Client - government agency for healthcare improvement 

The RS Agency for Certification, Accreditation and Health Care Improvement is Republic of Srpska’s public institution, conducting certification and accreditation process of public and private health care institutions of all levels, as well as monitoring and improving quality of health care.

Agency jurisdiction includes certification, accreditation, monitoring and evaluation of quality indicators.


Essential Dots was hired to implement a web solution for monitoring and evaluating of health care quality indicators on a republic level. The main tool used for monitoring and evaluation of quality indicators are clinical pathways, also known as care pathways or care maps. They are multidisciplinary management tools based on evidence-based practice for a specific group of patients with a predictable clinical course. Clinical pathways can be seen as an application of process management thinking to the improvement of patient healthcare. Essential Dots used TYPO3 web content management system (WCM) as a base for this purpose. Complete patient hospitalization data for the whole country was stored as a content in the WCM.


  • Track all hospitalizations across the country (around 150k a year)
  • No final definition of any of the clinical pathways
  • Request to allow the clinical pathway definition change at any point of time • Quality indicators needed to be fully customizable
  • Fine-grain permission settings: for health care agency, ministry, hospitals, special guest accounts and possibly more in future
  • Performance optimization in order to support heavy load on gigabytes of data (4 million of individual input data was collected in 2011)
  • Military-grade server security implementation due to existence of confidential patient data
  • Integration with 3rd party systems for data consistency evaluation
  • Technical support for medical staff using system in day-to-day operations


A complex database schema allowing customizable clinical pathways and quality indicators was developed thus allowing future changes of the input parameters collected for each hospitalization. The agency was allowed to create variety of input parameter types, with a simple way of configuring certain conditions. Furthermore, a special easy-to-use configurational language was defined to allow setting of visibility and obligingness of certain input parameters based on the values of other parameters.

Another configurational language for mathematical formulas was defined with purpose of specifying quality indicators. Advanced logic for calculating quality indicators was implemented, allowing swift response in showing realtime charts on vast amount of data.

What were the benefits of using TYPO3 as a base? 

  • Website and operational application tightly joined, sharing the same administration back-end application thus cutting costs greatly
  • Complete user interface system for defining clinical pathways, parameters and quality indicators was implemented using TYPO3 forms and with a help of TYPO3 page tree concept for storing data within days
  • Application itself was seamlessly integrated into the website removing the need for developing special communication protocol between the application itself and the hosting website
  • TYPO3 fine-grain user permission settings were used as a base for implementing custom access setting features
  • TYPO3 core is patched regularly thanks to the agility of the TYPO3 Security Team
  • TYPO3 AJAX support was used for implementing desktop-like web application (*)
  • TYPO3 clustering support was used for load-balancing and failover (*)
  • Build process developed specially for TYPO3 was used for promoting new versions with a single click (*)
  • Advanced caching logic was implemented on top of TYPO3 core’s caching algorithm allowing fast response at all times (*)

(*) Essential Dots custom development


Our agile development process and solid development stack based on the TYPO3 core, allowed us to accomplish this project in less than 6 months. The application has been in operational usage for over a year, proving Essential Dots competence and know-how in projects of this scale. TYPO3 as an enterprise web content management system has once again proved as capable of supporting applications of all sizes. 

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