DOCA project was initiated in January 1990 in AcademyTown near Novosibirsk,
which is well known in Russia and abroad as the multi-disciplinary Research
Centre of the Russian Academy of Sciences. Two organisations became the
backbone of the project: investor - Joint Venture "Utilex" (GM - Michael
Kazakevich) and pilot hospital "Medsanchast-168" (GM - Dr Gennady Rot). Dr
Rot was one of the very first Healthcare administrators in Russia who
recognised the value of computer-based technologies within the hospital
environment. He was persistent in implementing a system that could
transform the way the hospital performs and affects the medical
professionals within it.
Two specialists have been invited to lead the
project - Gregory Yanovsky, PhD in Software Engineering, and Efim Shulman,
PhD in Bio-medical research, - both with >10 years of academic background
and extensive experience in design and development of real-time
applications for bio-medical research and investigations.
task has been defined as to design, develop and implement a PC prototype of
Hospital In-patient Clinical records system, meeting the requirements of
various clinical departments with emphasis on user-friendly and intuitive
interface and gradual elimination of paperwork in Patient Clinical records.
The target time was set as two years for a team of five (two more
developers and one tester had joined the team working on the project).
Assuming that the prototype would get approved by the medical
professionals, the 2nd stage of the project was identified with the further
targets being to enhance and transform the prototype into Hospital
In-Patient Information System (HIPS) within Client-Server network
architecture that covered all the clinical departments (General Medicine,
Surgery, Neurology and Gynecology), Admission and Labs.
Finally - to evolve
the system into a commercial product, to offer the system for purchase to
hospitals that recognize the necessity and benefits of HIPS technology as
to improve the quality of clinical documentation and to contribute to the
quality of care.
After a careful consideration the Department of Surgery
and Clinical Lab have been selected for DOCA implementation to prove the
concept and to validate the solutions. Thanks to an enormous support of the
Hospital GM Dr Gennady Rot and a significant contribution by leading
medical professionals (Head of Surgery Dr Sergei Sparin, surgeon Dr
Alexander Pospelov, Head of Lab services Svetlana Egorova) the first
version of DOCA was launched into production in May 1991.
The next year was
dedicated to enhance DOCA functionality as well as to expand DOCA to three
other Hospital departments. Here again we would like to pay a full credit
to Head of General Medicine Dr Vadim Mironov, Head of Neurology Tatiana
Rot, Gynaecology surgeon Dr Tatiana Ovsyannikova, who put a remarkable
effort and their personal time into unveiling the specifics of their
departments and encapsulate DOCA technology into departmental daily
The next stage of the project was achieved in July 1993 when
all of the clinical departments, clinical labs and Admission rooms were
fully integrated into a hospital network. Thus the clinical records of any
patient had become accessible from any DOCA station restricted by users'
Over the two years, from the launch in Surgery department
(local network, 5 stations) to Enterprise level HIPS (hospital network, 40
stations) DOCA has changed the daily activities within the hospital
departments as far as clinical documentation is concerned. Most of the
records were entered at the point of service, no clerks or typists were
involved - medical professionals entered all the information themselves
using formalized and well-structured templates, aiming for the clarity of
clinical documentation. Paper-based medical records were not abandoned (due
to the regulations of the Ministry of Health) but preserved with the
printouts done after the documents are processed by DOCA. Physicians and
Labs communicated efficiently over DOCA interface - the lab orders
requested by doctors became immediately available to the lab personnel and
the results entered by lab technicians were made available to physicians
straight away. Doctors and nurses relied on DOCA for medication and
treatment orders requested by physicians - every morning the nurses printed
out the lists of medications and the changes to the medications for all the
patients in the department. Medical consultations performed by clinicians
from neighboring departments as well as the patient transfer between wards
and departments have become significantly paperless. Finally the discharge
papers were produced by DOCA within a minute. Based on the recorded
clinical data, DOCA automatically generated the discharge documents to
ensure the accuracy, completeness and quality of the documentation.
The advantages of DOCA-based patient history together with the transparency and
easy-to-learn user interface make up the mind of the strongest
conservatives within District Health Boards. DOCA technology has become
increasingly popular among Healthcare authorities, hospital General
Managers and medical professionals in the region. Despite of a very shaky
and unstable Russian economy in the early 90s, DOCA has been sold and
installed to nearly 20 hospitals in Russia, from a single DOCA station to
the enterprise-scale DOCA implementation. DOCA gradually has been
transformed into a commercial product with the support consultations and
free upgrades provided by DOCA team.
However such a reasonable success
could not generate enough revenue under Russian conflicting economical
reforms and within the limited budget available to hospitals on Information
Technology. DOCA team has not got enough resources and struggled to survive
between functional enhancements and continuing support to the clients. When
Gregory Yanovsky left for New Zealand, Efim Shulman took the leadership,
consolidated the team and largely focused on the maintenance and support as
well as the product sales to the rural hospitals in Novosibirsk region. By
the year 2000 nearly 30% of local and rural hospitals in the region
employed DOCA technology and used the system on 24x7 basis.
The IT tendencies in the late 90s, the tremendous spread of the Internet moved
DOCA team into a new challenging project being to transform Client-Server
technology into Intranet-based. Intranet implementation provides some
advantages that include a thin client-browser, an easy deployment, an
improved scalability, etc. At the same time the project nicknamed "DOCA+"
should have been significantly contribute to the new tasks that became
really important in HIPS implementations.
That included but was not limited
Computerized Physicians Order Entry Subsystem (CPOE) - to control and
verify drugs interactions and contradictions and to reduce the risk of
human errors while ordering the medications to the patients;
Decision making support Subsystem - to alert re the abnormalities in test results
and to provide SOAP recommendations based on statistically proven analysis
of the episodes of care within the similar diagnoses and clinical patterns;
General Manager's suit of tools - to administer and analyse the overall
hospital and departmental performance, to assist with planning and budget
forecast, to control a number of key hospital reporting parameters -
hospital length of stay, use and distribution of drugs, etc.; to develop a
criteria to quantify the quality of care, patient safety, cost of stay,
The team worked hard to achieve the goals. By the middle of 2002 the
development of a first version of DOCA+ has been completed. In September
2002, almost simultaneously, DOCA+ have been launched in two Healthcare
organizations - the Clinic of the Research Centre of the Russian Academy of
Medical Sciences and Chulym
multi-departmental rural hospital (Novosibirsk region). Both have been
using DOCA for years, which made the transition fairly smooth and painless.
The project is still growing; new features are in design and development.
The feedback provided by the users is important as to identify the key
priorities for enhancements. Development team is keen to achieve the best;
close cooperation and support from medical professionals is beneficial to
both parties and hence fruitful and ongoing.
This is not the end of the
story and we are certainly not prepared to come out with Hollywood-like
happy end final "shots". However this is a true story about the project
that went a long >10 years way from the idea to the implementation
eventually becoming an essential tool within a busy environment for nearly
40 hospitals in Russia.
Over this period of time:
- Tens of IT specialists and medical
professionals have contributed their knowledge and effect into DOCA
- Hundreds of hospital staff (managers, physicians and nurses)
have been using DOCA in their daily activities and through DOCA became
increasingly aware of the computer technologies in Healthcare;
- Tens of
thousand patients' demographic details, past histories and clinical records
have been recorded and stored within DOCA archives. This is a valuable
source of clinical data and treatment patterns. Together with the newly
built-in solutions this is a fair ground to achieve the remarkable goals -
further improve the quality of care, contribute to the patients safety and
to widely and wisely use DOCA+ to the benefits of the medical professionals
and the patients.
The True story, the Success story - to be continued, hopefully never ends…