Karolinska hospital is one of Scandinavia's most well known hospitals. The hospital, situated in Solna, has made a major imprint in Swedish health care, research and education and leads in medical breakthroughs in Sweden. With its wide range of services Karolinska hospital operates in areas that both extend and improve peoples´ lives. Each area bearing special importance within its specific field.

A particularly important field where eye-catching changes have been carried out lately is within the IT-department. Large amounts of money have strategically been invested in order to give way for better service, both to health care personnel as well as to patients and relatives. Through the journal system TakeCare and the new mutual health care database (GVD), patient information will be taken to new dimensions. Operating in the core of the system you will find the Xware platform xTrade Business Hub. Today, all communication between Karolinska hospital and suppliers/services passes through the platform, together with Stockholm County Council's all referrals and laboratory results. A total of 30 different systems exchange information with each other.

Quality improving communication
Approximately 20 000-30 000 messages stream daily through the hospital's message switch, originating from both journal systems and lab systems. The "geographical spread" is extensive; generally all health care units within the County Council who carry some form of data journal use the switch, alongside larger hospitals, local hospitals, emergency wards and private doctor's practises.
By providing this messaging service to their recipients, Karolinska hospital can easily eliminate many of their problems within logistics. Communication is streamlined and considerably smoother than on paper. The margin for error diminishes drastically since the user is not prone to make the same errors as before, "Everything goes straight into the system. It is definitely quality improving and time saving, at the same time as it is very popular, everybody wants it", tells Alexander Stendahl, head of EDI at Karolinska hospital.

Extensive changes
Several major changes have been carried out at the hospital during these last years, especially structure wise. The first major shift has been a general one, involving the centralisation of all hospitals to just one solution - something that has resulted in many positive consequences for all parties involved. The foremost effect of this union has been that competition between the hospitals has disappeared and instead given rise to a better climate with better cooperation. However, the probably biggest change at Karolinska hospital has been the merger with Huddinge hospital, an extensive project both practically and financially. At the same time as the merger, decision was made to abolish the previous journal systems BMS, PAS, Melior, these were replaced in favour of Profdoc´s journal system TakeCare, also used at Huddinge hospital.

TakeCare
With the TakeCare-system, personnel can follow up on a patient's health care history, no matter where at the hospital the information resides. This greatly reduces the risk for providing the wrong treatment due to incomplete information. TakeCare simplifies most things, for example replies are sent out directly which saves a lot of time, at the same time as the journal system is significantly easier to learn and use than previous systems. In TakeCare you will find all of the modules: all health care documentation, patient administration, health care planning, booking, electronic prescriptions, electronic referrals and replies. Financially speaking, the investment in the journal system will be very profitable. In the beginning, the estimated costs for TakeCare´s licence fees will increase with 2-3 million SEK, but long term, Karolinska hospital will be able to save 18-20 million SEK as the license fees for the other systems will disappear.

TakeCare is today the largest journal system in the County Council and is - besides at Karolinska hospital - also used at Norrtälje hospital, Stockholm's nursing home, Visby hospital, Nynäs health care, ASIH (Avancerad Sjukvård I Hemmet) Långbro Park and at 27 health care units. Add to this the emergency wards in Stockholm's county, all of which can easily access the information in the system. Presently, the system is available at more than 700 health care units within Karolinska university hospital and contains more than 1,3 patient journals.

GVD - Mutual Health Care Documentation
When visiting a health care central, you almost instantly can notice how spread out and incoherent the personal health care information really can be. First of all, it's not always that you visit the same health care unit the rest of your life, depending on circumstances, what kinds of health issues you are experiencing, etc. Because of this, patient information tends to end up here and there and often lacking a unifying source. Important information concerning for example allergies to medication, syringes, food, etc, is - as it is today - not available and instead it's up to the patient to inform about these matters.

A common problem within health care has for a long time been the incompatibility often witnessed between journal systems. Internally (within the hospital) sharing information between units is easy - which the previously discussed journal system TakeCare looks after. However, the gap between the hospitals is alarming. As it is today, Karolinska hospital is unable to read electronic journals from Danderyd´s hospital and Stockholm Söder hospital, in order to straighten this problem out Karolinska hospital decided to call in some help. WM-data was contacted and appointed the task to develop an electronic patient overview for caregivers, health care personnel as well as for patients and relatives. GVD includes a mutual storage-function for patient information, making it possible to communicate electronically between Stockholm County Council's all health care providing units. The service also provides the possibility to connect both municipalities and private health care providers.

With the mutual health care database the incompatibility problem will be nothing but a memory, Alexander Stendahl explains, "GVD will eliminate the sending of lab results and referrals between health care units out to their journal systems. Everything will be stored in a database at the County Council, in that way there will be more results to fewer recipients. The outcome will be a fairly tight structure, making it possible for everybody to send electronic referrals to receive lab results. Even those who don't use patient journals today will be given access to GVD (for example through a web-browser). With GVD I know that if I take a test at the emergency ward and two hours later end up at X-ray or the surgeon, I do not have to take the same test all over again, instead the personnel can just look in the system and find all the information there."

The work with GVD still proceeds, but sometime next year it is intended to be finished and ready to be implemented - to many health care unit's delight. However, first of all awaits a pilot project starting around the end of November - the system has to be tested - inside and out. And finally when the project is as completed as it can be, hopefully all parties within Stockholm's County Council will have access to the information in the database. In its full shape, the service is intended to comprise 20 000 simultaneous users and constitute support for all applications within health care.

The technical solution
Karolinska hospital has had a messaging service since 1994, but back in that time communication was more about lab results. Gradually as the service had to be expanded in combination with increased functionality demands from the recipients, Karolinska hospital realised quite quickly that the systems had to be altered in order to cope with all of the new requirements. A few years later Karolinska hospital issued a procurement with Danderyd hospital, which was won by WM-data, and through this the Xware solution xTrade came into the picture. xTrade has ever since been a permanent part of Karolinska hospital's IT-system. When all of the hospitals recently were centralised to just one solution, Karolinska hospital decided to stick with xTrade, other applications as AMTrix, XCB, Decabus, etc, were therefore phased out. No other products could measure up to xTrade, "In xTrade you get a much more flexible system. If one of our recipients has a specific demand, it can easily be fixed. Just about everything can be done in xTrade. There is no such thing as a "no"; right now it's more a question of politics whether we accept a customer or not. The technology is no obstacle", tells Alex Stendahl, and continues, "Within xTrade, we have all the solutions, we have a FTP-client, and straight away we are able to communicate with 90 percent of our recipients. In xTrade we are also able to execute specific commands on .exe files".

One of the main reasons why Karolinska hospital chose xTrade was because of the high security level. The hospital wanted to make sure that message handling was secured, protection procedures such as encryption was therefore something the hospital demanded. The suppliers that the hospital had worked with previously did not offer a solution for general encryption; instead all of them demanded that the hospital used the supplier's own server and client. With xTrade, Karolinska hospital immediately had a better solution, both technically and security wise. All encryption was now carried out inside the platform instead of at the suppliers. By integrating their processes with xTrade, Karolinska hospital has been able to improve the IT-structure noticeably and avoid connections that previously had proven to be both resource demanding and time consuming.

An improved and simplified IT-structure means a lot, not only to the connected parties in whole but also to the employees who can gain many benefits from the new and unifying structure. According to Alexander Stendahl, recipients nowadays are often actively involved in their own communication and continually request new functions that better support their own organisation, "When a party starts integrating, the benefits often show straight away, which makes it even more interesting to take it a step further and integrate even more".

Karolinska hospital and the future
The merger with Huddinge hospital, the introduction of both TakeCare and GVD, shows that Karolinska hospital wants to give 100 percent to further streamline and improve the organisation. TakeCare as a journal system has up till now harvested great success and also been appointed the "User's IT-award" by UsersAwards. Now, when the patient journal segment is finished and successfully introduced, the next step is to make GVD just as successful venture, "GVD will activate a lot of things. There will be large recipients instead of all these small ones, with several different types of messages. Everybody should have the option to send electronic referrals when needed; instead just on an occasional basis, or that only a few journal systems can do it. We will probably reach 100 000 messages per day within three years, at that point all of our projects are finished and up and running", concludes Alex Stendahl.

There's no doubt about that these last years have been marked by change. The differences between "old Karolinska" and "new Karolinska" are significant. Earlier, a lot of responsibility was placed on a few key persons who were spread out at different hospitals. By unifying all these parties and centralising the organisation, Karolinska hospital has been able to increase security and decrease vulnerability. Competition wise, the situation between hospitals looks more positive than ever. If a party wants to get connected, he/she can do so no matter which lab the other hospital uses, you don't have to buy and sell services between each other any more. One thing is for sure; Karolinska hospital has an exciting period ahead and the future looks very bright.