At a glance
Customer: Kronoberg County
Project name: Connect Prehospital Care II – MobiMed-Cosmic
Population 200,000
Vehicles: 17 daytime
Paramedics: 150
Patients: 25,000 per year
Summary
Kronoberg County successfully integrated its region-wide Cambio Cosmic digital patient record system with Ortivus MobiMed ePR, the electronic patient record (EPR) system used by emergency medical services (EMS). The integration allowed ambulance staff to document, update, and transfer real-time patient data seamlessly, improving continuity of care, reducing manual processes, and enhancing patient safety.
Challenge
Kronoberg County, in the south of Sweden, was facing many of the same challenges as healthcare providers around the world: the growing burden of chronic illness, rising numbers of ambulance callouts, growing resource constraints and increasing pressure to improve the continuum of care.
With 17 ambulances serving a population of 200,000 and making about 25,000 callouts a year, the county saw an opportunity to make the transition from ambulance to hospital better and safer for patients and healthcare staff alike.
Although paramedics could already document patient cases electronically in the ambulance via MobiMed’s electronic patient record solution (ePR), there was no way to quickly and easily deliver patient details, such as vital parameters, to the emergency department.
Because the hospital patient record system was separate to the ambulance ePR system, paramedics were forced to print out their records and physically hand them to emergency staff on arrival. This resulted in delays in treatment, loss of critical information, increased risk of errors, more administration, and less time to care for patients.
To bridge the gap between pre-hospital and in-hospital care systems and optimise workflows, reduce delays, and improve patient outcomes, Kronoberg embarked on a groundbreaking journey to synchronise its two electronic patient record systems, Ortivus MobiMed ePR for ambulance care and Cambio Cosmic, which is now used in all the region’s municipalities in hospitals and primary care.
The integration between Cambio Cosmic and Ortivus MobiMed ePR was carried out in two versions. The first version began in 2016 and led to significant changes in daily operations. As soon as a record was signed in MobiMed, a final note was automatically transferred to Cambio Cosmic with predefined fields. A PDF containing all information from the MobiMed system was also generated and attached to the footer of the final note. The system, launched in 2017, was named Connect Prehospital Care.
Shortly after the rollout of version 1, a feasibility study for version 2 was initiated. Ortivus, Cambio, and Kronoberg County jointly developed an enhanced solution in which ambulance patient information is displayed in real time to the receiving healthcare unit. This enables early documentation even before the patient arrives. The aim was to improve care quality, increase patient safety, reduce administrative workload, and enhance workflow for both ambulance staff and hospital emergency teams. With fast and reliable access to information, healthcare professionals are better equipped to prepare and act immediately upon the patient’s arrival.
The biggest challenges of implementing the project were:
- Ensuring real-time synchronisation between two complex systems while maintaining data integrity.
- Addressing differences in system architecture and data formats between Ortivus MobiMed and Cambio Cosmic.
- Adhering to stringent privacy and security regulations governing medical data in Sweden.
- Ensuring ambulance operations and hospital workflows remained uninterrupted during the integration.
- Gaining buy-in and training EMS and hospital staff to use the integrated system effectively.
Solution
At the heart of the solution designed and implemented collaboratively by Kronoberg County, Cambio, and Ortivus was the development of secure and scalable APIs that allowed seamless communication between the Ortivus MobiMed and Cambio Cosmic systems.
These APIs ensured that data could be exchanged in real time, enabling EMS teams to send pre-hospital patient data to hospitals while also allowing limited access to relevant patient history stored in Cosmic.
To achieve this, standardised data formats such as HL7 (Health Level Seven) and FHIR (Fast Healthcare Interoperability Resources) were used. These international interoperability standards ensured that the systems could share data efficiently and consistently, even though they were designed with different architectures and purposes.
Data standardisation
A significant focus was placed on ensuring that patient data transferred between the two systems remained accurate and secure. This involved mapping data fields between MobiMed and Cosmic and ensuring that all critical information, vital signs, treatments administered, medications, and observations, was captured and translated without loss or misinterpretation.
Additionally, measures were implemented to validate and secure data during transmission, ensuring compliance with healthcare regulations and safeguarding patient privacy.
Extensive testing paved the way for a safe launch
To minimise risks and ensure a smooth transition, the preparatory phase began with extensive testing, allowing the solution to be rolled out at full scale from the outset. Despite the thorough preparation, some adjustments were required as the system was put into real-world operation. Once the initial implementation showed positive results, usage was expanded to include all ambulance units and relevant hospital departments within Kronoberg County.
This incremental approach ensured that any challenges identified during the early stages could be addressed without disrupting ongoing care.
Training & support
Recognising that the success of the integration hinged on user adoption, significant effort was invested in training EMS teams and hospital staff. Training sessions were tailored to each group’s needs, focusing on:
- How to use the integrated systems effectively in emergency scenarios.
- Understanding the types of data being shared and their relevance to patient care.
- Troubleshooting common issues and accessing technical support when needed.
Ongoing support was also provided to address challenges as they arose, and feedback processes were established to identify opportunities for further optimisation.
Compliance and security
A core component of the solution was ensuring compliance with Sweden’s health data regulations, including Europe’s General Data Protection Regulation (GDPR). This was achieved through:
- Encryption of data during transmission to prevent unauthorised access.
- Secure authentication protocols for accessing patient records.
- Audit trails to track data exchanges and ensure accountability.
After a four-month pre-study, the development and implementation phase took 12 months.
Success factors
Strong collaboration: Close cooperation between Kronoberg County, Cambio, and Ortivus ensured alignment of goals, strong communication and efficient problem solving.
Focus on user needs: Early engagement with EMS and hospital staff shaped a solution that not only met real-world requirements but validated staff and included them in the process.
System testing in a controlled environment: Thorough preparation minimised risks, prevented disruptions, and enabled a full-scale launch from day one.
Results
The integration significantly improved the quality of the entire care chain in Kronoberg County, with the sharing of vital data ensuring that important patient information is always available to authorised personnel in real-time.
This also means that, for the first time, patients can now access their ambulance records via Sweden’s national health platform (1177), making healthcare more transparent and accountable.
Other improvements included:
- Time savings: Reduced manual data entry and paperwork for EMS and hospital teams, enabling faster, safer decision-making and freeing up more time to spend on caregiving.
- Accuracy: Reduced errors through automated data transfer and ensuring healthcare professionals had access to accurate and complete information.
- Regulatory compliance: The integration met all privacy and security requirements for handling sensitive patient data.
- Effective handover between ambulance and emergency department.
Award-winning
Kronoberg County’s integration between Ortivus MobiMed and Cambio Cosmic was awarded the Swedish Prehospital Award with the justification:
“Ambulance healthcare in Kronoberg County has, through diligent work and in close cooperation with record suppliers, various healthcare providers and NPÖ (the National Patient Overview tool), created a good example of ‘One Patient – One Record’ and put this into practice with good functionality. The work constitutes a milestone in patient safety work and continuity in the care chain and calls for both continued development and follow-up.”
Several regions follow
Kronoberg County has been followed by three other regions: Västmanland, Örebro and Norrbotten in implementing the same integration with Cosmic. Uppsala and Jämtland Härjedalen will start their integrations during 2025.
The next phase for Kronoberg County
The next phase of development for Kronoberg is to enable two-way communication. This means that paramedics, out in the field, will be able to retrieve patient data directly from Cosmic via MobiMed ePR. Soon, ambulance services in Kronoberg will have real-time access to past medical conditions, allergies and medication, all available at the touch of a button.
Learnings
Prioritise interoperability early
Addressing differences in data standards and workflows early on is critical for smooth integration.
User training is key
Comprehensive training for staff significantly improves adoption and ensures proper use of new systems.
Iterative testing yields better results
Extensive testing under real-world conditions uncovers issues that might not arise in controlled environments.
Maintain operational continuity
Integration projects in critical areas such as EMS must ensure uninterrupted operations at every stage.
