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Web Based Integrated Healthcare Information and

Resource Planning
Robert Meggle1, Gjergj Sheldija2,
Project Manager, robert.meggle@care2x.org
2Care2x Release Manager, gjergj.sheldija@care2x.org

Care2x is a Web based Integrated Healthcare Environment (IHE). It
allows the integration of data, information, functions and workflows in one
environment. Its design can also handle non-medical services or functions
such as security and maintenance. The software is web-based, modular
and highly scalable. All program modules are processed on the server side
therefore module updates and extensions do not require changes on the web
browser, thus avoiding network interruptions and downtimes. Its design
also supports multiple server configuration to distribute traffic and improve
speed and efficiency.
Care2x is open source software released under GPL v2.0 license. The first
public version was released in 2002 and within the first few years it was
translated into over 20 languages. It has a worldwide developer community,
comprised of developers mainly from developed countries. The requirement
was to provide software covering all the key areas in the hospital and thus to
avoid the problem of incompatible software in different hospital units - also
still a major problem in developed countries.
The requirements of hospital software tend to differ from country to
country and hospital to hospital and this is the main reason that there is no
standard package commonly used in the hospitals worldwide. This is the
big challenge in creating a large developer community and keeping them
working together. Local customised solutions with good support from
proprietary software companies together with better funding resources in
developed countries, have not given space for open source software in that
market. During the last few years the development efforts of the original
free version have been concentrated in developing countries, which is also
seen in the download statistics. Out of 16500 downloads to 150 countries in
the last year 85% goes to developing countries.

The four perspectives

Four basic perspectives as described in Fig. 2 are :
the patients perspective
financial perspective
management (internal business perspective)
the internal training (learning and growth perspective).

Fig.2: HIS Perspectives

Each perspective represents a single strategy that can be easily broken

down in simple levels, depending on the individual needs of the hospital.
Care2x can help solve these issues, by its ability to monitor the values of
the main Key Performance Indicators (KPI) in each of the aforementioned
Patient's perspective will focus the value of for example the top 10
diagnosis, infections, etc. when the patient consults a doctor.
The financial perspective concerns hospital stock management and
the financial department.
Management will have the focus on values of reporting like
budgeting aspects and future finances.
The learning and growth perspective about visions which will
sustain the ability to change and training improvements for staff.
Thus, by using those perspectives a metric can be designed to classify
processes, structures and finally the needed technical and functional
specification for any implementation.
All those four perspectives are part of the Care2x framework, meaning
that they must be assessed and populated in accordance to each business

case. In order to achieve this, a list of objectives that can be feasibly

measured has to be created for each perspective. And, a specific target
should be set and the initiative to reach that target has to be described. In
that way, the four basic perspectives create a more valid and future oriented
hospital information system and its strategy. These measurements are
intangible aspects of the system as shown in Fig. 2.
Specifications on implementation
In order to measure the key performance indicators, there is always a need
for a specific implementation plan. These include several steps, some of
these could be described as:
Determining of priorities
Comply with standards
Collect required information
Managing changes and improvements
Based on Fig. 2 a table can be created where above requirements of an
initial process are described.
As an example of a workflow we created a diagram of a patient flow by
using the patient perspective.
The result of those workflows is a set of tables, in which the minimum
available dataset needed for a correct implementation of Care2x is

Fig.2. example of simplified OPD workflow (patient perspective)

Each of the table elements below results from the analysis of the internal
hosptial process. Each process describes the base steps upon which specific
metrics for the needs of the hospital can be met.
Table 1: Based on OPD workflow an example to show up the four perspectives





Patient registration








Registration fee


interface to ERP






Lab test


values of batches per







As can be seen in Fig. 3, graphical reporting tools allow KPI values to be

compared with historic data in a simple way to gain better understanding of
the health situation covered by the hospital.

Fig.3.Progressive outpatient registration 2011-2014 report of an implementation in Albania


During the implementation process of Care2x, several key performance

indicators are enabled to create the overall picture. Care2xs main feature
is its Open Source license. All source files are open and free for everyone
to use. Similar requirements as well as specific adaptation can be easily
realized whenever extensions to the code are required. The individual
architecture layers are separated from each other and can be enriched with
standardized communication protocols, which also allows the use of mobile
devices at any time.
In addition, the increasing know-how over time at the hospital site will
result in further projects within the hospital. Many hospitals using Care2x
have now a variety of other specialized software, integrated with Care2x,
used by specialists, such as for finance, warehousing or reporting to reduce
the total cost of ownership. The current development plans for care2x
envisage the full integration of an ERP sytem into the core functionality.
We would like to thank Advanz s.a. in Luxembourg for sponsoring our
presence at Med-e-Tel 2014 (http://givingback.advanz.lu)
Authors Info
Name: Robert Meggle
Date of Birth: 27th of July 1970
Nationality: German
Family status: Married, three children
Extensive experience in enterprise systems. has led various
HIS migrations to Care2x and numerous implementations
of Care2x in East Africa and Germany.

Name: Gjergj Sheldija

Date of Birth:03.08.1981
Nationality: Albanian
Gjergj Sheldija (MSc) is one of the core members of the
Care2x project. Experience in Computer Science with
emphasis in Computer Systems operating in the area of
health, has led various HIS implementations in Albania.