The Regional logistics center (hereinafter the RLC), located at the Regional center of cardiology, performs monitoring, including cloud storage of data, and routes the patients in real time, at any moment, at any place in the region.

The RLC provides the healthcare institutions and the entire healthcare system with coordination and operational data management for making managerial decisions concerning organization of healthcare services in the cardiology area.

Toward the end of 2020 the RLC was restructured into the Regional canter for cardiovascular risk (CVR) management.

The RLC goals:

— Fast information exchange and decision-making in the issues of routing and treating patients with cardiovascular conditions (CVCs)

— Structuring and adjusting key points of public health management

— Healthcare system planning and management in cardiology

— Hierarchy and logic control when generating consultation appointments in cardiology

New capabilities:

As a result of the project implementation, the following new capabilities for organizing fast and efficient patient routing and systemic tracking of treatment processes were established:

— implemented the «Traffic lights» system allowing the RLC staff to direct the patient flows between cardiovascular clinics in the region depending on where a free OR is available. That cut down the waiting time between patient admission to the clinic and surgery considerably;

— expanded the advisory service capabilities. Each healthcare professional overseeing a patient (i.e. a paramedic or a local general practitioner) can make an appointment to get advice from a more competent doctor (with available documents and patient data, such as test reports, attached), and get fast advice via telemedicine technologies, treatment plan, or patient routing recommendations;

— implemented a system of control over healthcare services provision by the regional healthcare institutions. The system enables fast detection of deficiencies at all stages of healthcare services provision, analyze all cases of violations, run training and other corrective actions;

— implemented a system for cardiovascular risks management (screening) for healthy population in the region. The system includes key CVR factors control and monitoring, and enables timely detection of risk group patients, providing them with pertinent recommendations, and set up monitoring by a general practitioner and a cardiologist at the patient’s residence location;

— created CVC patients registries. The registries enable patient control while avoiding condition advancement or relapse.

How it works:

Information on all CVC patients presented to any healthcare institution in the region is forwarded to the RLC through Regional medical information and analysis system (RMIAS). After the information is received, the patient support and routing process starts in order to provide him or her with most effective care.

Example:

a patient presents to the emergency room (ER) or any healthcare institution. After the presentation they make an electrocardiogram (ECG). The ECG in digital format is sent to the RLC through the RMIAS. At the RLC the ECG goes through automated target group sorting. After the sorting, if necessary, the patient is routed to the nearest free OR available in the region. Extra tests are conducted. Based on those extra tests results, an RLC professional gives guidance to the ER team. Furthermore, the software automatically suggests different options for decision making, thereby lowering the risks for the patient.

— at the moment a patient presents to the ER or any other healthcare institution, the RLC receives a long distance consultation request (may be a request for urgent consultation). The RLC provides comprehensive support of the case around the clock till an outcome is achieved (including high-tech interventions, initial or delayed coronary interventions, or bypass surgery).

When managing the care process, they use the available key parameters.  Such as low-density lipoprotein levels, healthcare provision time, hospital mortality, or life expectancy after the hospital discharge. This approach guarantees that the result received will be objective.

The possible deficiencies are monitored at all stages of the healthcare provision. Any deficiencies are detected automatically. Prospective and retrospective analyses are run regularly in order to detect any systemic deficiencies in healthcare services. Based on the analysis results, corrective actions are developed and implemented.

In that way healthcare professionals training becomes considerably easier, and their workload lesser.

The RLC was implemented on a cloud platform supporting unlimited number of users and providing comprehensive support for healthcare institutions, including:

— entering patient data into the common database and its automated stratification by risk groups;

— decision making support for primary healthcare professionals, presented as personalized recommendations on how to correct the detected risk factors;

— systemic control of adherence to current standard and clinical guidelines;

— administering CVC target groups registers, including screening;

— analyzing risk factors correction efficiency;

— detecting gaps in professional competences.

For patients:

After the RLC launch the patients started to get routed to healthcare institutions best suited for them in the shortest possible time, thanks to the «free OR» function and close seamless interaction between professionals. As a result, the patients get all the care they need, including surgery, in the shortest possible time.

Replication:

The RLC professionals regularly develop technical specifications for CVC patient registry improvements, and for managing healthcare provided to the patients with acute coronary syndrome. They provide full methodology support and improvement of the logistics system.