All Judex development is done in close cooperation with our business partners using the MI-way project guidelines ensuring quality and costs. A project can span from developing a totally new product from idea to production or it can consist of solving some kind of technical issue like connecting a medical device to Hospital Information System or writing a device driver. Projects originate from commercial actors as well as from the research community or as ideas from individuals involved with healthcare.

Advisory Board

The Advisory Board consists of senior staff, representing a cross section of the necessary skills for a successful project implementation. All new projects are reviewed by the Advisory Board at start up defining a project road map, identifying possible issues and main concerns and allocating resources. The Advisory Board does regularly review project status, Gate Keeping, and can also be invoked on a when needed basis by the project manager. Gate Keeping is a method assuring that the development proceeds as planned both in time and functionality and if not to identify problem areas and give early warnings.

MI-way

MI-way is a structured project management strategy consisting of a well-defined set of guide lines and tools specially adopted for Judex's business area. It is easily scalable to suite large as well as small projects and is a guarantee for an optimized quality assured development. MI-way is based upon Steve McConnell's project model, combined with our own long experiences within this field.

Realization

Efficient development is achieved by using the experience of similar development tasks and the use of the existing extensive library of common components like, HIS connections, hardware interfaces, signal analysis, multi-language support etc.

Outsourcing

Some projects will include tasks involving special resources, like graphical design, special hardware development etc. Over time we have developed a network of external companies, specializing in a wide area of activities, which we can involve on an as needed basis allowing for very flexible and economical solutions.

Project Examples

Here is a selection of Judex projects:

• amPHI is a system that continuously synchronizes medical information between an ambulance and the emergency ward making it possible to optimize treatment and use of resources.
• Treat is a highly advanced decision support system assisting in the optimization of the use antibiotics, also known as Antimicrobial Stewardship.
• Stay@Home is a Home Care concept making it possible to move healthcare to the patient home through the use of telemedicine.
• MusicaHumana is a clinical database aimed at investigating how sounds and music in various therapeutic situations can decrease patient stress and anxiety and improve their recovery.
• DagKir is a ward system aimed at ambulatory surgery, optimizing the whole patient treatment workflow and process.
• MI-ro is a modular system for Anesthesia and Surgery departments used for a multitude of tasks such as a quality assurance, registration of time and resources, surgery scheduling etc.
• HyskoBase is a nationwide clinical quality database for Operative Hysteroscopy and Transcervical Surgery.

amPHI™ Prehospital Healthcare Record has been chosen by the 5 Danish regions to be installed in all Danish emergency ambulances and emergency admission units during 2014. amPHI is further developed and installed in close collaboration with CSC Scandihealth, Atea and Alexandra Institute.

All ambulances, paramedic vehicles, emergency response vehicles and emergency physician vehicles in the North Denmark Region have used amPHI™ Prehospital Healthcare Record since 2006. In the North Denmark Region amPHI is furthermore fully integrated with the electronic healthcare record, CSC Clinical Suite, and with the interactive boards in Cetrea Emergency and is thus part of a total solution for the emergency admission units.

From roadside to bedside

amPHI is a prehospital healthcare record which encompasses the entire prehospital care pathway from the scene of the accident until the patient is received and admitted to the hospital. amPHI is essentially based on making it easy to collect all relevant patient data as soon as possible and communicate it further up the treatment chain, thus ensuring the patient optimum treatment.

The amPHI prehospital healthcare record sends information about the patient’s condition and initial treatment from the scene of the accident and the ambulance to the hospital’s admission unit and for example clinical desk staff at the emergency dispatch center. All information about the patient’s condition is recorded continuously during the prehospital stage, which helps ensure an optimum clinical pathway, faster diagnostics and more effective treatment.

All registrations in the ambulance are made on a touch screen computer which communicates with the system’s central servers via a mobile phone network. Measurements from the ambulance’s patient monitors are transferred automatically to amPHI.

amPHI is characterized by:

• Basic content similar to the paper-based ambulance record
• Possibility to add other forms (trauma, triage etc.)
• Real-time registration of treatments, medicine etc.
• Medication list dependent on competencies
• Capture of data from patient monitor.

amPHI in the emergency admissions unit provides:

• Overview of current transports
• Online access to the prehospital healthcare record
• Transfer of data to the interactive boards at the emergency unit and the hospital’s EHR system.

In addition, amPHI supports supervision, routine log for all rescue workers, paramedics, and emergency doctors, as well as the ability to extract data for EHCR audit in accordance with the Danish Quality Model

amPHI can be enhanced with a number of different modules, including support of the EMC function (Emergency Medical Coordination) in case of major accidents and disasters.

Access to prehospital data in the emergency admissions unit

amPHI provides the emergency admission unit with easy access to an overview of the prehospital activities in the area. If you want to display the prehospital activity together with the other activities of the emergency admission unit, amPHI data can be continuously transferred to the admission unit’s interactive emergency boards, for example Cetrea Emergency.

amPHI provides online access to all data recorded in the ambulance as well as information about the patient’s previous contact with the hospital etc. for the individual transport. If a diagnostic ECG-12 has been recorded in the ambulance, this will also be transferred to amPHI, and will be available in the emergency admissions unit along with the other measurements and observations.

At the end of the prehospital activity the entire prehospital healthcare record can be transferred to hospital’s EHCR system, for example CSC Clinical Suite.

The Challenge

Bacterial infections are a frequent cause of death, but the risk of death can be substantially reduced by covering antibiotic therapy. Antibiotic treatment is in most cases initiated empirically, prior to identification of the causative pathogen. Appropriate treatment, that is matching in-vitro susceptibilities of subsequently isolated pathogens, reduces the overall fatality rate of severe infections with adjusted odds ratios between 1.6 and 6.9. In current clinical practice 20-50% of patients receive inappropriate empirical antibiotic treatment. No less of a problem are superfluous and unnecessary antibiotic treatments. Concurrently, hospitals are facing a grave problem of antibiotic-resistant infections driven by excessive and inappropriate antibiotic use.
Thus in current practice we both undertreat patients, placing them at danger, and increase the problem of resistance by excessive and inappropriate antibiotic use.
Even the most common problems in antibiotic treatment do not have simple solutions. Choosing one antibiotic drug from among several candidates entails balancing the benefits and the costs associated with each.
In choosing antibiotic treatment, doctors have to choose between the interests of present and future patients. Should you prescribe a broad-spectred antibiotic and thereby expecting to have covered the infection, or should you balance this with other considerations like the risk of facing future bacterial resistance and direct economic costs?

Different perspectives may lead to different conclusions:

• Patients expect to be treated as good as possible with no considerations for future patients and economy in general.
• Doctors want to - and are expected to - treat each current patient as effectively as possible while not contributing to future bacterial resistance.
• Infection specialists, as well as the society, want to limit the likelihood of developing antibiotic resistance.
• Hospital management wants to limit expenses for antibiotic treatment as well as other costs in addition to common clinical goals.

The solution

Treət is a computer system that can be installed in your hospital. It runs on any available computer that is connected to the hospital intranet, using web-based technology to access a hospital-based Treət server.
The attending clinician will usually draw samples for culture from an infected patient in the hope that the pathogen(s) can be isolated from the samples. The laboratory results are normally available one to two days later. Meanwhile, the clinician will institute the empirical antibiotic treatment based on the data available at the onset of the infection.
Treət can provide advice on empirical treatment at the onset of the infection and on semi-empirical treatment later, when the morphology and Gram stain of the pathogen is known.
Treət can do this because it is calibrated to each hospital with updated information on the prevalence of pathogens and their resistance to antibiotics.
Treət balances the cost and benefit of a treatment by a decision-theoretic approach.

Treət will help you through the phases of prescription of antibiotics:

• Is there a bacterial infection - how severe is it?
• Which site of infection?
• Which pathogens?
• Coverage by a given antibiotic?
• Balancing coverage of the treatment against drug expenditure, side effects and ecological cost

Saving Lives - and Money

In an observational trial at 3 major European hospitals covering antibiotic treatment was prescribed to 58% of patients by the clinicians, while Treət's advice was covering in 70% of the cases. Furthermore, relative to the clinicians, Treət reduced drug expenditure to 53 %, ecological cost to 41% and overall cost to 51%.
An interventional randomized controlled trial at the same 3 hospitals showed that clinicians with access to Treət achieved better coverage and lower costs and that a reduction of hospital days had been achieved. The rate of appropriate semi-empirical antibiotic treatment improved from 78% to 87%.
In both trials Treət preferred narrow-spectred antibiotics. The overall cost at each site and the costs related by the model to future resistance were significantly reduced by Treət.

Please visit the homepage for Treat Systems Aps for additional information.

Background

As a result of the ongoing centralisation of the hospital systems worldwide, the distance for the average citizen to the nearest hospital is growing. With the increasing number of ambulatory examinations, the need for patient transportation and the patient waiting-time is rising, causing inconvenience for the patient and additional expenses for the hospital system.

Investigating the idea

Utilizing the company's know-how within the area of telemedicine, the purpose of the Stay@Home project is to identify relevant ambulatory examinations that can be carried out at the patient's home. This will guide the development of a support-system enabling the ambulatory examinations to be carried out outside of the hospital environment. The identification of relevant examinations are done in cooperation with healthcare professionals, tailoring the system to cover the exact needs of the end user: The staff.

The solution

The system consists of a mobile system, enabling data registration away from the hospitals, and a central administrations system, in which data is stored and used for further analysis. These units are connected by a secure communication system, enabling on-spot wireless communication between the hospital and the mobile unit.

It includes a booking system, providing services for booking examinations from the hospital, and route-planning for the mobile staff. Arriving at the patient's home, portable equipment enables test samples and analysis to be performed on site, minimizing the inconvenience and discomfort for the patient. All measurements and registrations are transferred to a mobile device, and sent to the hospital in preparation for evaluating the patient's condition and further treatment. If needed, the mobile staff is able to book the patient for a new appointment.

The Stay@Home ambulatory examination system is developed adhering to the existing open standards like HL7 and DICOM, making it easy to integrate into existing Electronic Healthcare Record, as well as other manufacturers' equipment.

Music for patients in the recovery unit and for heart patients.

The clinical database MusicaHumana has been developed by Judex in collaboration with the MusicaHumana group, which includes several members having a medical or musical background.

The basic idea of the MusicaHumana project is to investigate the effect of a friendly acoustic environment. The clinical database is an effective tool for storing and analysing the vast amount of data being collected by questioners during the project.

With many users placed all over the country and limited support from IT professionals the MusicaHumana database was designed to be accessed through the Internet in order to avoid any local installation. To access the database the only thing needed is a computer with access to the internet, regardless of where you are placed physically.

Please visit the MusicaHumana home site for additional information:

www.musicahumana.dk