The Computerworld Honors Program
Honoring those who use Information Technology to benefit society
LOCATION:
Randor, PA, US

YEAR:
2007

STATUS:
Laureate

CATEGORY:
Business and Related Services

NOMINATING COMPANY:
Morgan Stanley

ORGANIZATION:
QlikTech International

PROJECT NAME:
Business Software that Saves Lives

Short Summary
Sahlgrenska University Hospital in Gothenburg, Sweden is Northern Europe’s largest hospital. Associate professor Daniel Stålhammar at the Neurosurgery clinic works to find the optimal treatment for severe head injuries. He had been searching for a simple, easy to use tool to aid doctors in predicting complications from cranial surgery. Complications from brain inflammation cost the hospital approximately $1,000,000 every year. More importantly it costs lives.
Professor Stålhammar is using QlikView to analyze a database of current patient status versus prior outcomes to predict when intervention is necessary. Through the use of this tool the hospital has been able to reduce the complication rate to zero, eliminate unnecessary tests and costs, and save patient lives.

Typically we think of Business Intelligence software as a tool for “driving revenue” or “improving profitability”. Here we find that BI software is used make a hospital more efficient, improve the treatment of critically ill patients, and to save lives.

Introductory Overview
Sahlgrenska University Hospital in Gothenburg is Northern Europe’s largest hospital with over 2700 beds divided into 165 wards and approximately 17 000 employees. The hospital is one of Sweden’s centers for critical cranial surgery. Cranial surgery is technically very difficult, but more importantly complications from surgery have a devastating impact on patient outcomes.

In particular, when brain surgery is performed after a severe head injury there is a great risk of getting an inflammation in the brain (meningitis). This risk occurs because the standard procedure is to leave one or more tube in the brain to drain excess fluid. Any infection around the tube or blockage of the tube can result in the rapid onset of meningitis. Every year there are about 20 people who get meningitis from this surgical procedure at Sahlgrenska hospital alone.

But doctors need support in knowing when to intervene and when the symptoms of the patient are simply a result of the invasive surgery. In the past this support has been encoded in a complex set of patient protocols which were difficult to manage, but more importantly did not reflect the most recent data and information. Professor Stålhammar worked to reformat the procedures after surgery based on analysis of data from prior outcomes. And, set in place a system whereby test results from current patients were fed into a database. This data was then read into QlikView for analysis.

The QlikView provides a real-time decision support system whereby doctors can see most recent test results compared with patient records over time. The system also automates the decision support tasks. Doctors are alerted by QlikView (email) when indicators show and increased risk of getting meningitis.


Benefits
Has your project helped those it was designed to help?   Yes

What new advantage or opportunity does your project provide to people?
Primarily the QlikView implementation serves as a tool to support doctor’s decision making. Deciding when a patient recovering from brain surgery has meningitis, and deciding how aggressively to treat the complication is difficult. QlikView gives doctors a simple, easy-to-use, and (importantly) fast way to sift through these results and assess whether the patient has meningitis and how it should be treated.

In the past these processes required doctors to manually sift through many sheets of paper detailing patient history and test results. They were required to manually make calculations and draw conclusions. Sometimes paper tests were absent or slow to retrieve. Most importantly there was no way for doctors to draw inferences and see associations between pieces of information across physical pieces of paper.

The “decision tree” task that doctors perform takes data from a number of different places – physical examination, tests, and other factors – and the doctor makes a binary decision of whether to treat or not. QlikView automates this procedure entirely and puts it at the finger tips of the doctors. They can focus on the patient, while QlikView crunches the numbers and builds the data associations.

The second major beneficiary is patients themselves. Patients who undergo brain surgery are engaging in a high risk procedure. Any tools which can improve their “odds” is tremendous. But more important than surviving the procedure is having the best possible outcome. For patients, QlikView provides a significantly greater chance of not having complications from surgery. And this can allow them to lead fuller, happier lives after surgery.

The third beneficiary is other patients at Sahlgrenska University Hospital. Treating complications from brain surgery is expensive. By reducing the resources spent on treating these complications, these resources can be utilized to improve the outcomes of all patients.

Has your project fundamentally changed how tasks are performed?   Yes

How do you see your project's innovation benefiting other applications, organizations, or global communities?
Sahlgrenska University Hospital is one of many hospitals in Sweden. The implementation of QlikView which is saving lives there can be used in hospitals around Sweden, the Nordics, and even the world.

In addition, the idea of applying information technology to support the decision making of doctors working on critical cases could be extended to other procedures.

Indeed the results were presented at the information days at Sahlgrenska Hospital and got at lot of attention. The next step is to present it to the board of doctors on April 26th. The complication costs of approximately $1,000,000 yearly are now has been reduced to zero. There is great hope that this method based on QlikView can be implemented to support other departments at Sahlgrenska.

The Importance of Technology
How did the technology you used contribute to this project and why was it important?
QlikView has four primary value propositions: it is rapid to implement; it is easy to use; it is fast; it automatically builds associations between data. Each of these contributed to the success of the project.

Rapid implementation has meant that the entire trial was conducted in just 3 months. In addition it was completed largely by the work of Professor Stålhammar himself. This is a critical feature of QlikView implementations – they are done by the “business user” (term misapplied here) themselves. So here we have a case of a doctor using a sophisticated business intelligence tool, not to analyze financial information, but to build an application for other doctors to use to save lives.

Simplicity and ease-of-use are key features of QlikView. End users understand QlikView intuitively and don’t require “training.” The UI paradigm is simple: if you click on it, it turns green; if it associated it turns white; if its excluded its gray. This simplicity is exactly what a doctor needs when they are working against the clock to make difficult decisions. They simply click on a patient name, see the test results associated with that patient, their chart history, calculations of key metrics, all on a single screen. Then they can click and navigate freely, all while maintaining the context of the current selections.

Speed is of the essence when dealing with sick patients. Waiting hours, minutes, or even seconds for results to come back is not acceptable. With a paper based process, waiting is the norm. And, even when you have the information at hand, calculations can take precious time. With QlikView, all this can be done in milliseconds.

Finally, QlikView builds associations between data. The key requirement for this type of medical analysis is that the doctor can see linkages between a patient, a test result, a prior outcome, etc., without “knowing” ahead of time exactly what he was looking for. QlikView’s Associative Data Model does exactly this – it maps all the data elements, how they link, and then displays this association (using the green, white, gray described above) to the user.

Originality
What are the exceptional aspects of your project?
What makes this project exceptional is twofold. First the results are fantastic. Saving lives and saving precious medical resources is great, especially if you can do it quickly and inexpensively.

But what really makes this project original is that it features the use of Business Intelligence software to solve a fundamentally human problem. Typically BI software is deployed in for-profit companies for the purpose of increasing revenue or saving costs. And, typically, it’s deployed to the privileged few who are the “business analysts.”

At Sahlgrenska University Hospital QlikView is being used to solve a very human problem. It’s helping doctors make better decisions about patient care. And, more importantly, its being used by the very people who make those decisions. QlikView has empowered the doctors with the information they need at their fingertips, to make decisions better and faster, and save lives.

How is it original?
Answered above.

Is it the first, the only, the best or the most effective application of its kind?   Only

Success
Has your project achieved or exceeded its goals?   Achieved

Is it fully operational?   Yes

How many people benefit from it?   hundreds

If possible, include an example of how the project has benefited a specific individual, enterprise or organization. Please include personal quotes from individuals who have directly benefited from your work.
“The most important thing is to make the right decision quickly. It can be the difference between life and death.”

“When I receive a patient, I can place myself in front of the computer screens and get the information I need immediately. It is completely fantastic. Now I have the total picture in front of me, and I do not have to search in different databases and waste precious minutes before still guessing something in the end.”

Daniel Stålhammar, Associate Professor, Sahlgrenska University Hospital

How quickly has your targeted audience of users embraced your innovation? Or, how rapidly do you predict they will?
QlikView has been in use at Sahlgrenska University Hospital since March 2001. The initial implementations of QlikView were centered around bringing together patient record data from as many as six different systems (including a massive Siemens patient management system). The project that with Professor Stålhammar has spearheaded extends this use of QlikView specifically to manage medical data and decision support for the cranial surgery area. The project began approximately 3 months ago as a trial. The trial is used by approximately 20 doctors and nurses. With the trial complete, QlikTech and the customer are working to extend the trial to other treatment areas within the hospital, and to other hospitals in Sweden.

Difficulty
What were the most important obstacles that had to be overcome in order for your work to be successful? Technical problems? Resources? Expertise? Organizational problems?
The most challenging problem that Professor Stålhammar faced with this innovative use of QlikView was organization change. Doctors, by nature, work one-on-one with patients and are reluctant to change the way they work. The great challenge in an implementation like this is to get users to accept a new system, and a new method of doing things. In addition, to make the decision support system work, it was necessary to get the input and expertise from a number of different doctors and experts.

Finally, there was the problem of the Swedish Healthcare model. Since healthcare in Sweden is a government service there is a reluctance to look to traditionally “business software” to solve problems. No one believe that “BI software” could make a difference in patient lives and medical outcomes.

Often the most innovative projects encounter the greatest resistance when they are originally proposed. If you had to fight for approval or funding, please provide a summary of the objections you faced and how you overcame them.
Every project needs a champion and for this project Professor Stålhammar is that champion. The initial introduction of QlikView to the Sahlgrenska University Hospital was when Professor Stålhammar personally downloaded the trial version of the product (for free) off www.qliktech.com. He had quite a bit of experience with traditional analytic tools, but had “stumbled” onto QlikView. The very first implementations of QlikView at the hospital were built by him alone without technical support. So, the way Professor Stålhammar has overcome objections is through “seeing is believing.” By showing what QlikView was capable of, and by showing how the tool could make a difference in patient lives, he removes the objections of the doubters and has made the project a success.
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