TOMTEC and Equalis AB

Partnership for better quality in echo examinations

Improving quality in medicine is a question of standardization of individual skills – especially in user dependent areas such as ultrasound. In Sweden, Equalis AB is the largest provider of external quality assessments in this field – and now switched to TOMTEC as technological platform.

Examining the heart via ultrasound is getting more and more important not only in cardiology departments but also in other disciplines such as Anaesthesiology. Considering the ease of use, harmlessness to patients and economic efficiency of ultrasound this is good news of course. On the other hand: Ultrasound is the most user dependent examination in cardiac imaging. Therefore the quality of results – and further on of treatment depends a lot on the abilities and the experiences of the doctor.

Evaluation of skills with External Quality Assessment

With Equalis AB, Swedish hospitals have a competent partner to assess their quality. The not-for-profit organisation offers External Quality Assessment (EQA) schemes with which doctors and other professionals like biomedical scientists or nurses can test their echocardiography skills anonymously and get feedback how good they performed – compared to colleagues, too. Participating in the EQA scheme has shown to be a valuable tool for the clinics in their education and internal quality processes as well.

Although this is not mandatory for hospitals, external quality assessments are required for accreditation through Swedac, the accreditation body of the Swedish government. This accreditation is a formal recognition of competence in accordance with European and international standards. “We have a really good coverage, with about 95 percent of Swedish clinical physiology departments participating in our EQA schemes”, explains Anna Karlsson, responsible for Marketing and Quality Management at Equalis.

One reason for Equalis´ success is that the schemes are of real good quality and very close to the clinical situation, as Emilia Svala, Scheme Coordinator at Equalis, adds: “Our aim is always to resemble the clinical real life setting as much as possible. For echocardiography this means to have appropriate images on one hand. On the other hand we need a tool that allows a comprehensive range of measurements which is close to what the doctors are used to from their daily routine. The previous software that was in use from the beginning in 2007, could no longer fulfil those requirements and we decided to switch to a new technological platform.”


TOMTEC ZERO as platform for external quality assessment

And this is where TOMTEC joined the game. TOMTEC ZERO  is a zero-footprint cardiovascular software solution that is accessible through web browsers – a crucial factor for Equalis business model. It is often not easy for our customers to install external software at their computers due to security settings. Emilia Svala pointed out one important reason for opting for TOMTEC. Another one was that TOMTECs technology offers a wide range of cardiac and vascular measurement functions and is very close to clinical setting in terms of handling and functionality.

Satisfied users lead to a satisfied customer

In short: TOMTEC ZERO was the perfect match for Equalis and its high approaches for the assessment settings. Nevertheless there were few things that needed to be adapted before going live. “One challenge was to enable the users to work simultaneous in the program. For echocardiography we have more than 300 users – potentially at the same time. So the systems have to cope with a heavy work- and dataflow”, Anna Karlsson adds. Moreover the software needed to fit in the existing IT-infrastructure of the 55 hospitals that opt for the assessment – all of them with their own systems and security standards. “We were faced with an extremely heterogenous setting. To cope with it the assessment software needed to be very flexible and interoperable so that it could be easily distributed into the clinical settings of the different hospitals. With TOMTEC ZERO we could offer a fully standardized way to provide the clinical applications by using standard browser functionalities based on HTML5 technology”, Tobias Clemen, Product Manager at TOMTEC, explains.

Another challenge was that everything need to be anonymous – the images as well as the measurements. Anna Karlsson adds: “Due to the good and close collaboration between Equalis, including our advisory group consisting of echocardiography experts from all over the country, and TOMTEC as technology specialist, we really built up an excellent system that meets the needs of participants quite closely.”

But not only Equalis itself is satisfied with TOMTECs software and the good collaboration with the company but also the users of the EQA schemes. After the first assessment round, Equalis asked for feedback. The evaluation of it showed: Most of the users rated TOMTEC better than the previous system in terms of speed, comfort and user friendliness.  Still, there are aspects that could be improved, for example the user comfort, but the Equalis Scheme Coordinator is convinced that using TOMTEC ZERO opens the door to expand: “Our aim is to cover quality assessment in all medical fields where echocardiography is performed and with the new software, which is very close to clinical settings and comfortable in use, we are optimistic to reach this aim in the future.”

About Equalis

Equalis AB is a not-for-profit company owned by the Swedish Association of Local Authorities and Regions, the Swedish Society of Medicine and the Swedish Institute of Biomedical Laboratory Science. The company is managed by a board consisting of representatives of the owners. Today, Equalis has 24 employees in the Uppsala based office and several advisory groups for medical and technical questions. Equalis offers EQA schemes for laboratory medicine, clinical physiology (medical imaging) and point of care testing. 2.200 health care facilities trust on Equalis services. (

Modules in use

* TOMTEC ZERO is part of TOMTEC-ARENA. TOMTEC-ARENA is a trademark of TOMTEC Imaging Systems GmbH