AGIT AB Regions and e Health in

RHC company profile Regional Health Corporation consists of 5 hospitals Total assets 5 billion CZK Basic capital 3. 6 billion CZK Estimated revenues 4. 5 billion CZK Total 6 342 employees, Ø Incl. 4 885 health professionals. 821 physicians, 2 671 nurses 2

RHC company profile The organization was established in September 2007 to merge these 4 district hospitals and 1 regional (Masaryk) hospital under one roof creating thus the biggest healthcare provider in the Czech Republic The share holding company is owned by The Ústí Region 3

RHC company profile The area covers about 820 000 citizens 6 342 employees (from that 838 doctors and 2 673 nurses) More than 3 350 beds (71 % acute care beds in the region) Basic, specialized and super specialized health care in a great number of departments and clinics 4

Masaryk Hospital profile Staff Beds Clinics and departments Average length of stay Inpatient 2 338 1 246 40 6. 5 42 316 5

Masaryk Hospital profile the largest healthcare facility in the region the biggest employer in the regional capital town the most important healthcare provider in the region 6

Masaryk Hospital profile The most modern and most efficient technological infrastructure has been built and it rates among the best Czech hospitals Masaryk Hospital is a filmless hospital since 2003 ISO 9001: 2000 certification since 2002 ISO 27001 certification is in progress 7

e. Vision of Masaryk Hospital filmless and paperless healthcare telemedicine EHR new services based on ICT and at the same time privacy policy legal protection financial health 8

Characteristics of IS/ICT area The Information Technology Center is a shared services centre of the RHC corporation The centre provides the unique regional healthcare computer network, based on dark fibre technology, DWDM and MPLS services 9

IS/ICT support for medicine research activities postgraduate and lifelong education of healthcare and information professionals 10

IS/ICT support for medicine scientific information services for healthcare community and for other clients special courses, training and other educational activities including lectureships and extramural education ICT administration for consultations and for telemedicine 11

IS/ICT support for medicine Videoconferencing in project management in education oriented conferences (with surgical theatres) in cooperation with university partners (CESNET) HD videoconferencing 12

IS/ICT support for medicine Video streaming from the education centre of RHC from theatres to the education centre of RHC IP streaming (IPv 6), MJPEG 13

3 D Full HD Broadcast from a Robotic Surgery Experts from CESNET and the Masaryk Hospital in Ústí nad Labem, performed a unique real-time 3 D Full HD stereo broadcast of a kidney surgery performed by a da Vinci s. HD robot. The online broadcast was conducted over a 10 gigabit link, which is a part of the standard infrastructure of the national research network CESNET 2. During the broadcast, the data stream reached transfer speeds of approximately 2. 5 Gbps and the signal delay along the transmission stream was less than 1 ms, enabling a truly real-time broadcast. The solution applied is capable of transmitting up to four 3 D HD video signals in either direction. 14

3 D Full HD Broadcast from a Robotic Surgery The successful transmission of 3 D Full HD video demonstrated the possibilities enabled by this technology to surgeons as well as education of both medical professionals and students. 3 D Full HD video transmissions as a telemedicine application benefits the most important contribution to improving the quality of care in the surgery for patients in Central and Eastern Europe and developing countries. 15

Assisted Robotic Operation to Japan Professionals of CESNET and Masaryk Hospital in Ústí nad Labem have demonstrated their experience with Internet transmission of robotic operations to their colleagues in Japan. Last week, they made a real-time 3 D Full HD stereo Internet transmission of a prostate carcinoma. The operation performed by the da Vinci robot, took place at Masaryk Hospital and it was transmitted on-line to the KEK—High Energy Accelerator Research Organization—IT centre in Tsukuba, Japan. Tsukuba city is considered to be Japan's Silicon Valley. The KEK IT centre was not a random choice. CESNET has maintained long-term collaboration with this renowned institute thanks to the fact that the CESNET 2 national research network is connected to Japan's latest network infrastructure, the SINET 3, by way of the Pan-European network GÉANT. 16

Regional dark fibre network Masaryk Hospital is a provider of The National Research Network CESNET 2+ (10 Gbps access to CESNET 2+ on DWDM) Clients of CESNET 2 can access to the research network through our regional network 17

Regional dark fibre network Similarly dislocated The Ústí Region EMS offices are interconnected through this network. The RHC hospital dark fibre network provides services of a federative identity management Shibboleth and participates on an international roaming system for teachers, students and researches Edu. Roam. 18

Design of the regional network 19

1 st shared applications Data and communication centre of IS/ICT services is in Masaryk Hospital in Ústí nad Labem The 1 st shared application is the regional ERP system my. SAP ERP 2005 Unified user management and central directory services Common intranet and document management system 20

1 st shared applications Common HR and payroll information system Central Help. Desk Security ID cards for all employees Access system Area camera system Common logistic and purchasing IS 21

1 st shared applications Common logistic and purchasing IS Facility management system Common information system for pharmacy Virtual IS for joint medical libraries (MEDVIK) 22

Shared health information systems There is a PACS system in the data centre as a core of the regional solution (Magic. Store concept by Siemens) Data storage is based on grids (MAS by HP) The RIS-HIS-PACS communication is based on integration layer (IHE) (Ensemble by Intersystems) 23

Scheme of Masaryk Hospital PACS (2006) 24

Shared health information systems Scheduling - solution based on interconnection of booking and calling systems. Their interconnection has led to increased flexibility of the whole system including multiplication of its functions. 25

Scheduling system structure (2008) 26

Clinical information systems 5 hospitals - 3 different systems in 4 versions Ensemble Integration Platform We haven't got a common repository of health records (excluding PACS) Nonconsolidated laboratories, nonconsolidated their IS 27

Clinical data exchange We cannot cooperate on exchange of the discharge summary, findings from the laboratory, pathology, etc. We have no real or virtual archive, which we were able to say that the documents stored there arose a fair way – that are "guaranteed" We have no mechanism to automatically publish and share our records to external parties, with the verification of both parties and auditing process The same situation is among our 5 hospitals 28

What we need Applicable Best Practices for practice in CR "rules" External registers of health professionals Electronic signatures for physicians Clinical information systems with support of electronic health record Verification of eligibility (even partial) of health care providers to lead, provide and share electronic health records 29

Related and supporting projects Successful cooperation on the project Research and development of integration and communication centre of health information (The grant of Ministry of Industry and Trade of the Czech Republic) with pilot realization in Masaryk Hospital 30

Related and supporting projects Public internet in The Ústí Region hospital network (EU Structural Funds) Broadband – patient scheduling through internet (The grant of Ministry of Informatics of the Czech Republic) Logistic and supporting processes optimizing (EU Structural Funds) 31

Related and supporting projects Medi. Grid – methods and tools for GRID application in biomedicine (The Academy of Sciences of the Czech Republic, National Research Programme) Distributed data storage (CESNET, in the frame of Czech. Light project and Medical applications activities, project POSN – building of private optical hospital network – so called North Side) 32

Related and supporting projects Med. Gate – information gateway for research and development in medicine – the tool of integration and effective use of the information resources in medicine (The grant of Czech Ministry of Education, Youth and Sports) Medical virtual library - MEDVIK, sharing of information resources for research and development (The grant of Czech Ministry of Education, Youth and Sports) 33

The regional EFEZ framework program „Information and communication centre of The Ústí Region hospitals – the secure information exchange infrastructure including medical images“ is also one of the running projects within the framework program Effective healthcare in The Ústí Region Conditions (in short EFEZ) 34

The future cooperation Cooperation and data exchange with regional PACS project of Brno and Prague Connection to Brno academic PACS project MEDIMED EHR in paperless corporation of hospitals Multiregional and international cooperation 35

The future cooperation Dissemination to other localities of The Ústí Region Cooperation/connection to other healthcare facilities and subjects 36

Contact us Martin Zeman, martin. zeman@kzcr. eu, Head of R&D Department M 37