The ANZ arm of international healthcare software solutions provider Dedalus is eyeing off the ambulance and emergency hospital admissions market in Australia and New Zealand with a new product suite from Danish firm Amphi Systems.

Amphi Systems’ amPHI suite is described as a complete electronic pre-hospital care record (ePCR) solution unifying communication across ambulances and paramedic vehicles, the dispatch centre, and the emergency department.

Italian-headquartered Dedalus Group completed the 100 per cent acquisition of Amphi Systems in April, and the local arm is now bringing the solution to Australia and New Zealand, opening up a new local market.

Dedalus already has a strong in-patient footprint in both countries, including patient administration and clinical information systems such as WebPAS and iPM, along with medication management through MedChart and hospital pharmacy system iPharmacy.

The pre-hospital sector is a relatively new one for Dedalus, but the amPHI prehospital patient record has been used for many years in Denmark. It was rolled out in the north Denmark region in 2006, where it is fully integrated with the electronic health record used in that region, Dedalus’ Clinical Suite.

It is now used by the entire prehospital sector in Denmark, with all Danish emergency vehicles, ambulances and emergency admission units adopting the technology in 2014. Stockholm in Sweden has also adopted the technology.

The amPHI solution is operated on a portable tablet device in the emergency units and from a web-based solution at the dispatch centres and hospitals. The device features wireless integration to patient monitors and the vehicle’s navigation system.

ePCR for ambulance

Knud Buus Pedersen, managing director of Dedalus’ prehospital solutions in Denmark and CEO of Amphi Systems, said Amphi was the one of the first companies in the world to begin developing an electronic health record for ambulance when it was established in 2000 with the aim of digitising inefficient paper journals.

By 2003-4, the first ambulances were equipped with the solution using Windows CE-based devices, Mr Pedersen said. These have now been replaced by modern in-ambulance tablet computers, which receive information from the dispatch centre, allow for documentation at the scene and sending data back to the hospital emergency system in real time.

Mr Pedersen said the system has a FHIR interface to enable the sharing of data, including with hospital EMRs. Denmark’s five regions use individual systems, but FHIR enables data sharing between different systems and amPHI.

“The whole point of this is the importance of sharing data and ensure that all actors in the treatment chain have access to the latest updated information,” Mr Pedersen said. “Because the system is online all information registered in the ePCR is immediately accessible to other personnel on their way to the scene of accident and also to the personnel at the emergency department.

“This allows personnel to be prepared for treating the patient in the best and most efficient way, which saves time and improves the outcome for the patient. Having this online prehospital ePCR also allows communication from the emergency department. If the patient is identified, the ePCR system can collect previous medical history for that patient, providing important information about the patient such as allergies and daily medication.

“When the personnel enter assessment, vital values and triage in the ePCR, the information is stored immediately. This is both important for the documentation, but it’s also important information for the hospital, because the hospitals have big screens in the emergency room where they can see this ambulance on its way to a patient.

“If it’s a critically ill patient that will be highlighted in the emergency room with a red colour and they would automatically start assembling a crew to take care of that patient when it comes in and will start communicating with the ambulance. The data in the ambulance is online and available; they can log into this patient and see all the details for this patient.”

The Amphi system connects to patient monitors in the ambulance. While the system connects by WiFi, the tablets also have a SIM card so if the ambulance is out of range, data can be uploaded when a connection is established.

Real-time transfer of patient data

Bernie Maher, ANZ sales manager for Dedalus APAC, said the prehospital sector was a new one for the company, but he was looking forward to it as an opportunity for Dedalus to extend its capacity to help clients provide safer and more efficient care for patients.

“It’s about capturing the information and managing it and then transferring it into those other relevant systems with the objective of providing a safer and more effective care for the patient, which is why we’re here,” Mr Maher said.

“We’ve had a lot of connection with ambulance services over the years through other engagements and we’re quite familiar with what the landscape is around emergency services and the ambulance systems.”

Mr Maher said there were a couple of existing ambulance systems that dominate the market but some of those are in the process of being replaced due to age or lack of capability. He expects the market to be receptive to technologically advanced systems such as amPHI and what they can do in terms of real-time transfer of patient data into the ED.

“With some of the systems that exist here in Australia now, it takes a long time for transcription of the data in the ED,” he said. “The flow on of that is that it takes the ambulance off the street and that means it’s not available. So it’s super exciting to be able to have a system that already does this and does it in real time, transferred into the ED systems.

“That reduces the amount of time the paramedics are involved in the capture, the management and the transfer of the data, which allows the ambulance to get back on the street.”

Mr Pedersen said the benefits of electronic capture and sharing of data in a structured way extended beyond the emergency department, with data also able to be shared with GPs and other specialists outside the hospital.

Frequent flyers

For patients who are regular users of ambulance services, it also provides the ability to suggest alternative care pathways rather than taking them to hospital.

Mr Maher said the percentage of ambulances that get dispatched to non-critical patients is quite high, so the ability to capture the right data, analyse it and then be able to dispatch an ambulance that has not only the right capability as an ambulance, but have the paramedics trained at the right level becomes very powerful.

“Not only does that allow them to operate much more efficiently, but they can be more effective and outcome driven,” he said. “The outcome for the patient can improve because they have the right type of ambulance and capability from a paramedic skill perspective to address a specific case.

“A cardiac patient might be an example or a stroke patient might be an example, and that allows the ambulance services to rationalise the types of capabilities that they will dispatch to a particular situation. That’s all data driven.

“If you can capture the data, manage the data properly, do the right analysis of the data, then it allows you to then redefine what you’re doing as far as the ambulance services are concerned. If there is a specific patient with a condition, that direct connection into the ED allows them to bring specialists in to provide care for the patient inside the ambulance and not just wait for them to get to the ED.”

Mr Pedersen said the pre-hospital solution also comes into its own in major incidents, whether that be a catastrophic accident, a terror attack, an earthquake or bushfires. The system allows for the prioritisation of patients in major incidents as well as a mapping function that allows incident managers to better direct ambulance crews. It also allows them to see the capacity of all the hospitals in the area.

“This has really become a major thing here in Nordic countries, in that everyone needs to be prepared for these larger incidents,” he said. “We have had a system taking care of this for the last 10 years in Denmark, but it has been upgraded to handle a lot more than it has in the past.”