and clearly available, avoiding the pitfall of multiple, confusing alerts.

Active Decision Support comprises the following functionality:

• Rules and Events functions at the simplest level by having a rule take two different fields and build a ready reckoner reference. Rather than query the database directly each time a decision support condition needs to be evaluated, this index can be referenced, dramatically reducing query times. Events are the triggers set in TrakCare. For example, an event may be as simple as one condition such as, “If the current patient is ordered aspirin,” with only one condition to satisfy this event. Complex events can also be created by attaching multiple conditions: for example, “If the current patient is ordered atenolol” AND “the ordered date is in the last two days” AND “for a patient with an active diagnosis of heartblock.”
• Actions are what we would like to happen if the conditions of our event have been met. For this reason, the action screen offers a broad range of options. Action types include:
  • Alert (pop-up) can be configured to display:
    • Error Message will not allow the user to proceed
    • Warning Message offers the user the choice of proceeding or aborting the intended event, by way of a pop-up message with “OK” and “Cancel” options
    • Information Message offers an “OK” button only, but will not affect the intended workflow
  • Messages can be directed to users, groups, or allocated care providers. The message can be standard or dynamic so that variables can be inserted into the message. They can take the form of e-mails, faxes, or TrakCare Message or Pager.
  • Set Field Action allows direct manipulation of database fields. For example, the order status could be changed for a particular order from “Verified” to “On-hold” by use of this action.

2.3 TrakCare Patient Administration System (PAS)

TrakCare PAS modules automate workflow within the Inpatient, Outpatient, and Emergency departments of healthcare organisations and community health areas. TrakCare PAS is used extensively in countries such as Thailand, where thousands of patients need to be managed and billed, and was an important tool in patient management during the aftermath of the 2004 tsunami in Phuket.

Each module assists in meeting the unique requirements for registering and managing the specific patient population. In addition, Record Tracking, Coding, and Operating Theatre functionality is available. The Tracking and Coding functionality allows the tracking of charts and coding of diagnoses and procedures. Operating Theatre allows close coordination between the theatre and bed management areas of a hospital.

TrakCare PAS can be implemented as a standalone product integrated with existing systems or in parallel with one or more TrakCare modules.

The integrative nature of TrakCare PAS provides administrative personnel with the tools to capture data and coordinate and manage patient encounters across the continuum of care in an intelligently efficient and automated way. Additionally, it means all encounters and services are available to be viewed in the EPR.

PAS Applications

Functionality

TrakCare PAS includes a number of modules. All PAS functionality starts with the PAS – Foundation module, which includes:

• Patient Master Index
• Inpatient Management
• Outpatient Management
• Medical Records Tracking and Coding

Additional modules include:

• Maternity
• Operating Theatre Management
• Patient/Client Billing
• Waiting List/Recall

TrakCare Community, Emergency, and Outpatient modules can be implemented as part of a phased implementation or as stand-alone.

Waiting Lists is an optional module that can be used with TrakCare Inpatient or Outpatient Management.

Patient/Client Billing is an additional module that can be used with any of the TrakCare modules.

2.3.1 TrakCare Inpatient Management

Envision a facility where a patient’s complete medical history is instantly available, up to date, and on-screen from the time his unique identifier is presented. How much easier would inpatient management become?

The TrakCare Inpatient Management (IPM) module is a comprehensive tool that can be run in any environment from a single hospital to large enterprise-wide organisations. It provides the functionality necessary to manage inpatient events.

Inpatient Management’s integration with other TrakCare modules ensures that information relating to pre-assessment, clinic attendances, emergency attendances, and past admissions are all available for viewing in the patient’s EPR. Additionally, patient medical records can be automatically or manually requested and tracked in accordance with patient movements. Where applicable, the IPM module also provides an automatic billing process for patients who have received billable services.

Core functions of IPM include:

• Registration
• Admission
• Leave includes temporary and contract patient leave.
• Movement records patient movement throughout the healthcare organisation.
• Discharge
• Condition includes patient condition, progress, and visitor status.
• Patient Enquiry
• Bookings/Pre-Admission allows the patient’s booking details to be entered directly, or selected from a waiting list.
• Ward Lists
• Bed Search
• Bed Request
• Letters includes a history of correspondence.
• Discharge Summaries
• Billing

Additional Features

• Floor Plans provides a graphical representation of the layout of the ward, including a true view of the bed activity of the area. Inpatient activity is provided using colours and icons as descriptors of the current status.

Example: Floor Plan

• Bed Management provides bed managers with a complete view of all beds, their current status, and prospective activity to assist with planning (including current inpatients and those expected to arrive for admission). Ward lists, status, occupancy, floor plans, bed requests, bed searches, and reports provide the bed manager with a total view to plan and allocate beds.

Example: Bed Managers Start Page

The functionality of the Bed Management module serves as a tool to help individual hospitals optimise bed availability and resources at all times by providing a comprehensive and global view of bed status.

It addresses communication issues specific to bed management and bed allocation by providing online, real-time access to constantly changing indicators.

• The Bed Management system manages:
• Available/unavailable beds
• Current bed occupancy
• Bed and patient bookings
• Time of bed availability (projected and actual)
• Location of available beds for emergency admissions, including specific services such as paediatrics, cardiology, and intensive care
• Proposed transfer of patients from one specialty to another
• Transfer of patient from one bed to another (drag and drop)
• Allocation of patient and bed status discharge times
• Closing and reopening cubicles, beds, rooms, or even wards
• Flagging/reserving a bed as pending for an individual patient
• Monitoring of patient movements to temporary locations (e.g., X-ray)
• Identification of boarders
• Monitoring of patients on leave and their return date

The system makes managing beds simple. Authorised staff can display all available, occupied, or booked beds for a single ward, single department (specialty), or the entire hospital. TrakCare will warn the user when hospital policies are violated.

A ward list displays colour-coded columns corresponding to various time frames to indicate estimated discharge dates. The number of patients per time frame appears in each column. Inliers, outliers, and booked patient numbers for each ward are also displayed.

From the Bed Management screen, staff can manage all functions, including opening and closing wards/rooms and beds, searching for available beds, and reviewing bookings and waiting list entries.

The Bed Management module also facilitates the movement of patients from the Emergency department to available beds in wards.

In the event of disaster management, the system will immediately identify bed vacancies in wards in relation to the Emergency department’s demand, allowing the department maximum access to beds.

This module can also act as a management tool in matching open and available beds to reflect nursing staff levels per ward.

• Icons in the standard TrakCare IPM include:
  
  
  

• Mental Health allows for the entry of patient details specific to and necessary for the completion of mental health data records.

• Mobile Devices (Point-of-Care Access) addresses the challenges faced when recording information at the point of care and complements the EPR, extending TrakCare to the client. It applies the latest technology to bring fast, affordable, accurate, computerised charting to the client’s home or bedside.

2.3.2 TrakCare Outpatient Management

Imagine treating 1,000 outpatient attendances per day in just one clinic. What about handling appointments where 80% are walk-in patients presenting to clinics without appointments? TrakCare clients face both scenarios, and the TrakCare Outpatient Management (OPM) module accommodates both extremes.

The TrakCare OPM, like all other TrakCare modules, is built on the Electronic Patient Record (EPR) and allows the capture, display, and analysis of patient-centric information, thus facilitating better patient care.

The TrakCare OPM module can be used in any environment, from traditional single-site outpatient units at small or large public or private hospitals to very large multi-site enterprises. OPM enables the coordination and efficient scheduling and management of healthcare professionals and outpatient locations (rooms). The coordination and management of daily planning and activity can be based on a centralised or decentralised booking environment. The application provides clinical and non clinical teams with clinical, location, administration, and billing functionality, and all users have access to the theatre in real time.

OPM is fully integrated with other TrakCare modules. This integration means information relating to pre-assessment, clinic attendances, emergency attendances, past admissions, and the services provided as part of these events is available for viewing in the patient’s EPR. For any clinic attendance, the patient demographic details, and admission, clinical, and billing processes are linked and allow for the real-time clinical and financial management of the patient.

OPM is a key patient administration module within TrakCare and is provided whenever TrakCare PAS Foundation is purchased. TrakCare OPM is not available as a stand-alone product.

TrakCare OPM provides the foundation for TrakCare Polyclinic.

OPM functions are delivered by the core feature set and may be further enhanced through optional implementation of the additional features described below.

Core Functionality

• Registration allows the user to create a new patient record or search for an existing patient previously registered in TrakCare. Search tools include phonetic and partial search for a variety of patient identifiers. The registration workflow supports the ability to quickly create an episode “on-the-fly” if one does not already exist in the system.
• Referrals enables system users to create and view outpatient episode/referral details for the patient. Patient appointments are subsequently attached to this episode/ referral. Appointments can also be attached to inpatient and emergency episodes.
• Multi-Referral allows the user to search for outpatient episodes/referrals within a given date range, or by clinic, doctor, hospital, or admission status. Appointments can then easily be booked for those on the returned list.
• Appointment Management facilitates the scheduling of patient appointments. The system user is able to:
  • Book single or multiple appointments
  • Make follow-up appointments
  • View appointment details
  • Record and update appointment status (e.g., arrived or failed to attend)
  • Record and update appointment outcomes (e.g., rebooked or transferred to other hospital)
  • Reschedule appointments
  • Cancel appointments
  • Notify relevant service providers of the need for transport or interpreter services for an appointment
  • Record the patient’s confirmation of attendance at an upcoming appointment
• Over Bookings allows clinics to accommodate additional planned or unplanned attendances. Users can be assigned permission to overbook as required.
• Schedule Management enables the management of outpatient clinics, including the management of appointment time slots and load levels. The ability to define and configure appointment slot service overrides, “not available” periods, services offered, and irregular sessions is included.
• Variance records details of any variance for a scheduled clinic relating to actual clinic start and end times and reasons for variance.
• Letters produces patient correspondence directed toward the patient or general practitioner, including appointment letters, notification of rescheduled appointments, cancellation letters, and waiting list notification letters. A history of correspondence is also available, detailing creation and reprint details along with the ability to view the sent documents.
• Clinical Summaries is a standard discharge summary functionality included in the OPM module. The system can automatically generate and send a clinical summary letter to the patient’s local doctor regarding an outpatient episode/referral. Please refer to the integration section for details of optional advanced clinical summaries functionality.

Additional Features

• Bulk Transfer allows the user to select a number of appointments for a given schedule, and then cycle through these appointments by transferring them to another clinic or clinic session using the appointment booking function. Alternatively, a number of appointments for a given schedule may be selected and automatically transferred to the next available appointments in a single action.
• Worklist for OPM displays the daily or weekly clinics and appointments for any polyclinic care provider. Many of the functions required for dayto- day management of clinics and appointments are available from the worklist, including “updating” an appointment status, changing the available appointment slots for a clinic session, or “updating” patient, appointment, and episode details. Users can also define their clinic preferences. Clinic preferences allows the user to define a list of regularly accessed clinics that he needs to manage.
• Schedule Calendar displays a calendar view for a selected care provider/clinic, and shows his/its workload for a given month. The calendar may be configured to display summary information or details.
• Flexible Session Management enables outpatient clinic details, such as appointment slot availability, services offered, or load levels to be controlled at both a session and a day level, thus allowing maximum flexibility.
• Schedule Transfer and Copy allows “schedule templates” to be copied from one care provider or resource to another to reduce set up time. The schedule template and all future appointments attached to the schedule can also easily be transferred from one care provider or resource to another.
• Medical Record Management allows medical records to be automatically requested in preparation for the patient attendance at a particular clinic.
• Labels and Forms produces a variety of printed documentation, including client labels and registration forms.

2.3.3 TrakCare Polyclinic

Whether you have a minor condition like a common cold or suffer from a chronic condition like diabetes, a polyclinic is a one-stop provider of healthcare needs. A diverse range of healthcare providers and ancillary clinics are usually found within a polyclinic, with services provided by general practitioners, nurses, and allied healthcare practitioners such as physiotherapists and podiatrists. Unlike traditional outpatient clinics which are located with tertiary care facilities, polyclinics tend to be autonomous and provide a broad range of services. These services range from management of acute and chronic medical conditions to health education, childhood immunisation, health screening, vaccinations, X-ray and laboratory services, as well as minor surgical procedures.

TrakCare Polyclinic, like all other TrakCare application modules, is built with the Electronic Patient Record (EPR) at its centre and allows for the capture, display, and analysis of patient-centric information to facilitate better patient care.

Polyclinic facilitates the efficient scheduling of healthcare professionals and clinic locations (rooms). The coordination and management of daily planning and activity and can be based on a centralised or decentralised booking environment. The application provides the clinical and non clinical teams with clinical, location, administration, and billing functionality, and all users have access to the clinic data in real time.

Polyclinic is fully integrated with other TrakCare modules when installed with them. This integration means information relating to preassessment, clinic attendances, emergency attendances, past admissions, and the services provided as part of these events are available for viewing in the patient’s EPR. For any clinic attendance, the patient’s demographic details are linked with his clinical and billing processes, which allows for the real-time clinical and financial management of the patient.

Polyclinic functions are derived from the TrakCare Outpatient Management module and Polyclinic is enhanced through provision of additional functionality as detailed below.

Core Functionality

• TrakCare Outpatients: Please refer to the TrakCare Outpatient Management section.
• Recall Management combines appointment scheduling and recall lists to facilitate the planning of patient care and assessments over a prolonged time frame to, for example, manage childhood vaccinations, preventative medicine, or annual assessments. TrakCare allows the user to define appointment schedules (including required order interventions) at regular or irregular intervals, with the flexibility to either generate the next patient appointment or place the patient on the defined recall list at completion of the appropriate appointment. This feature ensures maximum utilisation of clinic resources because appointments are made only when required and upon confirmation by the patient, thus minimising the amount of “no shows” for appointments.
• SOAP Consultation process allows care providers to create and document clinical consultations for patients based on a standard structure using Subjective, Objective, Assessment, and Planning (SOAP) information. Pre-defined categories of consultations help drive the information and functionality available to the care provider, including observation items, questionnaires and medication orders, recall management, patient and clinical information, as well as clinical summaries. Diagnosis assessments can be entered during a SOAP consultation which can also trigger a list of relevant orders for easy selection
  
  The SOAP methodology for consultation also allows the care provider to:
  • Group consultation visits by type
  • Copy consultation and orders from one visit to the next
  • Mark a consultation as significant
  • Enter a diagnosis using SNOMED, ICD, or site-specific naming conventions
  • Chart objective findings to display across all documented consultations with the active visit displayed in standard font and observations from previous visits displayed in italics for easy identification
  • Search for a specific consultation
• Walk-Ins easily manages patients who arrive in the polyclinic without an appointment. It allows the user to:
  • Triage the patient
  • “Attend” the patient without the need to schedule an appointment if he does not need to proceed to a general practitioner or clinic
  • Allocate the patient to a clinic appointment for that day or a future date
  • Automatically allocate a patient to an appointment with a care provider/clinic that is available to see walk-in patients
• Patient Tracking and Queue Management provides receptionists and care providers with an overview of where polyclinic patients are located with respect to their visit. They are able to determine if the patient:
  • Has arrived and is in the waiting room
  • Is with the care provider
  • Has departed the polyclinic
  • Is with another care provider
  • Has long to wait in the patient queue (if site uses a queue management system)
• Worklist displays the daily or weekly clinics and appointments for any polyclinic care provider. Many of the functions required for day-to-day management of clinics and appointments are available from the worklist, including “updating” an appointment status, changing the available appointment slots for a clinic session or “updating” patient, appointment, and episode details. Users can also define their clinic preferences. Clinic preferences allows the user to define a list of regularly accessed clinics that he needs to manage.
• Family/Carer Linking allows a patient’s/ client’s family members to be registered or added to the polyclinic database. This functionality assists with, among other things, managing communication and family group appointments.

2.3.4 TrakCare Medical Records

Tracking and Coding The TrakCare Medical Records Tracking and Coding modules solve the particular requirements of managing medical records and allocating clinical classifications to episodes of care. TrakCare Medical Records operates across the spectrum of healthcare environments, from single, stand-alone healthcare organisations to multifacility arrangements.

Integrated with other TrakCare modules, they assist those involved with managing the tracking of paper medical records and clinical classifications by facilitating the capture, display, and analysis of patient-centric information.

• Medical Record Management System provides a facility for tracking patient documents, including the patient’s medical records, dental charts, psychiatric records, and radiology films. In fact, any document that can be linked to the patient can be tracked.
• Document Tracking Facility helps to significantly reduce the time it takes to perform these clerical procedures. Each record is defined by both a document type and a volume number. There is no limit to the number of records that can be linked to a patient. Episodes can also be allocated to specific document types or volumes. The system will track records both within the Medical Records department and to external locations. It maintains a history of all movements for later analysis.
  
  Functions include:
  • Outstanding Medical Record Requests
  • Single Request
  • Single and Bulk Movement (Manual and Automatic)
  • Bulk Request
  • Outstanding Records List

The Coding System provides a facility for capturing the diagnosis and procedure codes assigned for each inpatient episode. The system can accommodate the range of versions of the WHO International Classification of Diseases and Procedures (ICD). With an interface to third-party grouping software, TrakCare can also record the Diagnosis Related Group (DRG) for that episode.

Functions include:

• Coding
• Coding Search
• Cancer Registration

Additional Features

• Automatic Record Request features Medical Record Management that allows for medical records to be auto-requested for inpatient, outpatient, and emergency patient attendances.
• Barcoding/Scanning can be used as a tool to move or request medical records within the system. It allows for timely processing of medical record requests and movements within a busy medical records department.
• Microfilm Entry (Single and Bulk) allows the organisation to record the roll number and position of information pertaining to a patient’s microfilm entry. This can be recorded individually for a patient or in bulk.
• Medical Record Types may be created, moved, and requested for patients. Multiple types may include a main medical record, community health record, X-ray record, dental record, and microfilm record, to name a few. pre-determined set of codes to a number of episodes. These codes are automatically assigned to the episodes and are best used when particular episodes at the hospital routinely require the same code sets (e.g., renal dialysis and chemotherapy).
• Copy Coding allows coders to “copy” codes between episodes for a patient. This saves valuable time when coding patients with many co-morbidities or coding patients who frequently present for the same condition/ treatment.
• Coding Edits assists in the accurate selection of ICD codes and reporting of coded data. The system allows for ICD edits to be defined against codes. Validations are activated upon update of the coding screen.
• Batch Grouping can be performed to automatically assign a DRG to an episode or a number of episodes according to a defined date range.
• Cancer Registration functionality exists to collect cancer/tumour details at the patient level, depending on the hospital’s data collection requirements. The Cancer Registration screen allows for episode details and clinical cancer details to be recorded. These can be extracted and reported manually or automatically to the relevant authority.
• Record Completeness allows the user to assign the level of completeness/status of a medical record at any time. For example, icons can display details at the patient level for any outstanding discharge summaries.

2.3.5 TrakCare Maternity

Prior to a woman’s delivery episode, on average she will have had around nine antenatal appointments. Subsequent to giving birth she will have multiple community interactions for either early discharge support and/or baby clinic, and vaccination services. So it’s important that the care provider with whom she is engaged has access to a dynamic module that captures both administration and clinical data during the antenatal, intrapartum, and postnatal periods of a pregnancy. The TrakCare Maternity module does just this with its Pregnancy Events Concepts.

TrakCare Maternity is built on the EPR. It provides a complete obstetric history for TrakCare clients, including planning and progress of care for both the mother and the baby.

The integrative nature of TrakCare Maternity provides administrative personnel the tools to capture data, coordinate and manage mother and baby encounters across the continuum of care in an intelligently efficient and automated way, and manage clinical data from pre-assessment, clinic attendances, emergency attendances, past admissions (obstetric and other), and services.

Core functions of TrakCare Maternity include:

• Pregnancy Events captures and displays past and current obstetric history, previous non-TrakCare obstetric history, and key risk management details.

  The Mother/Baby Link is a bi-directional link between mother and baby.

• Mother/Baby Link provides a bi-directional link between mother and baby. It provides a list of babies associated with the mother and ensures that maternal details also appear on the baby’s record. The link captures such information as:
  • Baby's registered name
  • Billing requirements
  • Discharge data
• Labour/Delivery facilitates recording of delivery details, baby clinical details, and placental details for single or multiple births. It provides a complete history of the first, second, and third stages of labour. Other information can include baby birth details; Apgar scores; baby specifications such as weight, resuscitation, and abnormalities; personnel present at birth; placenta details; and perineum details. It is also possible to link delivery details to the EPR. On completion of delivery, baby clinical, placental, and labour details are calculated and displayed. A number of validations are also available (e.g., validation of baby weight and gestation).

Example: Pregnancy Events List

• Registration allows creation of a new patient record or the ability to search for an existing patient who has been registered into the TrakCare module.
• Admissions admits the patient into the hospital.
• Discharge handles mother and baby discharge together or separately.
• Obstetric Enquiry provides users with an online Obstetric Data Enquiry tool. The user is able to select query criteria such as neonatal morbidity, delivery method, delivery outcome, and puerperium complications.

Specific to the Maternity module is the ability to:

• Configure the system to automatically trigger newborn registration and admission on update of the baby clinical details screen.
• Default fields on the baby registration screen. Some fields are defaulted from either the mother or the delivery screen.
• Icons provide a variety of interactive and static visuals relating to the patient, orders, and progress of the mother through the various stages of labour. Examples include:

2.3.6 TrakCare Operating Theatre Management

What if staff could instantaneously identify the whereabouts of any given patient, at any time, as he travels from pre-op to post-op? Or what if when a patient is booked for surgery and the surgeon’s name is entered into the system, the booking automatically called up and allocated the surgeon’s preferences for that specific type of operation – everything from assisting staff to surgical equipment and even music?

The TrakCare Operating Theatre Management module provides a comprehensive tool that can be used in a single day surgery unit, private hospitals or large, public, enterprise-wide organisations. This module enables the coordination and efficient management of the theatres, resources, and clinical staff. The coordination and management of daily planning and activities can be based on a centralised or decentralised booking environment. It also provides the clinical and non clinical teams with clinical, location, administration, and billing functionality – where all users have access to the theatre in real time.

Core functions of Operating Theatre Management include:

• Theatre Requests and Booking allows authorised staff to request or book a theatre slot for a patient for a particular operating theatre or surgeon.
• Booking Management facilitates the scheduling of patient theatre bookings.
• Schedule Management enables management of operating theatre rooms, including the management of theatre allocations and defining of irregular sessions.
• Schedule Variance records details of any variance for a theatre relating to actual schedule start and end times, and reasons for variance.
• Theatre Enquiry allows staff to make general theatre enquiries by procedure, surgeon, anaesthetist, resource, location, and patient.
• Care Provider Activity Tool enables the user to search for available session times. Time slots can then be assigned or offered to a surgeon and/or anaesthetist requesting additional operating times.
• Surgical, Anaesthetic, and Staff Preferences supports surgeon and anaesthetist preferences in terms of allocation of items to be used, staff and special equipment required for surgical/anaesthetic planning, and patient billing. The preference list for each of the perioperative phases provides a list of usual items required for that procedure, based on surgeon and/or aneasthetist and type of procedure selected.
• Anaesthetic and Operation Details allows the healthcare professional to enter specific details about anaesthetics given and procedures performed. Both of these screens are viewable via the EPR.
• Orders pertaining to specific procedures are defaulted automatically as per surgical preference definitions.
• Movements records a patient’s moves from ward to operating theatre, from operating theatre to recovery, and from recovery back to ward.
• Billing captures and records any procedures performed and/or services rendered as part of the surgical event.

Additional Features

• Bulk Transfer allows the user to select a number of theatre bookings for a given theatre and cycle through them, transferring the bookings to another theatre or surgeon.
• Worklist shows theatres, surgeons, or anaesthetists their daily, weekly, and monthly bookings. Many of the functions that enable day-to-day management of the theatre and the bookings are available from this worklist (e.g., changing a booking status or updating patient, booking, or episode details).
• Schedule Calendar displays a calendar view for a selected theatre showing utilisation for a given month. The calendar may be configured to display summary information or details.
• Schedule Transfer and Copy allows schedule templates to be copied to reduce setup time. Also, the schedule template and all future appointments attached to the schedule can be easily transferred.

Example: Procedure Preference

Preference items may include billable consumables, equipment that has a rental component, and implants or expensive items that need to be ordered in advance for patient procedures. These items default by allowing the care provider to flag unused items (if applicable), thereby deriving billing items/charges.

Example: Operating Theatre Anaesthetic, Surgical, and Recovery Preferences Items Used

• Icons relate to the patient and/or view of the patient’s progress through the various stages of surgery (pre-op, post-op, and recovery). Examples:

2.3.7 TrakCare Patient Billing

Billing can be extremely complex. Rules vary markedly throughout facilities, states, and countries. Conditions differ from patient to patient (e.g., throughout much of the world, nationals face different billing requirements than foreign visitors). TrakCare Patient Billing is an eminently flexible module. Used in more than 25 countries around the world, it is designed to handle the most challenging billing arrangements. It automates the billing process, produces on-demand billing, and reduces the time required to discharge a patient.

The TrakCare Patient Billing module enables staff to coordinate and manage bills for different patient types, including inpatients, sameday patients, outpatients, emergency patients, and various services such as allied health, community, radiology, and dental.

It allows billing to be controlled from a central point or in decentralised environments. Rules may be defined so bills can be generated according to different payers, payment agreements, contracts, and currencies. For enterprise configurations this means elimination of duplicate data capture and a complete financial and clinical history of patients regardless of which sites they have visited.

For those healthcare organisations that need to provide informed financial consent on behalf of the patient, TrakCare provides an estimate-of-cost tool. Estimates of cost can be derived and calculated prior to services being rendered or on arrival, and can be stored for retrieval, review, comparison, and update.

Core functions of Patient Billing include:

• Deposits records a deposit from a patient.
• Receipts Enquiry displays/tracks payment receipts through a date range search.
• Patient/Payer Bills (Total and Interim) displays all bill-related information as well as performs patient-related transactions (e.g., receipting, deposits, invoicing, journal adjustments, and general comments).
• Batch Invoicing allows invoices to be raised in groups on selected episodes.
• Batch Receipting allows the receipt of multiple invoices for an insurance fund or payer.
• Letter Statement generates letters or statements to either the patient or payer using several search criteria.
• Billing Comments/Notes records both billing and patient comments.
• Adjustments
• Payer Contractors

Additional Features

• Payers features a table defined within TrakCare that records the payers (health funds, government departments, and insurance companies) that can be involved in paying a patient’s account.
• Plan allows multiple plans to be defined for each payer. For each plan, there is an associated payment agreement.
• Contracts supports various billing arrangements (e.g., patient, payer, government, or combination via the system set-up of payer/plan, contracts, and billing rules) because healthcare providers/hospitals are generally funded on a contract basis. Contracts and billing rules are maintained by the client (i.e., in-house) and govern how the patient episode is billed.
• Payment Agreement defines levels of the contract. For each contract, the following can be set up:
  • Accommodation charges
  • Room/bed charges
  • Same-day charges
  • Step-downs
  • Theatre banding
  • Multiple theatre percentages
  • Tariffs (price list)
  • DRG/episodic billing

For each payment agreement, the bundled or unbundled information in the agreement can also be defined.

• Co-Payment is an amount a patient has agreed to pay as part of his level of insurance coverage should the patient be hospitalised.
• Excess is an amount the patient has agreed to pay as part of his level of fund coverage in the event of hospitalisation.
• Step-Downs pertain to accommodation rates (private room, or shared room) for various patient types (medical, surgical, or advance surgical) for a defined number of days. Generally, the charge decreases as the length of stay increases.
• Incremental Charges pertain to services, such as theatre or the intensive care unit where an initial base fee is levied along with an incremental charge according to duration of use.
• Multiple Same-Day Procedures allows payers in their contracts to define the amount to charge when more than one procedure is performed under the same anaesthetic (i.e., multiple procedures).
• Taxes allows for a tax (e.g., GST/VAT is levied in some countries on particular services provided in healthcare) to be either automatically applied when the service is provided or manually added.
• Multiple Payers Per Episode allows many payers to be associated on one episode (if this is the billing logic for that client and/or country), allowing the patient’s bill to be apportioned between the nominated payers (e.g., an insurance provider and a patient).
• Variable Room Rates allows the user/client to define different room rates (if applicable) based on the type of room the patient is occupying.
• Interim Billing is used in association with long-stay inpatient care. Invoices can be raised for a part of the inpatient stay prior to discharge, allowing reimbursement on an incremental basis from the payer.
• Recording Charges includes the following capabilities:
  • Charges can be generated manually and automatically
  • Manual charges can be added based on the user’s security level
  • Charges can be modified by the user (assuming appropriate privilege level)
  • Corrections to invoices are allowed, provided the invoice is still in a draft or pro forma state
  • Audit trail of activity is associated with the bill
  • Records allocation of charges based on payer contracts
• Recording Deposits captures information related to deposits to be received from a patient and/or payer and deposits to be allocated against selected invoices. It also allows refunds of deposits if necessary.
• Raising Invoices includes the following capabilities:
  • Invoices may be created either as a single invoice or as batch invoices
  • Invoice printing history is recorded
  • Invoices can be in a draft or pro forma state, allowing a user to review, modify, and finalise the bill prior to printing
  • Invoices may be generated showing patient portion and/or payer portion
  • Aging of outstanding invoices
  • Collection and allocation of invoice payments are managed at an invoice level or a service/order level
  • Partial payments
  • Cancellation of invoices
  • Records associated billing comments to a specific invoice
  • Invoices may be placed on hold
• Journal Adjustments includes the following capabilities:
  • Allows adjustments to an invoice
  • Captures adjustment reasons
  • Offers the ability to transfer a portion to the patient or payer depending on requirements
  • Lists all adjustments against that invoice
  • Enables adjustment allocation to the invoice level or to the service/order level
• Recording Receipts includes the following capabilities:
  • Generation/printing of receipts
  • Recording of receipt details/mode of payment
• Recording Information includes the following capabilities:
  • Recording of details against the invoice for inclusion on invoice
  • Recording of details to billing notes
• EDI Transmissions includes the following capabilities:
  • Creating, managing, and auditing invoices sent electronically (by EDI) to selected payers
  • Sending invoices to particular payers (as defined in reference/code tables) via an EDI extract, rather than printed as a paper invoice
• Icons in TrakCare Patient Billing are easy to read and include:
  
  
• Letters provides the functionality to produce correspondence such as “aged debtor” letters to send to patients. The form of the letters is defined by the hospital; InterSystems can provide an initial set of templates. A history of correspondence showing creation details and reprint information, and the ability to view sent documents are also available.

2.3.8 TrakCare Waiting List/Recall

TrakCare Waiting List is a dynamic module that allows the capture of both administrative and some clinical data prior to the patient attending the facility or appointment.

The Waiting List module is fully integrated with both the Inpatient and Outpatient modules.

The term “waiting list” is generally associated with public facilities for those patients requiring an inpatient surgical attendance, while “recall” is associated with outpatient attendance (e.g., an annual pap smear or general follow-up appointment that is booked more than six weeks in advance).

Core functions of Waiting List/Recall include:

• Registration
• Referrals allows the user to create and view referral details for the patient. Patients’ Waiting List entries in terms of various bookings are then associated with that referral.
• Add to Waiting List allows the user to add a new patient record to the system and create a Waiting List entry, or add a Waiting List entry to an existing patient record.
• Bookings/Pre-Admission provides the ability to record a patient’s prospective admission details, including expected date of admission and where the patient will be admitted, with a direct link to the Waiting List entry. This tool interacts with Waiting List calculations and facilitates speedy processing of the patient on the day of admission. Alternatively, a user with the appropriate authorisation can cancel a pre-admission (to come in) episode.
• Pre-Assessment Bookings allows appointments for pre-surgical work-up/ assessment clinic visits prior to the inpatient admission. This booking is linked to the Waiting List entry.
• Waiting List/Recall Management includes the following capabilities:
  • Placing a patient on one or multiple waiting lists
  • Making pre-assessment clinic appointments
  • Viewing appointment details
  • Recording/updating waiting list status (i.e., initiated, booked, admitted, or cancelled)
  • Recording/updating waiting list outcomes
  • Transferring from one waiting list to another
  • Linking waiting lists
  • Cancelling
  • Recording patient confirmation of attendance
• Variance records details of any variance for a waiting list and reasons for variance. Variance includes suspensions, cancellations, reinstatements, and transfers.
• Enquiry allows the user to search for a waiting list using Waiting List-specific criteria such as total days waiting, priority, and waiting list status. This enquiry results in a list of matches allowing the user to view existing Waiting List details and/or conduct other Waiting List management activities.

• Transfers allows the user to transfer single or multiple Waiting List entries to a different care provider, specialty, or hospital.
• Suspend allows the user to suspend a Waiting List with a status of “Initial” (Active Awaiting Booking). A suspension is used when a procedure or admission is postponed for a period of time for a medical or other reason. This is linked to Waiting List calculation times.
• Remove/Reinstate allows the user to remove a Waiting List with a status of “Initial” (Active Awaiting Booking) or “Suspend.” It allows the user to reinstate a Waiting List with a status of “Removed.”
• Waiting List History records transactions for any changes to the associated Waiting List status, creation/deletion of reviews, list transfers, and cancellation/completions.
• Days on List features auto-population from calculations made by a routine to determine the number of days a patient has been waiting on a specific list/ service.
• Letters enables production of correspondence to the patient. The form of the letters is defined by the hospital; InterSystems can provide an initial set of templates. A history of correspondence showing creation details, and reprint information, and the ability to view sent documents are also available.

2.4 TrakCare Community Management

Quality of care demands that even when at home, a patient/client should be treated with the same degree of professionalism and have access to the same tools as he would in the hospital. With TrakCare Community Management, healthcare providers can now achieve this. No matter where they are, medical professionals using mobile devices are able to view the same information that would be available in their own office, including a client’s medical history, medical or administrative alerts, referral information, and assessments. They can even schedule and change appointments or create a care plan, all from the client’s home.

Community Management is fully integrated with other TrakCare modules and supports all those involved with managing/providing services to the client in his community by providing timely information, better use of resources, and improved communications.

Core functions of Community Management include:

• Registration allows users to create a new client record or search for an existing client who has been registered into the TrakCare module.
• Client Alerts allows healthcare professionals to add newly identified alerts and allergies and to view those previously recorded. In addition to notifying healthcare professionals of potential risk, the nature and severity of allergic reaction is also available if it has been captured. The severity can be colour-coded to provide a visual display of allergic sensitivities.

An alerts facility is available for recording details such as:

• Administrative Alerts (e.g., client must pay up front)
• Medical Alerts (e.g., diabetic, sensitive to certain drugs)
• Other Alerts (e.g., beware, client has large dog)

Alert details can be restricted by user security level.

• Assessments utilises TrakCare’s Questionnaire tool, allowing the healthcare professional to define the content of the assessment and create standard templates. Assessments can be measurement-based using an algorithm that calculates a score. Any changes made to an assessment are entered, and a full history is maintained. The system provides electronic sharing of assessment information under security controls.
• Appointment Management allows healthcare professionals to schedule appointments for individuals at their clinics (or during rounds), or they can use the booking system to book multiple resources for a service.
  
  Appointment Management supports multiple departments and/or service locations. Each department may have multiple resources (staff or equipment) each day. Clients may register for any department resource. There is no limit to the number of clinical departments that can be pre-set.

A comprehensive set of functions for managing appointments includes options to:

• Book individual appointments
• Make multiple bookings for a client
• Attach multiple interventions to an appointment
• Make an appointment for a revisit
• Record an arrival
• Change appointment details
• Reschedule an appointment
• Cancel an appointment
• Print letters to the client and the general practitioner

Example: Client Care Plan

• Care Planning supports care tailored for the individual. Interventions derived as a result of care planning are matched and scheduled into the clinician’s diary. Standard Care Planning templates can be created. A care plan may be assigned to a client on the basis of assessment. Other functionality available includes the automatic integration of the required interventions, as determined in the care plan formulation, into the resource schedule. Once the course of the plan is determined, appointments will be scheduled at the required times. Any appointment conflicts generated in this process are highlighted and functionality to resolve these is provided.
• Enquiry Contact allows healthcare professionals to record, forward, and monitor the status of casual enquiries, either clientspecific or general. Details of enquiries, including enquirer’s name and contact details, client related to enquiry, and details of enquiry can be recorded and forwarded to relevant clinicians for further action.
• Referral Management allows the recording of episode details as well as client demographic details, which is critical to community health. TrakCare supports the creation and management of client referrals ensuring that all referrals are actioned.
  
  The Referral Management function includes:
  • Registering referrals
  • Referral assessments
  • Referral outcomes
• Client Record Tracking provides a facility for tracking client records, including medical records, dental charts, and psychology records. Any record that can be linked to the client can then be tracked. The Record Tracking facility significantly reduces the time it takes to perform these clerical procedures. The system maintains a history of all movements for later analysis.
• Client Discharge produces a discharge summary when care is completed for a client and the client is discharged.
• Automatic Notification to General Practitioners automatically notifies general practitioners of a client’s involvement with an agency, if desired. This notification can be faxed, e-mailed, or printed.
• Client Labels/Registration Forms produces a variety of printed documentation, including labels, and registration forms.
• Healthcare Professionals Diary allows the healthcare professional to manage his client population, view new referrals, and manage internal referrals from his diary. It is central to the Community Management module and provides a listing of all clients with open episodes that are assigned to the healthcare professional and ensures that all currently active clients are reviewed regularly. The diary function also provides the user with his list of appointments for a given day.
• Client Diary provides a client-centric view of appointments and activities, allowing healthcare professionals to schedule activities for a client from the client’s perspective.

Additional Features

• Client Billing charges for appointments and services rendered. Charges are determined by billing contracts with various payers. Refer to Section 2.3.6 (TrakCare Patient Billing) for details.
• Mobile Devices (Point-of-Care Access) addresses the challenges of recording information at the point of care and complements the EPR, extending TrakCare to the client. It applies the latest technology to bring fast, affordable, accurate, computerised charting to the client’s home or bedside.
  
  Mobile Devices eliminates the “record on paper and later transcribe” process of nursing and clinical documentation. Clinicians can chart activities and record the administration of medication, execution of treatment, and other orders.
• Event Creation and Management allows users to create and manage events – for a group of clients, clinicians, or both – from their clinician’s diary. The event creation system allows users to invite individuals to participate in a group or event and to keep tabs on RSVPs. Clinicians can be invited to attend and the system can also alert clinicians of upcoming events where they are responsible for presenting to a group.
• Complaints and Plaudits supports the tracking of poor and exceptional performance and can be utilised to review service contracts with contracted agencies. It allows recording and reporting of feedback, both positive and negative, in a formal and structured manner.

Example: Client Diary

2.5 TrakCare Emergency Management

It’s a particularly busy night in the Emergency department. How do you identify who has been seen and who hasn’t? Or what grade of triage has been assigned? Or how long an individual patient has been waiting? Or what rooms are available? How does a clinician keep track of a patient’s movements and know whether he’s been sent for X-rays yet?

Readily accessible information is critical in this environment, but it has to be uncluttered, with skillful use of colours and icons to alert where necessary, but not distract. More important, the information must be dynamically updated as events occur, allowing clinicians to make fast assessments.

The TrakCare Emergency Management module is a comprehensive tool that can be integrated with the Inpatient and Outpatient modules or used as a stand-alone application. It handles the triaging and treatment of patients and is designed to perform the registration, movement, and capture of care interventions during emergency attendance. The Emergency Management module facilitates the coordination and efficient management of the emergency rooms, resources, and clinical staff and provides clinical and nonclinical teams with clinical, location, administration, and billing functionality – where all users have access to the data in real time.

As the Emergency Management application is fully integrated with other TrakCare modules, pre-assessment, clinic attendances, past emergency attendances, and past admissions data can be available for viewing in the patient’s electronic record. For any event, the patient’s demographic, admission, clinical, and billing processes are linked and allow for the real-time clinical and account management of the patient.

Core functions of Emergency Management include:

• Registration allows the user to create a new patient record or search for an existing patient who has been registered into the TrakCare module.
• Triage allows healthcare professionals to distinguish the most critically urgent patients from less urgent cases, so care delivery is provided in the most effective and efficient manner. The Triage feature allows the user to enter a patient’s triage details including the triage date, time, and category; this will determine each emergency patient’s priority, with a specific colour assigned to each triage category.
• Clinician records healthcare professionals who actively participated in the delivery of care for a patient. A history of healthcare professional activity is maintained.
• Electronic Patient Record captures the continuum of clinical and administrative information about the patient. It contains patient demographics, medical history, previous admission information, previous surgical information, and obstetric history. The medical history contains allergies, disease history, family history, and social history. The EPR provides a visual display of all information that has been collected. It can also be extended to include orders and results from lab and radiology departments, prescribing, or the generation of a discharge summary for a specific episode or linked episodes. For the latter, please refer to the TrakCare Clinicals product sheet.
• Move records a patient’s movement to a temporary location (e.g., the Radiology department).
• Bed Requests is used if an emergency patient requires admission as an inpatient to a ward. The request can be recorded and transmitted to the Bed Manager. Allocation of a ward and bed by the Bed Manager will:
  • Notify the Emergency department that it may prepare to discharge the patient.
  • Display the patient as “pending admission from Emergency department” on the ward list of the ward the patient has been assigned to, thus alerting the staff of a pending Emergency department patient transfer/admission.
  • Contain available patient data so re-keying of information is eliminated.
• Chart Requests accommodates the requesting and tracking of patient charts. These documents can include the patient’s medical records, dental charts, psychiatric records, and radiology films. Requests for records can be triggered automatically or manually.
• Discharge allows discharge details to be recorded against a patient. Assigning a discharge date and time will automatically remove the patient from the Emergency Floor Plan and patient list.
• Letters enables the facility to produce patient correspondence. The format of letters is defined by the client; InterSystems can provide an initial set of templates. A history of correspondence showing creation details and reprint information, and the ability to view sent documents are also available.
• Patient Labels/Registration Forms
• Mass Disaster provides automated bulk registration to support mass disasters where the only known information is the estimated number of patients coming to the Emergency department at the hospital. It permits clinicians to proceed with the care of the patient.
• Billing

Additional Features and Benefits

• Floor Plans/Map provides a graphical display of the waiting room, cubicles, and procedure rooms within the Emergency department. At a glance, a user can see where patients are located, along with selected patient information. Static and interactive icons are also available in the Emergency Floor Plan.
• Scan Documents allows the user to associate a scanned document type to a particular patient. For example, a picture of an injury sustained from an accident can be scanned and assigned to a specific emergency visit/episode.
• Mobile Devices, available in the Community and Inpatient modules, is also available in the Emergency Management module to address the challenges of recording information at the point of care.
• Multiview allows users to search for admissions within a given date range for a location or location type.
• Billing allows billing of Emergency department attendances and services. The Patient Billing product sheet describes this functionality in more detail.

2.6 TrakCare Laboratory (LAB)

While travelling in India a person falls ill and goes to an outpatient clinic for a blood test. Blood is taken, sent to the lab, and tested. Using TrakCare LAB, as soon as the test is finished, results are made available with an alert sent to notify the doctor, highlighting any abnormal findings. If necessary, the results can also be made securely available to the patient’s hometown doctor or even to a specialist on the other side of the world for further consultation.

TrakCare LAB meets all of the operational needs of the modern pathology laboratory. It is designed specifically to streamline the diverse activities of laboratories in the areas of:

• Haematology
• Blood Bank
• Clinical Biochemistry
• Microbiology
• Histology/Cytology
• Specimen and request registration
• Accounts Receivable
• Phlebotomy
• Immunology/Serology
• Work sent out

TrakCare LAB provides a comprehensive solution for the data management needs of any laboratory via:

• Customised patient entry screens per department or laboratory user site
• Automatic faxing of results, including details of patient’s history and medical condition, to referring doctors
• Report scheduling
• Confidential printing of reports
• Remote system access
• Integration with Microsoft Word
• Export of information to other systems
• Patient management
• Defined patient and data flow
• Specimen pre-registration and online device load lists, facilitating rapid turnaround times
• Unlimited capacity for clinical history details and comments
• Image scanning

LAB Applications

Over 100 of the most common and latest analyser interfaces are already available, offering uni- and bi-directional capabilities with barcode reader functionality and direct TCP/IP interface connections via dedicated instrument terminal servers, utilising the ASTM or supplier/analyserspecific protocols. Interfaces are already available for new “black-box” analysers, such as Roche PSM and Roche Modular.

TrakCare LAB supports the needs of laboratory professionals to process and analyse results. It also provides caregivers access to those results in formats that they understand. Physicians have been able to use their mobile devices to access and review results in several hospitals. Some of the specific TrakCare LAB modules that can be used to address specific departmental needs are illustrated below:

• Daybook provides departmental control for registration of specimens, allowing automatic retrieval for inclusion in reports. Through this module users can allocate specimens, procedures, and stains to specimens, and enable the printing of specimen-specific labels for slides, blocks, and cassette writers, either in batch mode or on an ad-hoc basis. Users can create custom screens that are consistent with their department’s workflow.
• Worksheets incorporates multiple tests with defined turnaround times. A dedicated worksheet module allows users to enter results on a screen that mirrors the layout of the printed worksheet, significantly improving the time of result entry for manual assays when interfacing is not available.
• Reports allows report templates to be defined by the user and customised to suit the laboratory’s report types and formats. TrakCare LAB includes a significant number of reports that satisfy the requirements of even the most complex laboratory. In addition, TrakCare’s underlying technology is fully ODBC-compliant, allowing users to use third-party reporting tools such as Business Objects Crystal Reports to create custom reports on an ad-hoc basis.
• Electronic Claims creates electronic claim files suitable for exporting to other accounting system packages.
• Quality Control incorporates a fully integrated quality control module for manual assays and interfaced instruments, including Levy-Jennings and Youden Plot graphing capabilities, as well as inter- and intra-laboratory analyser quality control comparisons.
• Interfaces provides for both uni- and bi-directional analyser interfaces, including barcode reading functionality. For other interfacing requirements, TrakCare LAB uses PIT, HL7, and/or UN/EDIFACT formats. TrakCare LAB has also been configured to interface with external systems using client-specific proprietary formats.
• Specimen Storage includes a dedicated specimen storage module in TrakCare LAB (Version L64). Configuration of storage locations, including building, refrigerators, and the individual storage containers, can be configured entirely by users, ensuring accurate identification and retrieval of stored samples for further testing.

Section 3: TrakCare System Architecture and Technology

Unlike other systems, TrakCare was built from the ground up as a Web-based, patient-centric solution. It uses the most advanced technologies available in the market and is the first hospital information system to be built on an integration platform instead of a rigid database structure. This architecture facilitates the FastTrak to EPR and allows TrakCare to serve as the EPR while you implement new functionality over time.

TrakCare uses the browser as the client front end and requires little in the way of bandwidth or power at the desktop. The use of the browser enables the system to be used with full functionality over low-speed lines such as ISDN or dial-up without the need for expensive “thin client” technologies. This gives ubiquitous but secure access to appropriate information wherever and whenever it is needed via the Internet.

TrakCare is built on InterSystems Ensemble®, a rapid integration platform. Designed with today’s Web and service-oriented architectures in mind, TrakCare excels at quickly building and deploying new solutions that leverage the functionality of existing applications, orchestrating new business processes, and integrating data from across the entire hospital, outsourced service providers, and community health services.

3.1 TrakCare Technical Features

TrakCare supports a number of technical features that differentiate it from many competitive systems, including:

• Mobile Computing features offerings that differ substantially in both capability and flexibility. The capabilities of the applications on the various platforms will be directly related to the capabilities of the device. TrakCare has been developed to utilise the latest technology, with minimal or no modifications to the software. In broad terms, it can be accessed from any device that runs Internet Explorer Version 5.5 or higher. In the hospital environment, this allows pen-based tablets and laptop computers connected in a wireless network to be used to deliver patient information at the bedside. When staff work away from the hospital, such as in a community environment, TrakCare provides remote access to patient information.
• Security allows the hospital to establish its own desired security levels, departments, and roles in the system and to determine which functions and screens should be secured and at what security level. TrakCare also provides full data security, tied to user log-in names and associated passwords that limit access to the database.
• TrakCare allows for log-on security to be integrated with Windows log-on authentication, utilising pass-through authentication of the Windows log-on. This reduces the time it takes for users to get into the application and the need to have multiple log-ons for both Windows and TrakCare.
  
  Specific security features available include the following:
  • Access to TrakCare is user-name and password protected.
  • Restrictions can be placed on the actions a user can perform.
  • Users can be forced to change their passwords on a regular basis.
  • Access to TrakCare workflows that is restricted by the role the user is assigned (in addition to password protection).

TrakCare has additional safeguards to maintain the confidentiality of the data by associating patient records with treating doctors on a “need to know” basis. Only the treating doctor, or other doctors permitted by the treating doctor, can access such records.

• Reporting provides users with extensive facilities to manipulate data in a quick and easy manner. Since hospitals are dynamic environments, the information needs of clinicians vary considerably. TrakCare supports this requirement with the following features:
  • Each module of TrakCare comes with a number of standard reports for operational, managerial, and statistical purposes. Users can control the selection and sort criteria of these reports. These reports can also be modified by the hospital.
  • The hospital can develop its own ad-hoc reports using ODBC-compatible reporting tools.
  • TrakCare can be linked to business intelligence tools, allowing users to make their own ad-hoc queries on the TrakCare database (i.e., a user can make a query on the Patient Master Index to identify patients who are male, over 65 years old, and currently admitted).
    
    Reports may be viewed on-screen, printed, or imported to other office automation products, including Microsoft Excel and Word and e-mail systems. TrakCare can provide a seamless interface between its database and these products. TrakCare provides an interface to all Microsoft and open-system-compliant desktop packages.
• Auditing includes the following facilities:
  • Audit Trails keeps a record of all changes made to a patient’s record including the date, time of change, user making the change, and details of the change. Features include:
    • Configurable
    • Detail of changes made to the database
    • Time and date stamp
  • Audit Footprint keeps a record of any user who has accessed the patient’s record even if no changes were made. Features include:
    • Configurable
    • Detail of who views patient record
    • Time and date stamp
  • Code Table Audit keeps a record of all changes made to code table records including the date, time of change, user making the change, and details of the change.
  • Security Violations keeps a record of any security violation attempt.

3.2 Application Architecture

TrakCare implementations are created with the philosophy that you must use the right tool for the job. Solutions are built using a unique Component Framework, enabling rapid Web application development, extraordinary transaction processing speed, and massive scalability with minimal maintenance requirements, resulting in a high-performance, highly flexible EPR application.

The TrakCare component model enables rapid application development, a consistent user interface, a consistent and inherent model for system tailoring, and considerable reuse of system components.

TrakCare can be quickly and easily tailored to your requirements without the expense, delay, complexity, or risk of custom development. The system can optionally be tailored across some or all modules through configurable workflows and configurable views of data to best serve differing needs within organisations, groups, and even individuals.

TrakCare provides support for a range of secure multiple agency configurations. Solutions can be configured to meet specific requirements.

Typical model configurations include:

• Multiple instances of the application on a single server
• A single database with multiple hospitals in a multihospital configuration
• A multihospital configuration with independent databases and a single EPR summary
• A multiregion, multihospital, central EPR configuration with effective replication of the EPR with the patient’s home EPR

3.3 Operating System Environments

TrakCare applications are certified to run on a range of commodity operating system environments, including but not limited to Microsoft Windows NT 4 (SP4, SP5, SP6), Microsoft Windows 2000 (SP3, SP4), Microsoft Windows XP (SP1, SP2), Microsoft Windows Server 2003, Microsoft Windows Vista, and a range of Unix platforms including Solaris, Tru64 Unix, HP-UX and AIX (Web components require Microsoft Internet Information Services). TrakCare can run in a mixed-platform environment.

3.4 Logical Model

TrakCare is logically designed as a multi-tier system. The components in the different tiers are responsible for different tasks and can be logically grouped based on the type of work they perform. These tiers may be physically configured across one or more servers to provide scalability and resilience.

The four logical tiers are:

• Data Tier
• Application Tier
• Web Tier/File and Print Tier
• Client Tier

Data Tier

3.4.1 Data Tier

The Data Tier is made up of a database containing TrakCare transaction data and database schema. Typically both a primary and a secondary database server are active at all times. The primary database server is used for back-end transactions. The secondary (shadow) database is a mirror image of the primary database, which is kept current by copying transaction journals from the primary database and replaying the journals into the shadow database. The advantage of the shadow database is that it can be used for ad-hoc queries and reporting that would otherwise impact the performance of the primary database. Multiple shadow servers may be configured to suit reporting requirements and provide redundancy to enhance corporate disaster recovery plans.

Data Tier

Shadow Database

Application and Data Tiers communicate over standard TCP/IP network configurations.

3.4.2 Application Tier

The Application Tier is the workhorse of the TrakCare application, containing TrakCare application programs and data.

It is responsible for dynamically generating TrakCare application Web pages in response to client requests. One or more Web Tier servers connect to the Application Tier via a Web gateway. The application server constructs an HTML representation of the data, which is passed back to the Web server via the gateway.

Application Tier

Depending on your geographical requirements, the application servers can be located remotely from the Data Tier server, in which case they may also contain high-use static data, accessing the database server only when dynamic transaction data is required.

When the Application Server needs to access a remote data server, a protocol is used to access the remote database and cache data on the application server so future related data requests can often be satisfied without using network resources.

3.4.3 Web Tier/File and Print Tier

The Web Tier/File and Print Tier typically integrates with your existing infrastructure.

TrakCare utilises the Trak Reporting Model, which supports both centralised (system) printing and distributed (client preview) printing models.

Trak Print Service (TPS) supports a centralised queued model to manage system-generated printing, faxing, and e-mailing. TPS uses the worldleading Business Objects Crystal Reports RDC print engine. Multiple print services can be run simultaneously, with each instance aware of the total number of print processes currently running to effectively control licensing costs.

TrakCare can also integrate with Business Objects Crystal Reports Application Server for Web-based client previewing requirements. The reports are generated as dynamic HTML or HTML, or via an ActiveX viewer. The preview mechanism offers the flexibility to print to a locally defined printer and the functionality to export reports in various formats.

The Web Tier serves TrakCare application Web pages – created dynamically by the Application Tier – to client PCs and returns client transactions back to the Application Tier.

InterSystems Ensemble® utilises Caché Server Pages (CSP) technology from InterSystems Corporation, which allows the building and deployment of high-performance, highly scalable Web applications. CSP enables Web pages to be generated dynamically at runtime on the application server, allowing content (HTML, XML, style sheets, images, and other types) to be served dynamically.

The client connects to the Web server via a Web browser using standard HTTP protocol. The HTTP client (the Web browser) requests a page from the Web Tier using HTTP. The Web server recognises this as a CSP request and forwards it to the Application Tier using a fast server application programming interface. The CSP Server in the Application Tier processes the request and returns a page to the Web Tier, which in turn sends it to the browser. CSP manages communications between the Web Tier and Application Tier and invokes application code to generate the page.

CSP supports HTML, XML, WML, and other Web-oriented mark-up languages. CSP uses a dynamic server page technology based on the Document Object Model.

Web Tier

3.4.4 Client Tier

The Client Tier is the only part of the TrakCare system that end users interact with directly. This tier can be any low-maintenance, light-footprint client device that supports Microsoft Internet Explorer 5.5 or higher, and provides the single interface between the user and the components of TrakCare, including PAS, CIS, system administration, and viewing reports, and non-TrakCare applications.

In addition to the server-side code that executes on the Application Tier, some code, typically JavaScript, is run on the client browser, usually to support advanced functionality such as data validation, reformatting, or invoking serverside code. ActiveX and Java controls are also used to execute client-side applets to preview complex images and standard reports and to modify TrakCare page layouts. Use of the capabilities can be restricted to specific users or groups of users and may be subject to license restrictions.

3.4.5 Standards and Protocols

The TrakCare solution utilises the latest standards and protocols to enable connectivity and extensibility with other systems. Key technologies and standards are indicated (but not limited to) those illustrated below.

3.5 System Architecture Configurations

The innovative design of the TrakCare application using logical tiers results in considerable flexibility to tailor a solution to your organisation’s geographical and technological requirements. Multi-tier, multiserver solutions have the added advantage of providing outstanding performance, massive scalability, real-time data analytics, and robust reliability. Your solution can be designed to accommodate several hundred users or many thousands, in a single location or over many sites. An entry-level configuration can be extended to support additional users as your organisation’s use of TrakCare grows without the need to rebuild or redesign from scratch.

3.5.1 Single-Server Configuration

In the simplest configuration, a single server is used for all the logical tiers. This type of configuration can service a limited number of clients – typically up to 200 concurrent users – but can be extended to approximately 1,000 depending on the platform and TrakCare modules used.

The entry-level option is designed for deployment at a single site or for a limited implementation of TrakCare. Although the singleserver configuration does not immediately provide the necessary infrastructure to support future growth, additional servers can be added as your needs change.

A high-availability environment is possible by adding additional hardware. For example, a clustered or multi-tiered configuration would require at least one more server.

The preferred operating system for a singleserver configuration is Microsoft Windows 2003 Server.

3.5.2 Multi-Tier Configuration

The multi-tier, multiserver configuration uses distributed database communications to make it possible for a higher system capacity and greater system redundancy, allowing far more clients to connect to the system through the use of multiple application servers.

For sites requiring high capacity and high availability, it is recommended that the TrakCare Application and Database Tiers be distributed across multiple servers. The Web Tier should also be a separate tier. In addition, report services may be on separate servers depending on the reporting requirements.

In the simplest multi-tier setup, two or more systems, acting as Application Tier servers, are placed between the central Data Tier server and the Web Tier servers. In this configuration, the Application Tier servers host processes that perform work for the client's benefit, off-loading the CPU load from the database server. This type of configuration scales best for Web applications such as TrakCare, which offers a significant level of data read access. More complex configurations, with multiple data servers as well as data stored on application server machines, are also possible.

Typically sites use multi-tier configurations for scaling as well as for providing high availability, with application servers serving as hotstandby systems.

For entry-level high availability, only a duplicate system with the same specifications as the database server is required. Shadow and failover database servers are similarly sized.

3.5.3 Scalability and High Availability

A multi-tier architecture allows the system components to be spread across two or more data centres connected by high-capacity network connections.

The architecture does not alter significantly when scaling up, although the capacity of the components can be increased as additional sites and modules are brought online.

Acceptance, system testing, and training environments are located on their own pool of servers.

Multi-tier, multiserver system architecture is characterised by:

• Individual servers for the database and application servers
• Windows servers for the Web Tier/File and Print Tier
• High-availability clustering of the database servers
• Redundant Web, print, and file servers
• Disaster tolerance through geographically separate data centres and remote mirroring
• Private gigabit network between servers
• Use of SAN storage for all disk requirements (except operating system and system booting if required)

It is designed to scale through the addition of:

• Additional application servers
• Additional Web servers
• Scaled increments of hardware (memory, CPUs)

Unix systems are preferred for database and application servers for larger installations. However, Microsoft Windows Servers can be used in multi-tier configurations.

The following table compares single-server configuration and multi-tier configuration.

Table: Comparison of Different Options

3.5.4 Client Architecture

The recommended minimum hardware and software configuration of PCs to be used as client workstations are:

The main client application used in the TrakCare solution is Internet Explorer 5.5 or higher with Microsoft or Sun’s Java Virtual Machine (VM).

For report preview and the ability to customise the application components, the “local intranet” security zone in Internet Explorer must be configured to allow signed and unassigned ActiveX controls.

The additional software components required for application maintenance or configuration include:

• Visual Basic application for code table maintenance
• Limited Ensemble client installation and ActiveX control for editing layouts
• Full Ensemble client

Where Microsoft Word integration capabilities are required, Microsoft Word must be available to the client PC in addition to ODBC. Typical uses are clinical summaries and results reporting. However, alternate mechanisms are available through the TrakCare application such as creation of PDFs (which requires client installation of Adobe Acrobat Reader).

Users who wish to develop or maintain Business Objects Crystal Reports will also need Crystal Reports Designer and an Ensemble ODBC driver.

Required hard disk space on the client workstation for each additional component includes:

InterSystems certifies these environments with the TrakCare solution

3.6 Other Architecture Requirements

Several environments should be maintained as part of the entire healthcare information system infrastructure. It is expected that there will be several TrakCare instances on the servers supporting different versions of the TrakCare system.

3.6.1 Production

The production system used for live system activity.

3.6.2 System Test

An environment for vendors to place and run initial quality assurance tests. This environment can also be used for:

• Performance and stress testing
• Investigating the effect of alternative or emerging infrastructure components on application performance or availability
• Other testing (e.g., start-up, shutdown, backup, and recovery)

3.6.3 Training

Generally this is a copy of production (in functionality) but could be ahead if training is required for a new release. During planned training sessions, the database may be refreshed prior to commencement. The training environment is often used to acceptance-test latest releases prior to their deployment into the production system.

Server hardware for acceptance testing ideally would be the pre-production equipment. In large installations it may be necessary to maintain a replica of the production systems for the purpose of continual acceptance testing, however, this would be rare. Disk requirements may be scaled down to suit the expectation of the level of acceptance testing.

3.7 Additional Peripherals Supported

The TrakCare solution has the capability to support a broad range of commodity peripherals including tablet PCs, mobile devices, scanners, and barcode readers.

3.7.1 Tablet PCs

TrakCare supports the use of wireless tablet devices for deployment; these provide the full functionality of the desktop environment.

3.7.2 Scanners

TWAIN-compatible scanners can be interfaced into the TrakCare application. The interface is only limited by the TWAIN driver, however, the client must have an associated TWAIN driver. The interface is called using an ActiveX control via the browser.

3.7.3 Barcode Readers

The solution supports rapid and error-free search and selection through the use of barcode scanners. Typical uses include laboratory specimens and medical records.

InterSystems Corporation
World Headquarters
One Memorial Drive
Cambridge, MA 02142-1356

Tel: +1.617.621.0600
Fax: +1.617.494.1631

http://www.intersystems.co.kr/

InterSystems TrakCare is a trademark of InterSystems Corporation. Other product names are trademarks of their respective vendors.
Copyright ® 2008 InterSystems Corporations. All rights reserved 02-08