Recently, applying smart technology in daily life has been a common practice, especially in medical treatment. The smart technology nowadays provides faster computation, natural-command ability, wider presentation screens and applicably intelligent operation. (Emine, S., and Marco, S., 2009; Mohammad Mosa, A., et al., 2012; Yun Ahn, et al., 2016). It has been found that the advanced smart technology has also been widely used for medical healthcare purposes, for example, monitoring patients, tracing patient habits or patients’ health conditions, consultation to an expert or doctor, obtaining suggestion on healthcare meditation and many more. (Thinnukool, O., et al., 2017; Nora, A., et al., 2018). The number of people who requires doctors consultation or to get medical service could decrease by substituting new technology as an alternative. Although the smart technology trend in healthcare around the world has been increasing and the duties of medical staff has been decreasing, inadequate public health support and services are still problematic in Thailand. An application of smart technology has been developed to help the overcrowding of emergency care unit, but the system does not solve all the problems in the unit operation.
According to the National Bureau of Statistics in 2018, there were 220 million of out-patient in Thailand, There were 35,388 doctor staffs and where 180,589 were service providers and hospital staffs (Ministry of Public Health, 2018). From the numbers, Thai healthcare system should have a better system aiding primary care doctors. An ideal primary care system would include self-care system, long-distance patient care system, effective patient screening system and self-care knowledge providing channel which is important to help alleviate the public health unit workloads. The medical personnel, especially the primary care doctors could be effectively managed and patients can be forwarded in the correct order to fit with the available resources and medication using the technology. This is the key elements of the national strategic plan for public health in the 20 years following the Thai government policy of Thailand 4.0. (Suwankesawong, W., 2017).
However, the concerning limitation is the proportion between doctors and patients. The overcrowding problem in hospitals in Thailand is occurred due to many causes. For example, symptoms of the disease are sometimes difficult to predict. The side effects are sometime unclear and the illness caused by the accident would need a quick assessment. So, to save time in terms of decreasing the overcrowding in hospital, primary care physicians are very important factor for treatment and patient assessment in order to forward the patients to appropriate medical services either in the case of a normal illness or emergency in a timely manner (Suriyawongpaisal, P., et. al., 2014; Kaz,i B A., 2019).
Moreover, in many cases, the requesting of pre-hospital from rescue teams, rescuers, community hospitals and emergency medical volunteer are misrepresentation due to incorrect IDC or requiring over or under emergency resources. It has been reported by the national institute of emergency medicine of Thailand that 60% of patients who come to ER did not require any urgent treatment. This issue is similar to many regions when a patient needs an immediate care from medical providers due to lack of confident in primary care access. (Snooks, H. A., et. al., 2006; Coster, J E., et. al., 2017).
As the result, many patients are admitted to the emergency room and this causes the increase of overcrowding of the emergency care units of OPD and emergency rooms.
Thus, an effective patient assessment at the pre-hospital process can reduce the overcrowding problem in the hospitals. For example, in case of emergency the rescue teams, rescuers, community hospitals and emergency medical volunteer bear the responsibility to assess and analyze any suspicious symptoms of patient and requests an emergency resources. When these staffs do not have comprehensive health assessment field experience, the classification of patients by using CBD could be misrepresented due to incorrect IDC and leads to the requirement of over or under emergency resources.
The best way for correct assessment is to consult the provincial emergency command unit requesting a IDC by asking a CBD questions, which takes at least 2-3 minutes or more by phone. After a IDC is identified, the provincial emergency command unit will inform a hospital for medical resources to pick up the patient.
Trying to decrease time and increase performance of the pre-hospital process are still a challenging task for the National Institute for Emergency Medicine of Thailand (NIEM). Although the systematic patient assessment program developed by the NIEM has been used for patient assessment or to triage patients for IDC, it has been found that the program is somehow too difficult to use. A computer is required to run the program (Microsoft Access), which is not practical for primary emergency medical unit operation in nature. For that reason, the system from NIEM is not applied except for the provincial emergency command units because they are the center emergency units.
Moreover, most Thai medical doctors use the medical application in term of practical operation of the application. There are also popular systems, such as the Canadian Triage mobile application, Mobile ESI, which are the standard for emergency medical service in Thailand. The application is widely used by medical doctors for patient triage which provides ease of use on smart mobile phones for referencing triage protocol. The result of the study informs that mobile application may have better benefit for staffs experienced in triage (Savamongkornkul, S., et. al., 2017).
However, the limitation of this application is that the system will only be effective for users with medical knowledge, as the application requires medical terminology usage. For the pre-hospital process, there are not only medical staffs, but volunteers who also handle the pre-hospital process.
The research question is what kind of system can provide patients triaging for requesting IDC and what is practical for real-life operation by rescue teams, rescuers, community hospitals and emergency medical volunteers.
Moreover, there are some statements to be concerned in order to develop the system such as how the system can help decreasing the overcrowding of ER, how the system can increase patients’ knowledge when they are encountering suspicious symptoms, how would they know whether the encountered symptoms need any urgent treatment or not when they are at home.
Therefore, there should be a system that can help the primary care physicians or patients to perform illness screening for both normal and emergency cases. The system should also be able to provide a good referral to an appropriate emergency medical service. The application could also help patients to determine their own symptoms in many aspects such as symptoms severity evaluation and urgent treatment needs. The system should have a function to sort symptoms according to international standards.
Based on such problems, this research project aims to develop the functionally designed Thailand medical mobile application for patients triage base on criteria based dispatch protocol which can provide suitable use on mobile application systems. The application will serve as a tool for primary emergency medical practitioners and general users. In this study, a prototype will be developed using patients assessment data from the NIEM along with the analysis of the proposed model to reduce the limitations due to the user's specialized knowledge on the standard triage.
1.1 Triage Medical System
The use of technology on smart devices by health care professionals has transformed many aspects of clinical practices. Mobile technology including tablets have become commonplace in healthcare areas, leading to rapid growth in the development of medical software applications (apps) for these platforms. Mobile technology has played a huge role for users which includes, for example, offering them the information to track their health conditions, providing a suggestion on healthcare medication and being tools for medical providers for monitoring their patient (Deo, R C., 2015; Senders, J T., et. al., 2017).
Several benefits from healthcare system have been worthwhile for the secondary treatments in hospital or clinic. Additionally, using the system based on smartphones allowed an effective tracking or managing patients' health (Raybardhan, S., et. Al., 2005; Emine, S., and Marco, S., 2009; Mohammad Mosa, A S., Yoo, I., and Sheet, L., 2012; Thinnukool, O., et. al., 2017). In the content of application that associated to emergency case, many intensive researches have been conducted and we shall discuss about some of the works in this section.
Worldwide, incorporating information technology as smartphone into medical system have become conventional research and development in healthcare medical system due to its accuracy. For example, the study from Scott shows that the applied electronic triage provided more accuracy for triage protocol. The e-triage predictor and algorithm were applied and indicated probability of clinical care, emergency surgery, and hospitalization outcome to e-triage level (Scott, L., et. al., 2018).
Recently, Tadahiro developed the system for the emergency department operations. The prediction of ED disposition at triage remains challenging. The system approaches may enhance prediction and also improve the ability to predict disposition of patients as well and also support medical duties. (Tadahiro, G., et. al., 2018)
Lei and team work was aiming to use the triage to identify patients who require immediate resuscitation, to assign patients to a pre-designed patient care area, and to initiate diagnostic/therapeutic measures as appropriate. This study aimed to use emergency severity index (ESI) in a pediatric emergency room. The result found that the increasing performance of triage of nurses took approximately 2 minutes for triage. The results of triage made by nurses were similar to those made by doctors for ESI in levels 1-3 patients. This finding indicated that the nurses are able to identify severe pediatric cases. (Li, Wang, et. al., 2011)
Moreover, the development of triage mobile application especially in healthcare was applied to dental science. Corey, D. S., et, al., (2016) developed the mobile application system for the triaging dental emergency. The development research consisted of a need analysis and quality assessment of intraoral images captured. User can report habit themself by select or identify the most appropriate scenario that describes user discomfort and user were able to complete a report of triaging within 4 minutes. The application has helped the dentists and patients in term of self-triage prior to the dentist visit.
In Thailand, there is an application of medical system developed by Peradet, S., (2017), which can be used in tracking high-risk STROKE and STEMI patients who require services from Emergency Medical Services (EMS). The system can be operated on both Android and iOS operating systems together with GPS Tracker to provide the location of the transmitter at the current time. The use of GPS Tracker through GPS satellites and transmissions over the 3G mobile phone network are studied in this research. We focused on programming to integrate them with the system for semi-automatic usage. The program has been tested by focusing on the group of STROKE and STEMI patients who need emergency medical services at the scene in urban areas where mobile phone connection is accessible. This enable the system with revealing capability for accurate locations of emergent patient occurrences. For patient safety and emergency system optimization, emergency medical services can apply information technology to medical applications.
Ruangtananurak, R., (2014) has developed an emergency alert system including maps for positioning of emergency medical services. The patients or witnesses who encounter accidents can use the application on smart phone to send information from the scene, such as the accident location or other information, to notify the centers in the area. The information, along with the location of the scene, will be sent to the EMS. EMS unit can accurately locate the scene and the fastest route that allow emergency ambulances to get to the accident location quickly. It also includes directions to the nearest hospital.
As we can see from many examples, applying the system based on mobile application in triage is a suitable tool for identifying severe cases and then immediate interventions can be performed accordingly. However, the proposed system should also be able to help patients to determine their own symptoms in many aspects such as the symptoms description and their severity. Moreover, the mobile application should contain a function to sort symptoms based on Thai criteria based dispatch standards.