DOCA project was initiated in January 1990 in AcademyTown near Novosibirsk, which is well known in Russia and abroad as the multi-disciplinary Research Centre of the Russian Academy of Sciences. Two organisations became the backbone of the project: investor - Joint Venture "Utilex" (GM - Michael Kazakevich) and pilot hospital "Medsanchast-168" (GM - Dr Gennady Rot). Dr Rot was one of the very first Healthcare administrators in Russia who recognised the value of computer-based technologies within the hospital environment. He was persistent in implementing a system that could transform the way the hospital performs and affects the medical professionals within it.

Two specialists have been invited to lead the project - Gregory Yanovsky, PhD in Software Engineering, and Efim Shulman, PhD in Bio-medical research, - both with >10 years of academic background and extensive experience in design and development of real-time applications for bio-medical research and investigations.

The challenging task has been defined as to design, develop and implement a PC prototype of Hospital In-patient Clinical records system, meeting the requirements of various clinical departments with emphasis on user-friendly and intuitive interface and gradual elimination of paperwork in Patient Clinical records.

The target time was set as two years for a team of five (two more developers and one tester had joined the team working on the project).

Assuming that the prototype would get approved by the medical professionals, the 2^nd stage of the project was identified with the further targets being to enhance and transform the prototype into Hospital In-Patient Information System (HIPS) within Client-Server network architecture that covered all the clinical departments (General Medicine, Surgery, Neurology and Gynecology), Admission and Labs.

Finally - to evolve the system into a commercial product, to offer the system for purchase to hospitals that recognize the necessity and benefits of HIPS technology as to improve the quality of clinical documentation and to contribute to the quality of care.

After a careful consideration the Department of Surgery and Clinical Lab have been selected for DOCA implementation to prove the concept and to validate the solutions. Thanks to an enormous support of the Hospital GM Dr Gennady Rot and a significant contribution by leading medical professionals (Head of Surgery Dr Sergei Sparin, surgeon Dr Alexander Pospelov, Head of Lab services Svetlana Egorova) the first version of DOCA was launched into production in May 1991.

The next year was dedicated to enhance DOCA functionality as well as to expand DOCA to three other Hospital departments. Here again we would like to pay a full credit to Head of General Medicine Dr Vadim Mironov, Head of Neurology Tatiana Rot, Gynaecology surgeon Dr Tatiana Ovsyannikova, who put a remarkable effort and their personal time into unveiling the specifics of their departments and encapsulate DOCA technology into departmental daily activities.

The next stage of the project was achieved in July 1993 when all of the clinical departments, clinical labs and Admission rooms were fully integrated into a hospital network. Thus the clinical records of any patient had become accessible from any DOCA station restricted by users' access rights.

Over the two years, from the launch in Surgery department (local network, 5 stations) to Enterprise level HIPS (hospital network, 40 stations) DOCA has changed the daily activities within the hospital departments as far as clinical documentation is concerned. Most of the records were entered at the point of service, no clerks or typists were involved - medical professionals entered all the information themselves using formalized and well-structured templates, aiming for the clarity of clinical documentation. Paper-based medical records were not abandoned (due to the regulations of the Ministry of Health) but preserved with the printouts done after the documents are processed by DOCA. Physicians and Labs communicated efficiently over DOCA interface - the lab orders requested by doctors became immediately available to the lab personnel and the results entered by lab technicians were made available to physicians straight away. Doctors and nurses relied on DOCA for medication and treatment orders requested by physicians - every morning the nurses printed out the lists of medications and the changes to the medications for all the patients in the department. Medical consultations performed by clinicians from neighboring departments as well as the patient transfer between wards and departments have become significantly paperless. Finally the discharge papers were produced by DOCA within a minute. Based on the recorded clinical data, DOCA automatically generated the discharge documents to ensure the accuracy, completeness and quality of the documentation.

The advantages of DOCA-based patient history together with the transparency and easy-to-learn user interface make up the mind of the strongest conservatives within District Health Boards. DOCA technology has become increasingly popular among Healthcare authorities, hospital General Managers and medical professionals in the region. Despite of a very shaky and unstable Russian economy in the early 90s, DOCA has been sold and installed to nearly 20 hospitals in Russia, from a single DOCA station to the enterprise-scale DOCA implementation. DOCA gradually has been transformed into a commercial product with the support consultations and free upgrades provided by DOCA team.

However such a reasonable success could not generate enough revenue under Russian conflicting economical reforms and within the limited budget available to hospitals on Information Technology. DOCA team has not got enough resources and struggled to survive between functional enhancements and continuing support to the clients. When Gregory Yanovsky left for New Zealand, Efim Shulman took the leadership, consolidated the team and largely focused on the maintenance and support as well as the product sales to the rural hospitals in Novosibirsk region. By the year 2000 nearly 30% of local and rural hospitals in the region employed DOCA technology and used the system on 24x7 basis.

The IT tendencies in the late 90s, the tremendous spread of the Internet moved DOCA team into a new challenging project being to transform Client-Server technology into Intranet-based. Intranet implementation provides some advantages that include a thin client-browser, an easy deployment, an improved scalability, etc. At the same time the project nicknamed "DOCA+" should have been significantly contribute to the new tasks that became really important in HIPS implementations.

That included but was not limited to:

• Computerized Physicians Order Entry Subsystem (CPOE) - to control and verify drugs interactions and contradictions and to reduce the risk of human errors while ordering the medications to the patients;
  
• Decision making support Subsystem - to alert re the abnormalities in test results and to provide SOAP recommendations based on statistically proven analysis of the episodes of care within the similar diagnoses and clinical patterns;
  
• General Manager's suit of tools - to administer and analyse the overall hospital and departmental performance, to assist with planning and budget forecast, to control a number of key hospital reporting parameters - hospital length of stay, use and distribution of drugs, etc.; to develop a criteria to quantify the quality of care, patient safety, cost of stay, etc.

The team worked hard to achieve the goals. By the middle of 2002 the development of a first version of DOCA+ has been completed. In September 2002, almost simultaneously, DOCA+ have been launched in two Healthcare organizations - the Clinic of the Research Centre of the Russian Academy of Medical Sciences and Chulym multi-departmental rural hospital (Novosibirsk region). Both have been using DOCA for years, which made the transition fairly smooth and painless.

The project is still growing; new features are in design and development. The feedback provided by the users is important as to identify the key priorities for enhancements. Development team is keen to achieve the best; close cooperation and support from medical professionals is beneficial to both parties and hence fruitful and ongoing.

This is not the end of the story and we are certainly not prepared to come out with Hollywood-like happy end final "shots". However this is a true story about the project that went a long >10 years way from the idea to the implementation eventually becoming an essential tool within a busy environment for nearly 40 hospitals in Russia.

Over this period of time:

• Tens of IT specialists and medical professionals have contributed their knowledge and effect into DOCA success;
• Hundreds of hospital staff (managers, physicians and nurses) have been using DOCA in their daily activities and through DOCA became increasingly aware of the computer technologies in Healthcare;
• Tens of thousand patients' demographic details, past histories and clinical records have been recorded and stored within DOCA archives. This is a valuable source of clinical data and treatment patterns. Together with the newly built-in solutions this is a fair ground to achieve the remarkable goals - further improve the quality of care, contribute to the patients safety and to widely and wisely use DOCA+ to the benefits of the medical professionals and the patients.

The True story, the Success story - to be continued, hopefully never ends…