Current issues facing hospitals todayConvergence of several factors and challenges Growing demand Cost increase Innovation• Aging population • New diseases • Diagnostics and treatments• Immigration • Chronic disease • IT greater embracement• Universal benefits increasing • Technological complexity • Skilled workforce needs raise• Improve Diagnostic • Hospital technology silos • Patient safety and quality ofcapability • Clinical Productivity care• Targeted treatment • Care continuity • Process complexity• Manage pace of • Clinical communication • Resource optimizationinnovation • Patient Satisfaction • Knowledge sharing• e.g for chronic disease • POC information access • Technology alignment tomanagement, business/clinical priorities • Clinical traceability• Best practice adoption • Labor shortages Improve Speed innovation to Improve operational quality of care transform health efficiencies Mitigate risks
Clinical Productivity challengesExamples• Doctors: Seeking data and information − To and from meetings, rounds and demonstrations (Radiology, Pathology, Labs) − To see the next patient − Professional tasks are done sitting or standing at a work-place• Nurses: Seeking data, information, persons or assets − To and from patients in general − Responding to nurse-calls − Rounds − Checking and reporting med-tech. devices − Messaging and transporting paper-based information − Seeking for, and transporting assets• Productivity: Healthcare lagging behind other industries
How ICT can help• Medical staff − Manual processes automation − Digitization process / analog systems − Improve the capture and dissemination of clinical information − Facilitate mobility and location of personnel and health equipment − Integration of Clinical and Business Applications − Exchange and distribution of data, images and clinical information (i.e. e-salud initiatives)• Patient − Ensure that the required information is at the right time and place − Enable personalized and remote attention through collaborative tools (Telehealth, remote diagnostic, remote assistance, etc. ..) − Facilitate the monitoring of chronic and infectious diseases − Dissemination of health information (prevention campaigns, vaccinations, etc. ..) − Empower the individual to manage their own health
What is a Digital Hospital?− Relies on technology as an integral & fundamental part of its business strategy− Enables the organization to leverage its potential for delivering higher-quality patient centric care, in increasingly efficient ways through the use of technology & process redesign.− Builds on an Enterprise Architecture that goes beyond advanced clinical systems & includes technology integration to create a pervasive, real-time health information environment
The infrastructure silosin hospitals todayNurse Call Patient TV Door Phone Mobile ward round Opener Systems Intercom (PBX) CCTV Telephones Paper AGV DECT/Pager (Robot) Medical Devices RFID Wireless LAN WiFi Client PC Hospital Applications Light Blinds Heating Facility Control EPR PACS HIS LAB EHC
IP Convergence through a resilient, protectednetworkEnabling the transmission of vital informationPatient terminal IP phones IP wireless MDA/ PC Mobile Pager Nurses’ phones PDA phones portal (SMS) GSM OPC, SMTP, SMNP LAN/WLAN EPR PACS Laboratory IP converter I/O signal Etc. ESPA 4.4.4 converter Nurse call Patient monitoring Facility HP WiFi tags medical equipment control Digital Pen Everything over IP – IP Everywhere
What constitutes the Digital HospitalPatient Bedside Terminal & PortalMessaging & Alerts• Nurse call• Medical team assembly• Hospital orderly• Event driven alertsLocation &Identification Services• WiFi• Passive RFIDDevice Integration• Patient monitoring• Infusion pumpsIntegrationPlatformNetwork & CommunicationInfrastructure
HP Digital Hospital Solutionsframework•Integration •Electronic •Hospital •Patient •Digital Collaboration •Assetwith hospital whiteboard messaging &alerts bedside signage •Telehealth trackingapplications •Medical •Mobile nurse call interactive video & •Patient &- EPR / CIS / equipment •Medical team services & conferencing staff safety assemblyHIS interconnect communicati solutions •Temperature •Hospital orderly- Lab IS ons (Web, audio, monitoring •Order entry &-… results alerts video, IM, presence) Workflow Management / integration (Management, QoS, User RFID enabled location Presence, Instant Messaging, Unified Messaging & tracking Directoryintegration services IP Telephony, PBX replacement Converged Network, upgrade & security services Admin) Wired & Wireless Voice, Data, Video
The Digital Hospital Journey Inefficient Technology • Enhance integration of manual enabled efficient applications and services processes processes • Seamless communications & alerts • Patient bedside terminal/portal • Align applications with •Better quality of business processes care • Patient monitoring • Messaging & alerts • Patients & Assets •Reduced tracking with RFID number of errors• Converged IP network for voice, •Improved data and video productivity and • Reinvention and • Organizational decreased cost redesign of care virtualization processes • Ecosystem partners integration Physical Logical Ecosystem integration integration integration
St Olavs Challenges & VisionBuilding a state-of-the art hospital to deliver patient centric services• Hospital was too costly to operate, with • Located in Trondheim - Norway’s largest hospital annual rising costs • Premises: Main Acute Services Unit• Decision to build a patient centric new (75%) & University Hospital (25%) hospital that will provide outstanding • Managed by the Regional Health quality of care Authority of Mid-Norway • 950 beds• Opportunity to integrate clinical and • 8,000 Staff (+1,250 students) teaching/research areas • 413,000 patient treatments per year• From one large structure to 11 • Provides services & specialties for separate centres other hospitals in the region• Exploiting ICT to deliver information to the right persons at the right time at the point of care
St Olavs’ hospitalAdvanced logistics choicesPneumatic tube systems Automatic Guided Vehicles (transportation robots ) Clothes management through RFID chips and cabinets Automatic waste handling
The new St. Olavs’ hospitalA state of the art, patient centric hospital IP over all – all over IP : A single, converged IP network for voice, data and video • Secure, scaleable, resilient and responsive, 99.999% • Campus wide Wireless LAN in 11 buildings, inside/outside, Voice over WLAN • Seamless communications through 1400 IP phones messaging • Nurse call for 350 beds, 50 Nurse Stations • Emergency calls management from handhelds or patient signal system • Hospital Orderly – transport ordering, dispatching • Building alerts (30 technical systems integrated) • Patient terminal – Entertainment, integration with building control, access to clinical systems •HP Ipaq PDA’s (500)
Creating the Digital HospitalAssets – division of labour Nurse request wheelchair. LBS selects the nearest one. Transporter dispatch chair to the nurse.
Real time location and tracking Reduce costs Improve operational efficiencies Increase patient safety Workflow & Asset Equipment Temperature Patient & Resource Management Maintenance Monitoring Staff Safety Management Track Alert Manage Integrate …current and …automated alerting and …the utilization of …location and statushistorical location of notification (pump leaving a equipment, control information to existingmedical devices and protected zone, overdue for the workflow and hospital applications (e.gpeople, from a Web maintenance, requiring utilize location data asset mgmt, EMR, etc.) interface delivery, etc.) for operational analysis
Hospital Communication System Send and receive Replay and forward messages (auto and manual)• IP Phone messaging• Nurse Call• Medical team assembly Custom menus• Hospital Orderly Hospital and predefined• Building Alerts Comm. messages Melding- Predefined System sentral acknowledge alternatives On-touch duty or assault calls Lifts AGV Team Personnel Fire Patient Notifications Clinical Applications
Creating the Digital HospitalNursecall – Emergency Response 2 patients initiates nursecall. Each patient’s primary nurse receives request via IP phone. 1 patient requires emergency care and initiates emergency team assembly. System locates closest care provider for each of the team role and directs them to the patient.
Creating the Digital HospitalInformation push – Lab Test Orders blood test using PDA. Nearest qualified technician draw sample. Sample sent to lab via tubes. Lab process samples. Results are pushed to Doctor’s PDA.
Creating the Digital HospitalMonitoring – Locating nearest nurse A biomedical device generates an alarm. System locates closest nurse and instruct her to evaluate patient’s condition.
Benefits for Nurses – St Olav’s hospital“I now have greater freedom todeliver on the core services andmore time to spend with mypatients, which I used to spendfilling out forms, making endlessphone calls, chasing relevant patientinformation and test results, or justtracking down people.”Aud Olsen, Head Nurse, St Olav’shospital ProductivityWalking distances significantly reduced− Old facility 5.3 km = 1 hour 7 minutes of a 7 hour shift− New facility 3.5 km = 45 minutes of a 7 hour shift – 23 minutes per day released for patient care
Business Technology-In-ActionDigital Hospital Solution at St. Olavs Excerpts from IDC Case Study (Sept 2006) … a groundbreaking project … Patient … St. Olavs Hospital has been Audio /Video Patient Alarm terminal TV distribution Digital dictation IP Telephony tagged the most modern Peripherals Fixed/wirel ess hospital in Europe and probably Alarm and tracking among the world’s leading healthcare technology initiative Meta Catalog and is now fully operational …Messagesapplication … St. Olavs Hospital should be considered the world’sSecure Logon Medical Digital Assistant (Ipaq) benchmark in terms of tacticalCertificates Appl. . Public and strategic usage of . Network Operational Tools Data Appl. Data NTNU technology in life and death Network St Olavs scenarios for the better of their Cabling Infrastructure customers, the patients …
Experienced Results at St. Olavs• Treated more patients in 2007 than 2006 with smaller budget• Improved patient care with better access to data• Patient stays are shorter, less inpatients -20% in Neurology centre, 5.9d => 4.7d• Staff productivity increased through better collaboration• Reduction in yearly workload in 2006/2007
ConclusionHP and its partners can help healthcare providers increaseefficiencies, optimize resources et improve quality of care byintegrating IT, medical devices, and applications within the digitalhospital. HP brings industry leading track records in• Partners management• Delivery capacity• Commitments• Design, project management, complex solutions integration• Costs and risks reduction• State of the art technologies• Availability and security of information access, anywhere, anytime
Agenda• The Digital Hospital – vision, solutions framework• Functional view, solution benefits• St Olav’s hospital experience• Cost Benefits analysis
Healthcare Providers BusinessChallenges Speed innovation to Lower costs/Improve Improve transform health operational quality of care efficiencies Mitigate risks• Improve Diagnostic • Hospital technology silos • Patient safety and qualitycapability of care • Clinical Productivity• Targeted treatment • Care continuity • Process complexity• Manage pace of • Clinical communication • Resource optimizationinnovation • Patient Satisfaction • Knowledge sharing• e.g for chronic disease • POC information accessmanagement, • Technology alignment to business/clinical priorities • Clinical traceability• Best practice adoption • Cost containment • Labor shortages
¿Cómo pueden ayudarnos las TIC? • Personal Sanitario − Automatización de procesos manuales − Digitalización de procesos/sistemas analógicos − Mejorar la captura y difusión de la información clínica − Facilitar la movilidad y localización del personal y el equipamiento sanitario − Integración con las Aplicaciones Clínicas y de Negocio − Intercambio y distribución de datos, imágenes e información clínica mediante iniciativas de tipo e- Salud• Paciente − Garantizar que la información requerida está en el momento y lugar adecuados − Habilitar la atención personalizada y a distancia por medio de herramientas de colaboración (Telemedicina, Telediagnóstico, Teleasistencia, etc..), − Facilitar el seguimiento de enfermedades crónicas y contagiosas − Difusión de información sanitaria (campañas de prevención, vacunas, etc..) − Darle al individuo poder para administrar su propia salud
The Digital HospitalBuilt on• a converged , resilient, secured and adaptive network infrastructure,• Unified IP based communications, alertsEnabling• incremental solutions and integration to improve healthcare processes efficiencies, quality of care
The need for integration• A patient-centric healthcare service is increasing the dependency on information integration, to create complete and up-to-date Electronic Patient Records• EPR systems require integration at various levels, with objectives − To support the coordination, quality, and continuity of care − To improve health information communication under the control of the concerned patient − To reduce accidents and redundancies − To improve productivity• HP and our partners offer a new approach to integration, covering both applications, medical instruments for examination and observation, ICT devices and building control.
Medical applications & instrumentsintegration Presentations Blood bank Clinical Chemistry Integrations IMATIS Application Platform and Middleware Examination Observation Observation/Monitoring DICOM HL7 Waveform (real time) Software Discrete data ASTM Non Standard CTG, ECG, Endoscope, Microscope, etc. Remote Lab Instruments, FAG, OCT, etc. Infusion Pumps, CTG, ECG, Blood Pressure Monitors, etc.
HP and Imatis information integration solution Clients devicesBenefits• Connecting different communication and medical devices as well as IMATIS portal applications Applications• IMATIS portal sends data IMATIS SOA Platform - Middlew are to the right communication device• Transaction processing with real-time control and storable sets of rules provides necessary Adapters, Gateways, Drivers security Sources of data and information• Instant real-time event driven information delivery
Real time location and trackingsolutions Asset Equipment Temperature Patient & Workflow & Management Maintenance Monitoring Staff Safety Resource ManagementExample: Asset tracking at St Vincent’s Productivity Patient serviceshospital improve productivity and time with (QoC)patients- Active RFID solution to track assets •Increased patient •Reduced safety throughput incidents- Automated inventory management and •Increased capacity of •Reduced wait timesalerts critical departments •Increased staff time- Integration to order fulfillment system (OR/ER) with patientsBenefits •Increased staff productivity Costs savings- Improved equipment availability - 20% •Reduce staff time spentcost reduction in rental costs and lost on manual searching,equipment •Reduce purchase of logging and monitoring new equipment- Improved service unit staff productivity - procedures •Reduce rental costs20% increase in nurse time with patients •Staff efficiency
Patient Terminal Patient services • gives patients more control whilst recovering, enables them to communicate with external world • Opportunity to carry training programs for patients with long term condition • TV, Video, Radio, Telephone via IP • Internet/ E-mail / Access to hospital information system • Lights & blinds control • Integrated Nurse call system (IP or analog) • Console Games • Patient Billing Productivity • Access for clinicians to the hospital information system via smart card
Video conferencing and high resolution images sharing Patient services (QoC)• Highly accurate remote diagnosis and knowledge-sharing with specialty centers and other hospitals regionally and globally • Peer-to-Peer clinical discussions • Shortened decision cycles • High level patient case management, Costs savings bringing greater patient safety and convenience • Community outreach for specialty - Large US orthopaedics specialty practices with counseling and resources between 19 offices, six surgery centres facilities - Adopted UC real-time video collaboration to• Community outreach for specialty relieve physicians attending training and counseling and resources between compliance meetings travel burden facilities - In nine months, the system saved 100 hours of physician travel time, meaning more time for• Foreign language patients assistance patient care• Staff development – Training, Peer to Peer interaction, Mentoring and best practices
Presence, Instant Messaging Patient services Productivity (QoC)• Large NHS Healthcare trust • Contact specialistsemploying 7,000 people over 8 to rapidly respond tohospitals improved employee patient queries andcollaboration using a UC solution react faster toproviding IM, VoIP, video and web medicalconferencing. emergencies• Benefits reported includeenhanced patient care through •Locationimproved collaboration, significant information can alsotime savings through presence, and help identify the closest and mostmuch reduced email traffic. suitably qualified Costs savings person to respond.• Dramatic improvements in quality and cost of care are possible by the introduction ofUC tools such as presence, IM, conferencing with PACS, to enable instantcommunication between physicians as an integral part of the radiology workflow (*) * Survey conducted by Carestream Business Diagnostic Studies
Digital Signage in hospitals Patient services• Digital Signage in Waiting Areas −displays carrying a mix of news, health and wellness information −content tailored by department −for private health providers, promote higher- margin services Productivity• Touchscreen Directories and Wayfinding Systems −help patients navigate your facility, increasing on time arrival at appointment Costs savings• Patient Registration and Check-In Kiosks −self-service kiosks to fill out new patient profiles −Staff savings, while reducing wait times
Registration zone Smart Technologies Registration Area Self Service Counter Digital Signages While waiting, have a coffee or some gaming Wireless Network Technology
HP Digital Hospital Customers• St Olav’s hospital, Trondheim, Norway• Nye Ahus hospital, Oslo, Norway• Asklepios, Bamberg, Hamburg Germany• University Hospitals Leicester NHS Trust, United Kingdom• Medish Spectrum Twente hospital, Netherlands• Katharina Hospital, Netherlands• University of Michigan Health System, MI USA• University Health Network, Toronto Canada• IMSS, Lagos de Moreno, Mexico
Business Context• New Hospital building planned in Northern France• Opportunity to provide modern care based upon modern hospital – equipment, facilities AND IT infrastructure• Want to assess impact of many solutions together• Model data set at 250 bedsSolution Components:• Hospital Messaging• Information Integration• Location Based Services• Patient Terminal• IP Infrastructure
Cost/Benefit Analysis• Identification of business • Measures: objectives − Quantitative benefits• Establish key facts – salaries, • Time saved time taken for tasks • Cost reduction • Revenue enhancement• Estimate process improvement with solution − Qualitative benefits • Patient satisfaction• Calculate benefit in time saved • Staff satisfaction• Convert time saved to financial value using key facts• Assess impact on qualitative measures. Can be applied pre- and post- implementation
Business Objectives - ExamplesDriver StrategyIncrease operational Information available anywhereefficiency: Asset tracking Single networkImprove Patient Safety: Prescription Policy online Medical Team AssemblyIncrease patient satisfaction: Enhance bedside facilitiesIncrease staff satisfaction Automate patient administration
Impacts of the solution - examples Necessary solution components Converged Secure Network and Hospital alerts integration of VoIP Location Patient and information Services terminal Wired, messaging and medicalStrategie Wireless equipments Information available everywhere•• Find & locate personal equipment• Unified and integrated network• Specialised medical equipment alerts• Provision of bed side services• Automated administration processes50 9 March 2009
Implementation PlanDevelopment of the Release 1 Roadmap• Align opportunities •100% IP backbone,• Identification of pre- VoIP; Wireless •60% Information Release 2 requisites intégration •60% Hospital Alerts &• Definition of the project Messaging phases Content •50%Phase 1 Terminal Patient •40% Information Release 3 Integration• Identification of costs and •100% Location benefits by phase Services •40% Hospital Alerts & Messaging •50% Patient Terminal Time (months) 6 12 18
Benefits and Costs (K€) 10000 8000 6000 Benefits 4000 Total Costs 2000 0 Phase Phase Phase Phase Phase Phase Phase Phase 0 1 2 3 4 5 6 7 At current prices; 4 years illustrated
Release of Benefits Phas Phas Phas Phas Phas Phas Following Value released e0 e1 e2 e3 e4 e5 Year 5 0 0 1.0 2.1 2.1 2.1 4.2 Hospital Messaging 0 0 3.2 5.4 5.4 5.4 10.8 Information integration 0 0 0.5 0.5 0.5 0.5 1.0 Location Based Services Patient Terminal 0 0 1.0 1.0 1.0 1.0 2.0 0 0 5.7 9.0 9.0 9.0 18.0 Total Benefits (M) (6.4) (6.5) (6.5) (1.6) (1.3) (1.3) (1.3) Costs (6.4) (12.9) (13.7) (6.3) 1.4 9.1 16.7 Net Benefits Phase = 6 months Return on Investment = 28 months; Total Net Benefits (3 years) = 9.1M €
Digital hospital – workshop• Looks at the hospital from Business Why • Drivers, goals? view • Content? − Business view • Criteria for − Functional view measurement? − Technical view Functional • Data? Whic − Implementation view view h • User? • Services?• Determines • Quality? − Business drivers Technical • Structured? How − Vision, goals and analysis criteria view • Planned? • Realised?• Defines the digital hospital strategy − Principles Implementation • With which products? − Motivations view • With whom? • When/where − Implications (rollout, implementation)? Result Management report & presentation incl. • Strategy and solution description • Business benefits and ROI • Investments and work packages
Partner selection• Cisco, Cardiac and • Create a roadmap of deals• Xevit• Lincor • Point solutions pave the• Nortel way to the total Cardiac• ProCurve solution.• Trident (Jaotech)• Ascom• Lifeline (Cloaverleaf)• JDM• Axis• J&K• Aeroscout• Philips• Nervecenter
ConclusionDigital Hospital Delivering Business Outcomes Accelerate business growth: Lower costs / increase Mitigate risks: Speed innovation to efficiency: Improve quality of transform health Improve operational care efficiencies• Clinical information automatically captured and fed into elec patient record• Electronic decision support --- accelerating and improving treatment decisions• Interactions between patients and staff are radically improved• Changes in patient conditions can be communicated real time enabling faster response• Location-based services and WiFi tags helps staff locate resources faster and manage assets better• Bar coding and RFID technologies greatly improve medication administration – one of the most error prone care procedures• Portable devices and wireless communication extend the organizational boundary, leading to better, more efficient care for chronic-condition patients• Vast amounts of data can be captured for medical research, speeding the creation of new treatments and healthcare delivery options• Happier Patients
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