TripleA
ANYPLACE ANYWHERE ANYTIME

 

AAA Medical is a free, ‘occasionally connected’ electronic health record (EHR) and workflow app that works in the connected world but also for the 4.6bn people who live in the unconnected world. It also works in many current UK hospitals where Wi-Fi is poor or where Trusts just don't have the funds to install connectivity everywhere. We use the UK Government interface standards for interface and notation. Medics or patients can record health data in remote or off-grid locations and this data is then shared as and when group members 'sync'. Images, lab results, video, Jobs, treatments or vitals can be completed, new tasks issued or updated when any member of the group has a connection but more importantly all these tasks can be done when they don't have a connection. Medics can work off-grid just as they would as when they are connected. It's simple and intuitive to use, needs no IT skills to set up and runs on low cost smart phones. It works anywhere and at anytime when you need it. Try it for yourself and make up your own mind, no credit card required, just download the app and try it out or watch the video on YouTube.

 

WHY is AAA different ? For the technically minded, we use a technique called 'State Machine replication in distributed computing' - We don't just 'interpret text' we manipulate objects and re-align their effect in time. This allows us to give tasks\jobs\workflow a given 'state' at specific points in time. The data model we then use to control these processes can be updated, modified or added to by any of the group members when they are connected but also when they are not. Their additions or changes are then propagated to the other group members in the correct order as and when they synch. The model is also dynamic, it's different and adaptive to each users needs.

It works anywhere - you don't need a connection to the web, Wi-Fi,2G, 3G - that means the top of Mt Everest, the Gobi desert, airplanes, helicopters, Ambulances, EMR shielded rooms, basements, Mars and Pluto. It can be used by a single user or by a group who need to collaborate and share jobs and tasks. AAA users create their own workflows and environments that mimic their current working practices. 

AAA Works in disaster zones where there is no connectivity. Record patient ailments, treatments and take a GPS position. When you connect again, all that data is made available to the rest of your team.

A paramedic in an ambulance that was in an area of no connectivity could for example take vitals, administer medications, take images, video, patient notes and observations. AAA will continually attempt to send this data until it is successful. The phone or device will automatically find the best available connection be it 2g,3g,4g or Wi-Fi as soon as it becomes available. Everything you do before you had a connection and everything you do when you are connected is recorded and transmitted to your group as soon as it can be.

There are No infrastructure costs, No infrastructure, No installation, No system integration, No contracts, No salesmen, No I.T. Consultants, No demos, No feasibility studies, No pressured sales, You won't get fired for trying it and did we mention.. It's free.

  

AAA runs on a £30 smartphone - So what ? If everyone (or their employer) had £600 or more of spare cash to spend on a smartphone that's what we would have written AAA for. Of the 4.6bn people who don't have regular access to a web connection, many of them live on less than $10 a day. For these people or the medics who care for them £30 is too much and £600 is just not possible.

AAA allows medics in those countries to collect data in parts of the planet the web has not reached. Remote communities can have their medical conditions monitored on a single device. Advice and treatments can then be made and prescribed when the data from that device is seen by a Doctor or midwife for example (who could be anywhere on the planet). That advice and treatment can then be taken back to the people who need it and administered Anyplace - Anywhere - Anytime.

That's What !

See our Mission statement.

 

AAA Mimics your Existing Working processes The workflow system in AAA is dynamic, you build it to be exactly what you need and want. Every hospital is different and has different processes. The people who know these processes best are the people who work with them every day. AAA gives you the ability to re-create that exact system with every last nuance.

AAA is Global Consult and work with who you choose, wherever they are anywhere on the planet securely. Once you invite a colleague, they can see patient notes, vitals, images, video and all treatments. They can suggest actions and leave comments or advise. Once you remove the medic, all AAA data on their device is automatically purged even if they never connect to the internet again.

AAA is GPS aware and advises which medic is closest to each patient (or which patient is closest to you). It will also deliver turn by turn directions to get there even when off-grid or during a natural disaster. A dynamic workflow system allows the creation of custom solutions in a secure environment. Once a group is created and members invited, all data is shared and useable between them. Synching requires a 2G connection for a few seconds.

 AAA helps you be more productive With a few taps, AAA answers questions such as 'Tell me all the jobs I need to do in this ward ?' - 'Tell me all the jobs that are outstanding for this patient?' - 'Show me the most outstanding jobs in my Group ?' - 'Show me the outstanding jobs closest to me ?' - 'Show me which medic in the group has most outstanding jobs ?'. Work more efficiently and more productively wherever you are.

3 Fully independent profiles on the phone at a time - You may have up to 10 Profiles

  

 

AAA is Built for you We have built in full details for the 100 largest NHS UK hospitals - Select your hospital from the list and it's built in seconds. That's details and ward names for every Ward including, number of beds, contact names, telephone numbers, ward specialities, floor plans, visiting times and much more. It's a true working environment. Move patients between wards as you need but using actual ward names and locations. AAA is designed to seem like it's been written just for you. Place patients in a GPS aware model of your exact environment. You can also create your own 'custom' environment or Domiciliary systems that also work off-grid - We even 'reverse-geocode' patient locations from postcodes to within 2 meters. You enter the postcode, we do the rest. AAA will get you to your patient anywhere on the planet.

 

 

AAA is secure - Every single packet of data we send is encrypted with 256bit AES encryption (excluding your texts but including e-mails and group chat). AAA data is then only ever sent over an HTTPS connection. Data is AES encrypted on your device, during transmission and when stored in a HIPAA compliant data storage facility. We use SQL Server 'Always Encrypted' databases for storage. Additional Biometric security such as Windows 'Hello' can also be used if you enable this on your device and bitlocker on Windows phone devices. Windows phone has a FIPS 140-2 security certification - provided you have set up the security on the phone, even if you lose the phone. your data is safe. When you create a group and invite colleagues, we also use multi-factor security authentication and on top of this, we time limit the invitations. Despite this, we know that there is no 100% secure system. How secure is 256bit AES encryption ? (don't take our word for it) https://en.wikipedia.org/wiki/Brute-force_attack

"AES permits the use of 256-bit keys. Breaking a symmetric 256-bit key by brute force requires 2128 times more computational power than a 128-bit key. Fifty supercomputers that could check a billion billion (1018) AES keys per second (if such a device could ever be made) would, in theory, require about 3×1051 years to exhaust the 256-bit key space."

 

Why no PACS \ Link to our internal hospital imaging system. Glad you asked and when your existing vendor tells you they can do this easily, lets just consider a few facts.

DICOM medical images are often 100's of MB and some are Gigabytes. Like phones, medical imaging continually increases resolution and it's not going to stop. Some scans are now made of thousands of 'slices' where as a few years ago that would be hundreds at a much lower resolution. DICOM images cannot just be compressed\converted as most of the contrast information (DICOM Modalities) in the images would be lost. Additionally, the cost and management of re-digitising the library (old and new images) to a smaller image is out of the question. If just 4 or 5 doctors simultaneously try to download a few GB's of images to their iPads\iPhones at the same time, the bandwidth needed will degrade the entire Wi-Fi network. The 802.11n standard has a maximum throughput of 600Mbps or about 75MB/s. You may however be lucky and have 802.11ac (170MB/s) but your device still has to receive that amount of data and that speed is typically about 30-40Mbps (that's megabits) - it's going to take a while. If you have ever tried to download a 4k movie or stream to your iPad or iPhone you know how long this will take. It is usually a limitation on how fast the device can get the data. Gigabit Ethernet ports on desktops are a different matter.

If your hospital allows, you can take a photo of the screen of an imaging workstation and attach it to the main patient record but we can't deliver a full DICOM image to your device. We don't like to disappoint so it's not a feature we offer - just now.

 

AAA is a communications hub  - Every ward, patient, patient GP, colleague, department can be contacted with ease in a context sensitive way by email, SMS, voice or chat. If for example you select 'E-mail patient GP', AAA will pre-populate the subject email with the patients name. If you call the patients ward, AAA will tell you the name of the contact i.e. Sister Jane Smith. Not only that, the contacts are shared by the group so the numbers, bleeps and contacts are the ones that are relevant to you and your group. It's not just a massive list of 'possibly' relevant numbers created by your HR department, it's a concise list of numbers that are relevant to you and the group of medics you work with.

 

AAA is a group collaboration tool. When you create a 'Group', AAA then automatically creates a GPS aware model of the user’s hospital or environment. Group members can then be given tasks or create tasks assigned to themselves to be actioned on patients or beds or wards. The workflow and processes are dynamic, YOU create the actions and tasks that mimic your current processes and work for you. AAA then lets you allocate these tasks to members of your group and shows you details that lets you choose the medic best suited for the job. These details include how far away the medic is from the patient, what the medics speciality is and how busy they are. You can make an informed decision and not a random guess.

We don’t expect AAA to replace major IT systems but be used in conjunction with them or when they are absent. AAA empowers it's users to create their own solutions so the system seems like it's been written for your exact needs. ‘Tasks’ are designed by users mimicking your current workflows. Once created, the users share data so for new members of the team, all the combined knowledge of the group is available to them. For new recruits in a large hospital, this is invaluable as it creates trust, engagement and makes those first days a little less daunting.

The Action system is Dynamic - Create what you need

 

Step 1 -  Select an 'Action' - Step 2 - Add your detailed requirements - Step 3 (see screen above) Assign the job to a Medic Step 4 - Create the task.

 

 

So how do I get data out of AAA and into my main system - On the main patient record screen there is a menu option 'Email me a copy of this patients record'. When you select this option the entire patient record and all events are compressed into a file and then encrypted with 256bit AES encryption. This file is then automatically attached to an email which you can send to yourself. Once this E-mail arrives at your main PC or workstation, you can then open the file by entering your password and then cut and paste data from the e-mail into your main system. The file is password protected with your AAA password. Only you can open it and see the contents. This method of transmission and encryption is compliant with both HIPAA and HITEC. This method is not perfect and we would like to do better and make it seamless but that requires interfaces into your main system and that exposes both systems to security vulnerabilities. Any other mobile or tablet system that interfaces directly to your main system must be carrying a 'key' or is at least a gateway into your main system. The risk is that it's a mobile key that can get lost or be stolen. The issue is convenience on one hand and security on the other. AAA does not directly interface to any other system.

AAA has many uses so use what you need. You don't have to use it all or store patient data. We have added features you need such as encrypted group chat, personal panic alarms, ICD10 lookups (short and full), a phrase library, group wide banner messaging, hospital floorplans, ward contact and phone numbers, bleep\pager numbers, calendar integration, reminders, news, maps, jobs and much, much more.

Unlike most systems, When we say 'Always on' we mean 'Always on' even when you have no connection at all and even if the cloud goes down (which it does from time to time), AAA keeps on working. Even in Airplane mode, in the basement, in x-ray shielded rooms - absolutely anywhere on the planet and anyplace you are in. No expensive cabling, new terminals or Wi-Fi\network upgrades

 

 

AAA is Empowering - You are in control. Anyone, no matter how junior or senior can try and see if AAA can help in their environment. You create your own solutions that suits how you and the people you work with operate. It may come to nothing and if that's the case at least you tried to improve things BUT you may just come up with a gem of a solution on your own without a management consultant or a feasibility study in sight (and not having spent a penny). We hope AAA is a tool you can use to bring your ideas to life and make your working day easier, more manageable and efficient but also safer.

Here's hoping people on the ground can make a difference.

 You Choose - We won’t send a salesman in a suit with a briefcase to visit you nor will you have to talk to a sales consultant before you see the software – Just download AAA and see if it works for you.

 

So where are you going with this - What's the bigger picture ? We have been working with multi-user databases since 1982. On one particular project, we designed a PLC system that controlled a large industrial plastic resin production plant that ran 24x7x365 (A bit like a human being). The costs of any downtime was large (hot plastic sets). We therefore built into the system a 'self maintaining' A.I component where we calculated the statistical probability of components failing based on actual failures. The more data and failures we encountered, the better our predictions became to the point where we replaced components before they failed. It was almost like looking into the future. Algorithms such as these are now commonplace in most industries but guess where it's not ? Read our mission statement and see where we are going. 

Plan for the unexpected - We recently had a situation in Central London where an entire area of the capital lost its data connections for months http://www.bbc.co.uk/news/uk-england-london-32231725 due to an underground fire. This is London, one of the most advanced cities in the world in 2016. If it can happen here, it can happen anywhere.

AAA uses MS-Azure which has a 99.95% monthly SLA and all our data is geo-redundant but we still don't even rely on that. Even with that 99.9%, it's for nought if your Wi-Fi is down, the cell tower is congested or an underground fire destroys your web connectivity. Even without these, AAA will still keep going.

Azure has gone down before (as has AWS and all cloud suppliers).

If that happens with any conventional client server \ web based system, everyone stops work and resorts to a paper based backup system.

When it comes to re-keying that data, the problems don't stop. Many date and time sensitive items no longer make sense as they are keyed in days later and have to be 'manually corrected'.

When AAA can't connect (or you don't want to) it stores all its transactions and then transmits them when your connection is restored or it's suitable for you.

This technology is called 'occasionally connected' - It embraces a technical architecture design goal of a 'loosely coupled' system in that a failure in any part of the system won't bring the rest of it crashing to it's knees or just plain dead.

For example :-

One of our Azure servers goes down (AAA is spread over many servers) AAA Keeps on working
All Azure \ The cloud goes down AAA Keeps on working
Your mobile network provider goes down \ Fails AAA Keeps on working
The cell tower in your area goes down \ gets congested AAA Keeps on working

An Underground fire destroys all the network cabling in the area

AAA Keeps on working
Your local Wi-Fi \ internal network fails AAA Keeps on working

You have a local power cut (More common that you would think)

Royal Stoke University Hospital - 22 July 2016

Northwick Park Hospital 04th January 2016

Royal Berkshire Hospital 31 July 2015

Arrowe Park Hospital 5th March 2015

AAA Keeps on working
Your Mobile phone fails \ you drop it  - Use a colleagues phone AAA Keeps on working
Your colleagues phone's battery runs out - Find another colleague AAA Keeps on working
You need to work 'Off-Grid' AAA Keeps on working

 

As long as any device survives you will still be able to record patient data. You will never lose it. As soon as the other components recover, all data is realigned, all devices re-synchronise and it's as though the failure never happened. AAA essentially 'Heals itself' but in it's own time as and when the phone data is uploaded.

Even this is not perfect and we will always 'push the technology' - in our next release we hope to incorporate very cheap personal RFID data stores for AAA data (plastic armbands). Any group member who has access to the group will be able to scan a patient band and know exactly what has happened to the patient even if no group member has managed to sync. It's the modern version of the clipboard at the end of the bed. Paper may be old technology but sometimes it's hard to beat.

Our current architecture makes AAA highly resilient to failure and it's ground breaking technology. What we have planned for RFID's is already partly built and it's on the way - We already have plans on the next generation after RFIDS. Watch this space as they say. 

 

 

 

 

 

AAA has many ‘use cases’. Users can choose any part of the application that is of use to them and ignore others. For example AAA can be used to make the experience of a new medic starting work in a large hospital feel less daunting by arming them with essential ward names, contact names, floor plans and telephone numbers that’s always available even if they have no net connection. Reminders, appointments, the panic alarm, ICD10 features and many more functions can be used in isolation of all others. AAA does not have to hold patient data to be useful.

When you tap an event, an expanded view will be shown allowing you to drill down.

   

 

   

  

A ‘group’ can be created by users with a custom workflow tailored to your business processes and medical practices in minutes. This includes using your existing stationary and forms.

New data and amendments which were made off-grid are synchronized with all members in the group once they again obtain a connection. AAA always works even when conventional systems fail.

 

AAA also delivers topical jobs, events and a magazine to all groups. The content below is a sample of what would be supplied to a maternity group. The magazine contains up to date and relevant content for the group. The jobs are relevant only to the user. If an advertiser specifies 'Nursing' positions for nurses who work in maternity groups, those adverts will only be shown to nurses meeting those criteria. We won't send you disengaging and irrelevant offers.