Implementing hybrid cloud and unified communications across a hospital network


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Cloud Asia Singapore 15 May 2013

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Implementing hybrid cloud and unified communications across a hospital network

  1. 1. Unified Communications inHealthcareCloud Asia 2013, May 2013Leon JacksonHead of Healthcare IT (CIO)University of Malaya Specialist Centre
  3. 3. UM Care Delivery PortfolioPrivate Tertiary Care HospitalSees about 100,000 patients ayearPublic Teaching HospitalDoes Primary to Tertiary CareSees over 1 Million patients ayear
  4. 4. UMSC Differentiation in the Private Healthcare MarketUMSC is built on the same DNA of the UM Healthcare system, with an emphasis on aholistic, cutting edge and interdisciplinary delivery of care in the Tertiary andQuaternary space. Our clinical talent comes from the best of the Faculty of Medicine.CAREEDUCATONRESEARCH
  5. 5. The Origins of UMSCUMSC begun as a “private wing” to the popular University Hospital more than 11 years ago as astrategy to retain the clinical talent in the public teaching hospital but matured into a full blownprivate tertiary centre and an important source of revenue to this hybrid system over the years.
  6. 6. Transformation of UMSC from Virtual to ActualUMSC is currently virtual with a good number of resources running from UMMC but will soonhave its own independent infrastructure with the completion of the health metropolis.CLINICWARDO&GRAD$
  7. 7. The UM Health MetropolisWith the completion of the UM Health Metropolis, UMSC will grow into a 490 bed Hospital andbe expandable to a 980 bed Hospital. With this new infrastructure, our combined healthcaresystem is expected to be providing care to more than 3 Million Patients a year.Regional Healthcare IconCentre of Excellence & Integrated Healthcare EcosystemFull Continuum of Care (Primary  Tertiary  Quaternary)International health travel hubCapacity to treat 1.0 mil patients per annum490 beds, 180 clinics, 16 OTs (Stage 1)2016
  9. 9. The lifeblood of any Clinical practice is the Medical RecordThe provision of care spans through different episodes with different Clinicians and careproviders – at the heart of any efficient and safe practice is an effective medical record that isavailable to the provider as an when needed.
  10. 10. Patient Angelina Jolie 360 DegreesLab TestMedicationHistoryAestheticTherapiesImagingAllergiesBlood TypeHospitalization &TreatmentsCulturalFamilyHistoryPaymentPlan WorkoutLogs
  11. 11. EHRs, Enabling Collaboration between CliniciansA longitudinal, inclusive & comprehensive lifetime healthcare record that spans multiple caregivers and ensures a continuity of care for patients. This patient centered approach will allow ashift from a silo-ed episodic view of care prone to waste, duplication and sub optimaloutcomes to case based and lifetime care management paradigm.nurturenatureMajor Events Timeline
  12. 12. HIT for Enabling Collaboration between CliniciansHIT enabled platforms for collaboration between Clinicians will enable a consolidated lifetimehealthcare record and allow care providers access to more markets without geographicalconstraints.
  14. 14. Silos EverywhereFrom applications, to data repositories,to back end infrastructure, more than10 years of healthcare IT has left uswith silos of many forms making it verydifficult to achieve;• A Longitudinal complete view ofthe Patients Medical Record• Comprehensive Clinical Analytics• Collaborative platforms forClinicians
  15. 15. Undigitized,Unstructured DataMuch of the Medical Data is trapped onpaper and difficult to provision to the pointof care in a timely manner. Simultaneoususe by different teams collaborating for acomorbidity or differential diagnosis isvirtually impossible.Scanning it in to create an online copyallows concurrent use, but the software isstill agnostic of the content and cannotassist in analytics.
  16. 16. Applications, Access to InformationMany popular & specialized clinical applications are made by incumbent life science vendors andoften require specialized computing environments to function, causing a proliferation of differentterminals and devices needed to access different types of information in the delivery of care.Reference MaterialClinician’sNotesLab ResultsHospital BillingSystem
  17. 17. IT Infrastructure Silosare unsustainable inthe long runThe average cost of a TB of storagein a Zero Information lossarchitecture is about RM 15,000 –30,000 per TB – an IT systemproliferating Silos is unsustainable.Every 500MB mammogram is really500MB x 3 to the Hospital IT, 1 onproduction, 1 on DR and 1 in Backupon a tape.
  19. 19. The lifeblood of any Clinical practice is the Medical RecordThe provision of care spans through different episodes with different Clinicians and careproviders – at the heart of any efficient and safe practice is an effective medical record that isavailable to the provider as an when needed.
  20. 20. Case Management, Clinical Pathways & WorkflowsThe attending Clinician files a Case and plans his care process that will be executed by Nurses andAllied Healthcare staff – some diagnostic task and some therapy. These task are often dynamicand communicated verbally running the risk of;1. Getting inaccurate diagnostic data2. Applying the wrong therapy or amount of therapy to the wrong patient
  21. 21. Nurse, whereare the labresults?*NurseCallBuzzing**SMSfromDoctor**Question fromLab on LabApplication**Call aboutto betransferredto her *Killer SilosIn the typical hospital, Nursing staff are bombarded with request from too many channels withduplication and risk of communication errors. There is a correlation proven in UMSC betweenbusyness and mistakes. Streamlining task and communication with HIT and UnifiedCommunication not only improves efficiency and mitigates risk of errors, it also has savings fromsiloes of communication infrastructure.
  22. 22. CAUTION: DistractingNurses can killHere is a simple example of howseriously the hospital takes notdistracting Nurses. Those on roundsdispensing medication wear this vestso that the others in the ward donot distract or interrupt him/her.
  23. 23. Consequences of identification errorsWrongly identifying a Patient has serious consequences from the possibility of misdiagnosisto execution of the wrong treatment or administration of the wrong drug resulting inmortality or morbidity.
  24. 24. Care Plans, Protocols and WorkflowsThe Orchestration of the ESB driven by a Healthcare specific Business Process Management(BPM) Engine, the capability of data to flow across multiple systems will allow for the creation ofcare plans and protocols that translate into actionable task and alerts at the point of care.New AssessmentsCareCoordinator ActionsNew Labs,Diagnoses, etc.A variety of events cantrigger case tasksDrive Assessment and ClinicalWorkflowsDrive Alerts to the Care Team
  26. 26. The UM Healthcare Cloud,transacting approx 3 Million Patientsa year by 2017 on site with anadditional 40% through the internet.
  27. 27. Private & PublicSecondary CarePrimary Care& GPsAllied Health Partners1. Dietary2. Physiotherapy3. NursingNursing & CareManagersDrugs & TherapyLabsOMICS LabsImagingNext of Kin ,Volunteer CareManagersThe PatientRemoteMonitoring &BiometricsPrivate & Public Tertiaryto Quaternary CareTHE NEBULLICOLLABORATIVE CARE,DECISION SUPPORTAND HEALTHCARERECORDS PLATFORMUMClinical Research
  28. 28. ClinicalDecisionSupportCustomerEngagementFinancialDecisionSupportBrandAmbassadorsHIT Outcomes
  30. 30. Patient Management |Hospital Call CentreIn outpatient and tertiary careclinics, the consultation oftenbegins with a call to the hospitalcall centre. The call centre has tobe equipped to identify returningpatients and referral partnersand translate that into anappointment with a clinician.The call centre also managesreminders to patients to reducethe amount of no shows.
  31. 31. Patient Management | Customer Service & HospitalityA unified Hospital Information System can facilitate the identification of a patient andtransaction at the various points of care, translating to more comfortable patient experiencewith the added benefit of the timely and accurate generation of all charges.
  32. 32. Patient Management | Queue and Appointment ManagementIntegrated Queue and Appointment systems can significantly speed up the patient journeywhile allowing the hospital to maximize its patient volumes. It can also enable a morecomfortable wait with the right digital signage, where the patient’s next of kin could pass thetime in more comfortable settings such as a cafeteria or library.
  33. 33. Patient Management | Patient ThroughputThe goal of Patient Management systems is to get Patients in and out of the system asquickly as possible while ensuring their safety and comfort. This is a win/win, morethroughput means the Care Delivery Organization can see more patients while no patientenjoys staying in the hospital longer than they need to.
  34. 34. Patient Management | Automated Identification & Patient TrackingAutomating the identification of patients during the process of care is a fundamental ofpatient safety, reducing the risk of medication errors or mixing up diagnostic information.RFIP technology can also enable active tracking of patient in larger hospitals and even alertnurses when a patient falls or is unusually inactive outside of their ward beds.
  35. 35. Patient Management | Amenities & EMR InterfacesThe bedside tablet can be offered as an amenity which can provide the patient access to the internet,piped in entertainment and even paid on demand content. The patient can also order additional productsand services from the hospital or surrounding vendors and have it charged to their bill if they so choose.The patient can also have access to their bill if so configured. The screen also had clinical functionality,with the ability to video call a clinician and give clinicians access to the patients EMR at the bedside. Thiswill reduce the risk of cross infection when a clinician carries a tablet with him from patient to patient.
  36. 36. Patient Management | Billing AutomationBilling systems with interoperable data models that automatically capture charges during thepatient journey so that the patient always finds the bill waiting for them, and not vice versa. Awell modeled billing system will also be interoperable with payor networks, to reduce waitingtime for authentication and credit checks against GL payments.Gangnam SeveranceHospital, YonseiUniversity, Gangnam,Seoul
  37. 37. Patient Management |Self Service KioskSelf service kiosk can reducepatient waiting times by allowingpatients to register themselves,get statements, diagnosticreports, etc and even scheduletheir next appointment bythemselves.Such kiosk have the added benefitof reducing the manpowerneeded to service patients.Gangnam SeveranceHospital, YonseiUniversity, Gangnam,Seoul
  38. 38. Patient Management | Website and Social NetworkingThe hospital website should be an application that serves the patients with the utilities theyneed and are willing to do remotely. This can include finding the right clinician, making anappointment and paying your bills. The website should also be a source of information forcounseling and preparation of patients for consultation, treatment and procedures.
  40. 40. The ideal systemGuiderails toencouragestructuring oninputNLP, ESB and DataManagement Enginederives meaning anddelivers valuableanalytics and decisionsupport on the frontencouraging Clinicianto document anddepend on dataPlatform allows flexibility for using multipleapplications and interfaces such as mobiledevices, etcNLP Enableddigitizationengine to parsepaper records,with supportfrom MedicalRecords driventranscriptionEmerging digital toolssuch as DICOM enabledECGs, Ultrasounds, Etcprovide digital data tothe recordCPOE provides alldiagnostic informationneeded and is servedback to record via ESB &Data ManagementEngine
  41. 41. Clinical Information Management| MobilityMobility enables realtime consumption and contribution of clinical information of the patient allowing formore efficient workflows, better productivity resulting in higher patient throughput and better safety. Apatient record or note made in front of a patient is always more accurate than one made retrospectively frommemory later at a desk.
  42. 42. Clinical InformationManagement | PharmacyDrug AdministrationElectronic prescribing by clinicians with warddrug administration automation reduce riskof medication errors by ensuring that theright drug is administered to the right patientin the right form, dose, frequency and route.In an electronic workflow, pharmacist cancollaborate with clinicians in real time toadvise of drug interaction, adverse sideeffects, pharmacokinetic andpharmacodynamic parameters. Decisionsupport subscriptions are also availableelectronically to advise clinicians at the pointof prescription.An integrated EMR and PIS has the addedbenefit of being able to data mine for theright profiles for clinical drug trials.
  43. 43. Voice Recognition and Natural Language ProcessingVoice to text with Natural Language processing is able to add conversations in voice to theessential and comprehensive medical records. We are just 2-3 years away from the systemslistening to the Clinician interact with the patient and automating documentation to themedical record as well as interacting vocally with the clinician to provide decision support.
  44. 44. HIT on The Cloud | Personal Health RecordsThis is the perfect time for PHRs in Malaysia. PHRs will hand the ownership ofmedical / health records back to a patient so that they can own and participate inthe partnership designed to manage their health.
  45. 45. Personal Biomedical Telemetry @ The Quantified SelfWith a PHR, Healthcare service providers, wellness partners can provide patients withtelemetry devices designed to work with existing technology such as mobile devices,broadband connectivity, etc. These devices will transmit back diagnostic data to their PHR sothat clinicians can better help monitor and advise such patients on their progress, conditionsand overall health and wellbeing. It can also play very specific monitoring assignments forpatients with chronic conditions, pushing alerts to the respective partners when necessary.
  46. 46. HIT on The Cloud| Telemedicine, Enabling Collaboration between Cliniciansdespite the distanceTelemedicine will help provision tertiary and highly specialized care to remote locations thatdo not have the volumes or demand to keep such clinicians on staff. They also open newopportunities for nurse driven homecare or other primary care interfaces with the remotesupervision of a clinician.
  47. 47. HIT on The Cloud| TeleradiologyTeleradiology solves the problem of access to radiologist, by allowing the hospital tooutsource reporting on diagnostic images from specialized teleradiology units. This can speedup turn around times to get a patient imaged and supplemented by a radiologist report.
  48. 48. HIT on The Cloud| Mobile ComputingMobile access will translate into better access to talent on individual cases as junior clinicians can get accessto opinions of senior clinicians who have remote and mobile access to their case notes and diagnosticinformation. It will also enable clinicians to be more productive and deliberate on their cases at theirconvenience as they rush around between their various commitments.
  49. 49. Infotainment is now so easy to produceAn online presence also opens up opportunities for Infotainment. UMSC is leveraging on ourspecialist to create educational content to seal our position as a trusted source of advice andexpertise.
  50. 50. OUR STRATEGY
  51. 51. Our Unified Comm Strategy• Build the HER/PHR to ensure the flow of aLongitudinal, Patient Centred, Comprehensive,Prospective Healthcare Record along with local Telcoand SAS partners to ensure it becomes a larger-than-us network• Move UMSC stakeholders towards software basedcommunication such as IMs and Softphones• Collapse Multiple communication silos into softwarebased tools integrated into the EHR mentionedabove• Build workflows that leverage on Mobility and BYODpowered by the local Telco Partners
  52. 52. Our Unified Comm Strategy• Shift customer interaction to social powered platformssuch as meeting them on popular social media andcreating new channels to reach us such as IM• Create profiles and accounts for customers on top oftheir personal healthcare records to facilitate structuredcommunication for telemedicine and customer service• Drive Telco’s to provide healthcare vertical communitiesand offerings compactible to our healthcare cloud.• Invest in voice to text to add relevant information fromvoice to the EHR
  53. 53. Our Unified Comm Strategy• Finally invest in CRM tools and big data analytics ofsocial media to get a more comprehensive view ofour customers and stakeholders not available fromjust EHR data