Updated: Aug 26, 1998
This is the most recent structured information on this project. Complementary data can be found on previous documents
TANIT II Telematics for Anaesthesia and Intensive Therapy II

Overview

In the 3rd Framework Programme, TANIT (A2036) delivered innovative design frameworks for Critical Care departmental systems. These directly address the need to improve clinical efficiency, to improve quality of care and to improve control of costs. Using the Anaesthesia Department and the General Adult ICU as exemplars, partial implementations of these designs were achieved in TANIT. These represented scaleable prototypes which provided a test-bed for a first evaluation of the key design concepts, including the user interface. In TANIT II, the functionality of these early prototypes has to be effectively frozen, with the emphasis being on the early verification of the two pilots in seventeen European hospital sites from six countries. The evaluation activities focus on the user acceptability of the pilot systems.

TANIT II is founded on numerous years of experience in the Critical Care domain. For example, the two major industrial partners (Kontron Instruments Ltd. and Drägerwerk) have been successfully active in this sector for over twenty five years, and were responsible for the development of the innovative pilot systems for Intensive Care and Anaesthesia in the earlier TANIT project.

Purpose and objectives

1. To identify priority areas to extend the functionality of the sub-pilot systems:
   Project-wide and hospital-specific user panels were used to achieve consensus on the priority areas for future implementation in follow-up projects.

2. To prepare the two Critical Care demonstrators for early verification in a number of European hospital sites from six European countries:
   Each hospital has a different time-frame for user trails, according to their phase of and requirements for installation. At the outset site preparation is required, including training of users and technical personnel, and ensuring appropriate hardware, networking and device connections are in place. All importantly local user panels, comprising of doctors, nurses and technical personnel need to be set-up. It is vital that the introduction of information technology into any environment is carefully managed if it is to be accepted by the users.

3. To define the evaluation methodologies to be used in the early verification:
   A variety of methods were used in the early verification of the Critical Care demonstrators in TANIT II, including questionnaires, semi-structured interviews, local user panels and logs of reliability. With the tight schedule of the project, the methodology had to be specifically tailored to maximise the results from TANIT II to ensure essential feedback to the pilot developers.

4. To undertake user trials:
   Early verification of the selected components of the demonstrators was undertaken in seventeen hospital sites from six different European countries.

5. To further European / international standardisation developments in areas that impinge on Critical Care:
   In particular, to make available information (emanating from both within TANIT II and also direct from the companies) and to co-operate with the AORTICS project and with CEN/TC251 WG5 Project Teams that are addressing the field of medical device interoperability.

6. To ensure maximum European benefit by exploiting and disseminating the project's results:
   This has been achieved by, for example, continued market surveillance, co-operation and information exchange with other 4th Framework Programme projects and by presence at European / international congresses and at Concertation Meetings.

Results

The overall results have been very positive. It has shown that the emphasis and direction of the ICU system development has been correct. From the survey, particularly strong features of the system are its ability to give a rapid overview of patient state, its intuitive and clear interface interface and its ease to learn. The ICU system was also considered to be reliable, and importantly to be an improvement over their current manual record keeping systems. There was strong agreement that the ICU system was based on sound underlying concepts and that it has strong future potential. Particularly its ability to link seamlessly with other computer systems in the hospital and healthcare environment was considered a large benefit.

An important finding from the survey was that a healthcare professional does not have to have any prior computer expertise in order to find the system valuable and easy to use. From the outset, it was intended that the ICU system be as easy to use for a healthcare professional who also happens to be “computer expert” as for one with no computer expertise. Healthcare professionals with greater clinical experience (gauged by number of years worked in Intensive Care environment and also the number of ICUs worked in) rated the system slightly higher than those with less experience. The ICU system has been designed to reflect the working practices of healthcare professionals. Those with less experience of these working practices would probably find any new approach to supporting care delivery more difficult than their more experienced colleagues.

Summary of Results for Anaesthesia sub-pilot system:

The major results of the evaluations of the clinical component can be summarised as follows:

• The experiences of the hospital personnel in the anaesthesia department in relation to data management and computers are sufficient for daily use of the anaesthesia system.
• The possibility to configure the system for every hospital can be considered as very good.
• The introduction training before the early verification can be done within a short time.
• The early verification methodology was accepted by the personnel of the hospital; however they propose also to list the detailed remarks and comments so that this input can be used for an improved specification. These detail remarks are reported in the Deliverable D06.1.

The concept of the anaesthesia pilot is well accepted; most of the problems were due to instability of the software of the system. The system is quick and easy to use. The documentation process is quicker and safer after people get used to it. The ergonomic touch screen approach is seen as a major step forwards.

The inter-operative phase of the system is the most important one - the other information is less important and can easily be entered by the other staff. The representatives of the two hospitals are missing in the sub-pilot the complete resource management functions: the Resource Management functions should be completed and included in future systems. The evaluators have the opinion that the anaesthesia system should be in the first place a reporting system. Although data management aspects will become more important in the future, the focus for the first step should be on the reporting task. Representatives from the Canisius Wilhelmina Hospital in Nijmegen are proposing to use Patient Flow Management Technologies. They have given a first proposal / suggestion Patient Flow Management for the anaesthesia department.

The results of the investigations evaluations on the resource management functions are as follows: First of all, the result of the work in this project is that it has been confirmed that the users, department managers and financial managers, have a real need to get a real time tool for Resource Management. KPMG defined also through their investigations the more detailed needs of the Anaesthesia departments. In fact, not only the needs has been defined but also a major of part of the specifications.

Further results that the development concept of Resource Management is working in practice in many hospitals. From the start of the introduction of the system in the Anaesthesia Department the professionals are learning how to improve their organisation. Examples are given in the Deliverable D06.2. Medical Pathways are developed making use of the developed Phases and Procedures for the Resource Management functions.

Involvement of users:

The ICU and Anaesthesia system development teams have found the results of TANIT II invaluable. Not only has it demonstrated that the design concepts on which the ICU and Anaesthesia systems are founded are correct, but it has also given feedback on the priority areas for further enhancement and future development. Moreover, the process of conducting user acceptability surveys at hospital sites has, by its very nature, made the users feel part of the system introduction process as their views are being asked throughout. Actively seeking the views of system users through formal surveying techniques, and acting on them, can only enhance the user acceptability of the system.

List of deliverables

Year 1

• D. 1 Hard/Soft characteristics (4, Sp, Pu)
• “User needs / benefits for Interoperable Critical Care Systems”; mth 8; Report; Restricted

Year 1

• D. 1 Hard/Soft characteristics (4, Sp, Pu)
• “Interim report on clinical trials of Intensive Care Unit Sub-Pilot; mth 18; Report; Restricted
• “Interim report on clinical trials of Anaesthesia Department Sub-Pilot; mth 18; Report; Restricted
• “Early verification / clinical trials of Intensive Care Unit Sub-Pilot; mth 18; Report; Restricted
• “Early verification / clinical trials of Anaesthesia Department Sub-Pilot; mth 18; Report; Restricted

List of participants

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