Proper safeguards can reduce adverse patient events such as healthcare-associated infections, medical errors, and patient falls. This paper outlines the strategies and logic for modeling a hospital’s infrastructure on the human autonomic nervous system through the use and integration of intelligent automated building solutions. These building solutions can lead to improved clinical outcomes, increased patient satisfaction and safety, as well as greatly reduced costs to the hospital.
Paper records of a person’s health and medical care history, including both written reports and graphic information, can pose not only confidentiality concerns but also accessibility and accuracy problems that can interfere with timely and effective treatment.
Electronic health records, as part of an integrated health information system, address these problems by making a patient’s health information available anytime, anywhere. EHRs also support patient self-monitoring systems, home care, remote monitoring and other increasingly prevalent practices. Further, EHRs help save energy and paper and support more sustainable processes.
Schneider Electric has been involved in integral electronic health care information and management systems since 1996, refining the technology to achieve optimum support to health professionals. As a result, it offers the TiCares solution, which has been implemented in several hospitals in Spain and Latin America; references are available. This solution is helping health professionals diagnose and prescribe treatment and preventative actions more efficiently — and benefitting all stakeholders.
This document discusses the use of standard-based design for personal health solutions using IEEE 11073 (X73) standards. It describes how X73PHD standards can enable interoperability between personal health devices (PHDs) and centralized systems or managers. Example applications discussed include using X73PHDs for ambient assisted living, intensive care unit monitoring, health and wellness, and integrating PHD data into electronic health records. Open challenges mentioned include developing X73PHD testbed environments and integrating X73PHD standards with other standards like SCP-ECG, EN13606, and HL7.
1. The document proposes a wireless sensor network architecture for remote health monitoring of assisted living residents.
2. Sensors embedded in the body and environment continuously monitor vital signs and environmental conditions. Data is transmitted to a central database for access by caregivers.
3. An experimental smart home has been set up with motion, temperature, and other sensors communicating over a wireless network to a central computer. Preliminary results found no false detections over one week.
Embedded systems in biomedical applicationsSeminar Links
Embedded systems are increasingly being used in medical and healthcare applications. They are integrated into devices and appliances that interface with patients and the environment through sensors and actuators. Key trends include remote patient monitoring and management of chronic conditions using embedded medication and treatment systems. Emerging areas include ambient intelligence systems using wireless sensors, hybrid computer/drug systems, and assistive technologies like surgical robots. Embedded systems provide real-time interaction and control that is essential for many healthcare and medical applications.
Paper Alberto Esteban - Distributed and synchronized users’ profile managemen...WTHS
OHMS allows physicians to perform continuous monitoring of elderly patients through a distributed system of personalized and synchronized XML profiles. This solution ensures that information accessed by both elderly and physician clients is always up-to-date by validating updates through a communication channel using web services and OSGi architecture. The health profile contains medical history, medications, sensor measurements, and protocols to manage this information based on a user's health conditions. OHMS was tested in European pilots to assess its ability to monitor users and react appropriately to emergency situations or medication changes based on profile information.
security and privacy for medical implantable devicesAjay Ohri
The document discusses security and privacy concerns for implantable medical devices (IMDs) as they increasingly incorporate wireless capabilities and coordination between devices. It presents a framework for balancing traditional goals of IMD design like safety and utility with new security and privacy goals. Some key tensions identified include restricting unauthorized access to device data and settings while still allowing necessary access in emergencies, and keeping IMD operations secure without compromising energy efficiency. The framework can help manufacturers and regulators address challenges from evolving IMD technologies.
IRJET- An Information Forwarder for Healthcare Service and analysis using Big...IRJET Journal
This document proposes a system for collecting and analyzing healthcare big data using cloud computing. It discusses how healthcare data is growing rapidly in volume and variety due to data from various sources like sensors, and how traditional storage and processing may not be suitable. The proposed system has three layers - a data acquisition layer to collect data from sensors, a transmission layer to send the data to the cloud, and a computational layer in the cloud to analyze and classify the data using clustering and fuzzy rule-based classifiers. This would allow real-time remote healthcare by efficiently storing and processing the large amounts of heterogeneous healthcare data in the cloud. Evaluation metrics like response time, accuracy, cost and false positives are used to compare the proposed system to existing techniques.
Paper records of a person’s health and medical care history, including both written reports and graphic information, can pose not only confidentiality concerns but also accessibility and accuracy problems that can interfere with timely and effective treatment.
Electronic health records, as part of an integrated health information system, address these problems by making a patient’s health information available anytime, anywhere. EHRs also support patient self-monitoring systems, home care, remote monitoring and other increasingly prevalent practices. Further, EHRs help save energy and paper and support more sustainable processes.
Schneider Electric has been involved in integral electronic health care information and management systems since 1996, refining the technology to achieve optimum support to health professionals. As a result, it offers the TiCares solution, which has been implemented in several hospitals in Spain and Latin America; references are available. This solution is helping health professionals diagnose and prescribe treatment and preventative actions more efficiently — and benefitting all stakeholders.
This document discusses the use of standard-based design for personal health solutions using IEEE 11073 (X73) standards. It describes how X73PHD standards can enable interoperability between personal health devices (PHDs) and centralized systems or managers. Example applications discussed include using X73PHDs for ambient assisted living, intensive care unit monitoring, health and wellness, and integrating PHD data into electronic health records. Open challenges mentioned include developing X73PHD testbed environments and integrating X73PHD standards with other standards like SCP-ECG, EN13606, and HL7.
1. The document proposes a wireless sensor network architecture for remote health monitoring of assisted living residents.
2. Sensors embedded in the body and environment continuously monitor vital signs and environmental conditions. Data is transmitted to a central database for access by caregivers.
3. An experimental smart home has been set up with motion, temperature, and other sensors communicating over a wireless network to a central computer. Preliminary results found no false detections over one week.
Embedded systems in biomedical applicationsSeminar Links
Embedded systems are increasingly being used in medical and healthcare applications. They are integrated into devices and appliances that interface with patients and the environment through sensors and actuators. Key trends include remote patient monitoring and management of chronic conditions using embedded medication and treatment systems. Emerging areas include ambient intelligence systems using wireless sensors, hybrid computer/drug systems, and assistive technologies like surgical robots. Embedded systems provide real-time interaction and control that is essential for many healthcare and medical applications.
Paper Alberto Esteban - Distributed and synchronized users’ profile managemen...WTHS
OHMS allows physicians to perform continuous monitoring of elderly patients through a distributed system of personalized and synchronized XML profiles. This solution ensures that information accessed by both elderly and physician clients is always up-to-date by validating updates through a communication channel using web services and OSGi architecture. The health profile contains medical history, medications, sensor measurements, and protocols to manage this information based on a user's health conditions. OHMS was tested in European pilots to assess its ability to monitor users and react appropriately to emergency situations or medication changes based on profile information.
security and privacy for medical implantable devicesAjay Ohri
The document discusses security and privacy concerns for implantable medical devices (IMDs) as they increasingly incorporate wireless capabilities and coordination between devices. It presents a framework for balancing traditional goals of IMD design like safety and utility with new security and privacy goals. Some key tensions identified include restricting unauthorized access to device data and settings while still allowing necessary access in emergencies, and keeping IMD operations secure without compromising energy efficiency. The framework can help manufacturers and regulators address challenges from evolving IMD technologies.
IRJET- An Information Forwarder for Healthcare Service and analysis using Big...IRJET Journal
This document proposes a system for collecting and analyzing healthcare big data using cloud computing. It discusses how healthcare data is growing rapidly in volume and variety due to data from various sources like sensors, and how traditional storage and processing may not be suitable. The proposed system has three layers - a data acquisition layer to collect data from sensors, a transmission layer to send the data to the cloud, and a computational layer in the cloud to analyze and classify the data using clustering and fuzzy rule-based classifiers. This would allow real-time remote healthcare by efficiently storing and processing the large amounts of heterogeneous healthcare data in the cloud. Evaluation metrics like response time, accuracy, cost and false positives are used to compare the proposed system to existing techniques.
The document discusses a case study of the Canton of Geneva in Switzerland creating an electronic healthcare network called e-toile using Cisco's Medical Data Exchange Solution. The solution allows healthcare providers and patients to access medical records securely from any system. It has improved patient care by giving providers a more complete health history and reducing errors. The network provides benefits like increased efficiency, cost savings, and higher quality care for both patients and the healthcare system.
IRJET- Hiding Sensitive Medical Data using EncryptionIRJET Journal
This document summarizes a research paper about securely hiding sensitive medical data using encryption. The paper proposes a system that distributes a patient's data across multiple encrypted data servers. It uses Paillier cryptosystems to allow statistical analysis of the encrypted patient data without compromising privacy. The system includes wireless medical sensors that monitor patients and transmit encrypted data to a database. It uses an access control system and statistical analysis protocols that employ Paillier encryption to allow authorized users like doctors to access and analyze the encrypted patient data without revealing its contents. The goal is to protect sensitive medical information from privacy breaches while still enabling useful analysis of aggregated patient data.
The document discusses HP's Digital Hospital solution framework which was implemented at St. Olav's Hospital in Norway. The framework utilizes a converged IP network to integrate clinical systems, devices, and applications. This allows for improved communication and information sharing. At St. Olav's, benefits included increased productivity, shorter patient stays, and better patient care through improved access to data. The Digital Hospital framework can help healthcare providers optimize resources and improve quality of care through IT and application integration.
Information technology is increasingly being used in healthcare at all levels of the community. Recent times have seen many nursing education programs offered online. There are two main types of online education - store and forward which transfers information between locations, and face-to-face programs using video conferencing. Technologies like email, digital photography, teleradiology, telepathology, and videoconferencing allow for fast, reliable, and economical communication of health information worldwide. These technologies make sharing images and data easier and reduce costs while increasing access to specialty care for rural populations. However, there are also challenges to greater telehealth adoption like physician licensing across borders and lack of infrastructure in some rural areas.
The document provides an overview of a smart hospital blueprint. It discusses challenges facing hospitals such as rising costs, staffing shortages, and lack of interoperability. It proposes using technology and automation to streamline workflows, create a single patient view, and support mobility. This would help address issues like quality of care, access to specialists, and underserved areas. The blueprint suggests optimizing infrastructure with a hierarchical network design, security, wireless connectivity, and virtualization. Collaboration tools and building automation could also improve efficiency and reduce energy use.
The document describes the typical workflow for a scheduled radiology study from pre-acquisition to results distribution. Key systems involved include the electronic health record, hospital information system, radiology information system, modalities like CT and MRI machines, picture archiving and communication system, and reporting software. Patient data and images flow between these systems as the patient proceeds through the exam and diagnosis.
IRJET- A Core Medical Treatment System forEmergency Management using CloudIRJET Journal
This document proposes a core medical treatment system using cloud computing to improve emergency management. The system would store patients' medical histories in the cloud to be accessible from any healthcare facility. This would allow doctors to access vital patient information during emergencies even if the history is from a different healthcare provider. The system would use encryption algorithms like Twofish to securely store private patient records in the cloud. This would help provide timely treatment, identify pre-existing conditions, and save more lives during medical emergencies by giving doctors access to full patient histories.
Portable Real Time Cardiac Activity Monitoring SystemIRJET Journal
This document describes a portable real-time cardiac activity monitoring system. The system collects electrocardiogram (ECG) signals to examine heartbeats and detect abnormalities. It uses a sensor to detect heart activity signals, sends them wirelessly to a smartphone via Bluetooth, and stores the signals in a network. The system analyzes heart rate and variability in real-time on the sensor to conserve power by only sending a few parameters. It is intended to remotely monitor patients' cardiac health over long periods by continuously collecting and analyzing ECG signals.
Abstract: Wearable sensors that measure limb movements posture, and physiological conditions can yield high resolution quantitative data .It can be used to better understand the disease and develop more effective treatments. In existing, classification algorithm is used to extract the feature from sensor, so these feature selection may lead to rapid battery depletion due to the absence of computing complexity. The notion of power aware feature selection is proposed which aims at minimizing energy consumption also it considers the energy cost of individual features that are calculated in real time. A graph model is introduced to represent correlation and computing complexity of the features. The problem is formulated using integer programming and a greedy approximation is presented to select the features in a power efficient manner. Experimental results on thirty channels of activity data collected from real subjects demonstrate that an approach can significantly reduce energy consumption of the computing module, resulting in more than 30 percent energy savings while achieving 96.7 percent classification accuracy.
The document discusses research on using wireless sensor networks for healthcare monitoring. It proposes using environmental and physiological sensor nodes integrated into wireless networks to remotely monitor human health conditions and environment. This could help build an e-healthcare system that monitors, predicts, and informs medical staff to prevent diseases while not interrupting daily activities. The system aims to link human health with environmental monitoring for a holistic view of well-being. Future work includes further development of tools, system design and implementation, analysis of results, and publishing papers on this research topic.
IRJET- Applications of Wireless Sensor Networks in Healthcare: An Overview of...IRJET Journal
This document discusses applications of wireless sensor networks in healthcare and related challenges. It describes how wireless sensor networks are being used for vital sign monitoring in hospitals, at-home and mobile health monitoring, and assistance with motor and sensory decline. Examples discussed include monitoring systems called CODEBLUE, HEALTHGEAR, and AMON. It also discusses an epilepsy monitoring smart clothing system called WEMU and a wearable health care system called WEALTHY. The document outlines challenges at the physical, MAC, network, transport and application layers and security threats involving confidentiality, integrity and availability. Physical layer challenges include bandwidth limitations while security threats include eavesdropping, traffic analysis and denial of service attacks.
The SENSACTION-AAL project aimed to assist older adults in maintaining independent mobility and reducing fall injuries through physical activity interventions using wearable sensors. It developed three main applications: a virtual trainer for home rehabilitation exercises providing audio feedback, a smart monitor for tracking daily mobility, and a remote assistant for detecting falls and alerting caregivers. An initial clinical trial with 18 older adults found the system feasible and that it increased adherence to exercises, awareness, and reduced falls. However, further validation is still needed including improved methods for simulating falls versus detecting real falls.
IRJET- A Secure Data Sharing Scheme in Public Cloud for ECG Signal Monitoring...IRJET Journal
This document presents a secure data sharing scheme for electrocardiogram (ECG) signal monitoring in public clouds. It proposes improvements to an existing location-based key management scheme called Location Dependent Key (LDK) to address issues like communication interference and insufficient nonces. The improved scheme is called LDK+. It incorporates grid-based location information into the key revision process and proposes a new key establishment process using grids. It also constructs new key update and revocation processes to better resist insider attacks. A simulation confirms that LDK+ has higher connectivity and lower compromise ratio than LDK. It also analyzes how deploying sensor nodes in a hexagonal pattern can reduce network costs without compromising connectivity.
IRJET- A Survey on-Security for using Pervasive Healthcare Monitoring Sys...IRJET Journal
This document discusses security issues in using mobile cloud computing for pervasive healthcare monitoring systems. It first introduces how mobile devices and cloud computing are being used to remotely monitor patient health metrics. However, transmitting sensitive patient data over networks poses security and privacy risks. The document then examines different approaches for securing such systems, including using encryption keys for authentication and communication protection between wireless sensor nodes, hospitals, and mobile apps. It also discusses challenges in securing data and devices across the various tiers of healthcare cloud and mobile computing architectures. Overall, the document analyzes how security can be improved for remote mobile healthcare monitoring systems that leverage cloud-based approaches.
ICT has had a major impact on many aspects of healthcare including accessibility, costs, and quality of care. eHealth can provide improved access to services especially in remote areas, decrease costs by decentralizing care to lower-level facilities, and improve quality through technologies like telemedicine and remote monitoring of patients. As populations age, eHealth will be increasingly important to cope with rising healthcare needs and costs through home monitoring and telehealth. ICT also enhances medical education and training through e-learning and supports health promotion through online resources.
This is Dr. Peter Madras' presentation that was given at the Health Innovators meeting on July 21st.
For more information on Health Innovators, please visit us at http://www.healthinno.org
This document describes a dynamic medical machine that is deployed in rural areas without easy access to doctors. The machine contains sensors like a temperature sensor, heart rate sensor, and ultrasonic sensor to monitor patients' vital signs. It is connected to a doctor via video and audio calls to allow virtual consultations. Based on the doctor's diagnosis and prescription, the machine automatically dispenses the appropriate medicines to the patient. This aims to make healthcare more accessible for common illnesses in remote locations while reducing costs.
Smart Environments and Ambient Assisted Livingcampone
The Smart Environments Research Group at Ulster University studies smart home technologies and ambient assisted living. They research areas like activity recognition, assistive technologies, and mobile applications. Clinically, they focus on supporting people with conditions like dementia, chronic pain, and autism through home-based monitoring and self-management tools. Their research aims to develop technologies that allow independent living for older adults and those with disabilities. They have experience collaborating with hospitals and healthcare organizations to evaluate these technologies and transfer the results to improve clinical care and commercial products.
This document summarizes a research paper about developing an intelligent medicine box system using IoT technologies. The system uses sensors and wireless communication to monitor patients' vital signs and medication adherence. If abnormal readings are detected, alerts would be sent via SMS to predefined caregivers. The system aims to provide personalized healthcare monitoring while patients are at home. It incorporates an ARM controller, wireless sensors, and WiFi to remotely track health data and environmental conditions in real-time. The feasibility of the system was proven through field testing, with the goal of improving home healthcare services.
Copyright AIST Reprinted with Permission. Presented at the 2013 Iron and Steel Technology Conference and Exposition (AISTech 2013). Coke is one of the base materials for any integrated steel mill production. Coke quality and properties affect the blast furnace operation and, as a result, plant performance is directly impacted. The control characteristics of coke plants combine process control with machine interlocking coordination, in a distributed automation and
supervision architecture.
The document discusses a case study of the Canton of Geneva in Switzerland creating an electronic healthcare network called e-toile using Cisco's Medical Data Exchange Solution. The solution allows healthcare providers and patients to access medical records securely from any system. It has improved patient care by giving providers a more complete health history and reducing errors. The network provides benefits like increased efficiency, cost savings, and higher quality care for both patients and the healthcare system.
IRJET- Hiding Sensitive Medical Data using EncryptionIRJET Journal
This document summarizes a research paper about securely hiding sensitive medical data using encryption. The paper proposes a system that distributes a patient's data across multiple encrypted data servers. It uses Paillier cryptosystems to allow statistical analysis of the encrypted patient data without compromising privacy. The system includes wireless medical sensors that monitor patients and transmit encrypted data to a database. It uses an access control system and statistical analysis protocols that employ Paillier encryption to allow authorized users like doctors to access and analyze the encrypted patient data without revealing its contents. The goal is to protect sensitive medical information from privacy breaches while still enabling useful analysis of aggregated patient data.
The document discusses HP's Digital Hospital solution framework which was implemented at St. Olav's Hospital in Norway. The framework utilizes a converged IP network to integrate clinical systems, devices, and applications. This allows for improved communication and information sharing. At St. Olav's, benefits included increased productivity, shorter patient stays, and better patient care through improved access to data. The Digital Hospital framework can help healthcare providers optimize resources and improve quality of care through IT and application integration.
Information technology is increasingly being used in healthcare at all levels of the community. Recent times have seen many nursing education programs offered online. There are two main types of online education - store and forward which transfers information between locations, and face-to-face programs using video conferencing. Technologies like email, digital photography, teleradiology, telepathology, and videoconferencing allow for fast, reliable, and economical communication of health information worldwide. These technologies make sharing images and data easier and reduce costs while increasing access to specialty care for rural populations. However, there are also challenges to greater telehealth adoption like physician licensing across borders and lack of infrastructure in some rural areas.
The document provides an overview of a smart hospital blueprint. It discusses challenges facing hospitals such as rising costs, staffing shortages, and lack of interoperability. It proposes using technology and automation to streamline workflows, create a single patient view, and support mobility. This would help address issues like quality of care, access to specialists, and underserved areas. The blueprint suggests optimizing infrastructure with a hierarchical network design, security, wireless connectivity, and virtualization. Collaboration tools and building automation could also improve efficiency and reduce energy use.
The document describes the typical workflow for a scheduled radiology study from pre-acquisition to results distribution. Key systems involved include the electronic health record, hospital information system, radiology information system, modalities like CT and MRI machines, picture archiving and communication system, and reporting software. Patient data and images flow between these systems as the patient proceeds through the exam and diagnosis.
IRJET- A Core Medical Treatment System forEmergency Management using CloudIRJET Journal
This document proposes a core medical treatment system using cloud computing to improve emergency management. The system would store patients' medical histories in the cloud to be accessible from any healthcare facility. This would allow doctors to access vital patient information during emergencies even if the history is from a different healthcare provider. The system would use encryption algorithms like Twofish to securely store private patient records in the cloud. This would help provide timely treatment, identify pre-existing conditions, and save more lives during medical emergencies by giving doctors access to full patient histories.
Portable Real Time Cardiac Activity Monitoring SystemIRJET Journal
This document describes a portable real-time cardiac activity monitoring system. The system collects electrocardiogram (ECG) signals to examine heartbeats and detect abnormalities. It uses a sensor to detect heart activity signals, sends them wirelessly to a smartphone via Bluetooth, and stores the signals in a network. The system analyzes heart rate and variability in real-time on the sensor to conserve power by only sending a few parameters. It is intended to remotely monitor patients' cardiac health over long periods by continuously collecting and analyzing ECG signals.
Abstract: Wearable sensors that measure limb movements posture, and physiological conditions can yield high resolution quantitative data .It can be used to better understand the disease and develop more effective treatments. In existing, classification algorithm is used to extract the feature from sensor, so these feature selection may lead to rapid battery depletion due to the absence of computing complexity. The notion of power aware feature selection is proposed which aims at minimizing energy consumption also it considers the energy cost of individual features that are calculated in real time. A graph model is introduced to represent correlation and computing complexity of the features. The problem is formulated using integer programming and a greedy approximation is presented to select the features in a power efficient manner. Experimental results on thirty channels of activity data collected from real subjects demonstrate that an approach can significantly reduce energy consumption of the computing module, resulting in more than 30 percent energy savings while achieving 96.7 percent classification accuracy.
The document discusses research on using wireless sensor networks for healthcare monitoring. It proposes using environmental and physiological sensor nodes integrated into wireless networks to remotely monitor human health conditions and environment. This could help build an e-healthcare system that monitors, predicts, and informs medical staff to prevent diseases while not interrupting daily activities. The system aims to link human health with environmental monitoring for a holistic view of well-being. Future work includes further development of tools, system design and implementation, analysis of results, and publishing papers on this research topic.
IRJET- Applications of Wireless Sensor Networks in Healthcare: An Overview of...IRJET Journal
This document discusses applications of wireless sensor networks in healthcare and related challenges. It describes how wireless sensor networks are being used for vital sign monitoring in hospitals, at-home and mobile health monitoring, and assistance with motor and sensory decline. Examples discussed include monitoring systems called CODEBLUE, HEALTHGEAR, and AMON. It also discusses an epilepsy monitoring smart clothing system called WEMU and a wearable health care system called WEALTHY. The document outlines challenges at the physical, MAC, network, transport and application layers and security threats involving confidentiality, integrity and availability. Physical layer challenges include bandwidth limitations while security threats include eavesdropping, traffic analysis and denial of service attacks.
The SENSACTION-AAL project aimed to assist older adults in maintaining independent mobility and reducing fall injuries through physical activity interventions using wearable sensors. It developed three main applications: a virtual trainer for home rehabilitation exercises providing audio feedback, a smart monitor for tracking daily mobility, and a remote assistant for detecting falls and alerting caregivers. An initial clinical trial with 18 older adults found the system feasible and that it increased adherence to exercises, awareness, and reduced falls. However, further validation is still needed including improved methods for simulating falls versus detecting real falls.
IRJET- A Secure Data Sharing Scheme in Public Cloud for ECG Signal Monitoring...IRJET Journal
This document presents a secure data sharing scheme for electrocardiogram (ECG) signal monitoring in public clouds. It proposes improvements to an existing location-based key management scheme called Location Dependent Key (LDK) to address issues like communication interference and insufficient nonces. The improved scheme is called LDK+. It incorporates grid-based location information into the key revision process and proposes a new key establishment process using grids. It also constructs new key update and revocation processes to better resist insider attacks. A simulation confirms that LDK+ has higher connectivity and lower compromise ratio than LDK. It also analyzes how deploying sensor nodes in a hexagonal pattern can reduce network costs without compromising connectivity.
IRJET- A Survey on-Security for using Pervasive Healthcare Monitoring Sys...IRJET Journal
This document discusses security issues in using mobile cloud computing for pervasive healthcare monitoring systems. It first introduces how mobile devices and cloud computing are being used to remotely monitor patient health metrics. However, transmitting sensitive patient data over networks poses security and privacy risks. The document then examines different approaches for securing such systems, including using encryption keys for authentication and communication protection between wireless sensor nodes, hospitals, and mobile apps. It also discusses challenges in securing data and devices across the various tiers of healthcare cloud and mobile computing architectures. Overall, the document analyzes how security can be improved for remote mobile healthcare monitoring systems that leverage cloud-based approaches.
ICT has had a major impact on many aspects of healthcare including accessibility, costs, and quality of care. eHealth can provide improved access to services especially in remote areas, decrease costs by decentralizing care to lower-level facilities, and improve quality through technologies like telemedicine and remote monitoring of patients. As populations age, eHealth will be increasingly important to cope with rising healthcare needs and costs through home monitoring and telehealth. ICT also enhances medical education and training through e-learning and supports health promotion through online resources.
This is Dr. Peter Madras' presentation that was given at the Health Innovators meeting on July 21st.
For more information on Health Innovators, please visit us at http://www.healthinno.org
This document describes a dynamic medical machine that is deployed in rural areas without easy access to doctors. The machine contains sensors like a temperature sensor, heart rate sensor, and ultrasonic sensor to monitor patients' vital signs. It is connected to a doctor via video and audio calls to allow virtual consultations. Based on the doctor's diagnosis and prescription, the machine automatically dispenses the appropriate medicines to the patient. This aims to make healthcare more accessible for common illnesses in remote locations while reducing costs.
Smart Environments and Ambient Assisted Livingcampone
The Smart Environments Research Group at Ulster University studies smart home technologies and ambient assisted living. They research areas like activity recognition, assistive technologies, and mobile applications. Clinically, they focus on supporting people with conditions like dementia, chronic pain, and autism through home-based monitoring and self-management tools. Their research aims to develop technologies that allow independent living for older adults and those with disabilities. They have experience collaborating with hospitals and healthcare organizations to evaluate these technologies and transfer the results to improve clinical care and commercial products.
This document summarizes a research paper about developing an intelligent medicine box system using IoT technologies. The system uses sensors and wireless communication to monitor patients' vital signs and medication adherence. If abnormal readings are detected, alerts would be sent via SMS to predefined caregivers. The system aims to provide personalized healthcare monitoring while patients are at home. It incorporates an ARM controller, wireless sensors, and WiFi to remotely track health data and environmental conditions in real-time. The feasibility of the system was proven through field testing, with the goal of improving home healthcare services.
Copyright AIST Reprinted with Permission. Presented at the 2013 Iron and Steel Technology Conference and Exposition (AISTech 2013). Coke is one of the base materials for any integrated steel mill production. Coke quality and properties affect the blast furnace operation and, as a result, plant performance is directly impacted. The control characteristics of coke plants combine process control with machine interlocking coordination, in a distributed automation and
supervision architecture.
AspectCTRM is the only Web-based trade, risk and operations management solution.
Fuel Marketers can now benefit from this leading professional system with an efficient
and cost-effective way to manage streams of trading and transport activity. Traders, risk
managers, schedulers, procurement and back-office personnel rely on this comprehensive,
affordable solution.
How Service-Oriented Drive Deployments improve VSD Driveline UptimeSchneider Electric
Variable Speed Drives (VSDs) have proliferated and are now installed in large numbers throughout various industries. However, since these technologies are relatively new, not much thought has been given to the proper integration of these drives, nor have their potential energy savings and business continuity entitlements been fully realized. This paper examines how the intelligence within VSDs can be leveraged to perform predictive maintenance so that plant uptime can improve.
[Oil & Gas White Paper] Gas Day Planning: Managing volatile end of day run-upSchneider Electric
Efficient management of gas day operations involves matching supply to demand, keeping pressure in the pipelines relatively constant and avoiding big swings. The biggest challenge is volatile demand during the day, particularly during its final days, or end-of-day run-up, which combines the greatest volatility with little time to adjust before the end of the day.
Operators already use forecasting models to plan the overall daily delivery, but to best cope with these challenges they need the ability to plan for gas output throughout the day to match hourly swings. By utilizing tailored industry solutions and established best practices, pipeline operators can use accurate forecasting solutions to break down daily demand forecasts into hourly predictions. Using hourly forecasts instead of a flat daily projection better matches actual demand and while small deviations from the forecast will occur, an hour-by-hour system allows pipelines operators to track the accuracy of projections and more easily adjust for unanticipated changes.
These forecasts are not based only on current factors, but rely on historical analysis as well to develop a more accurate prediction of demand. Particularly during the extra-volatile end-of-day run-up, compiling and analyzing historical data on a continual basis provides a rational prediction of demand for any given conditions. Taking these existing tools and data sources, the challenge of managing the end-of-day run-up can be significantly reduced.
[Oil & Gas White Paper] Gas Measurement and Analysis to Support FinancialsSchneider Electric
An advanced gas measurement and analysis system provides several benefits to natural gas companies: it continuously monitors pipeline measurements and validates the data in real-time to ensure accuracy for financial reporting; it determines gas composition which is needed to calculate energy content and greenhouse gas emissions; and it detects equipment issues and supports efficient maintenance. This system enables best practices around transparency, estimation, balancing, and documentation of measurement data across the enterprise to improve operations, competitiveness, and environmental stewardship.
The Use of Ceiling Ducted Air Containment in Data CentersSchneider Electric
Ducting hot IT-equipment exhaust to a drop ceiling can be an effective air management strategy, improving the reliability and energy efficiency of a data center. Typical approaches include ducting either individual racks or entire hot aisles and may be passive (ducting only) or active (include fans). This paper examines available ducting options and explains how such systems should be deployed and operated. Practical cooling limits are established and best-practice recommendations are provided.
The document discusses key concepts in quality management and patient safety. It defines patient safety as freedom from accidental injury during care according to the Institute of Medicine. Medical errors in the US healthcare system lead to tens of thousands of deaths annually and billions in costs. Most medical errors are systems-driven rather than due to individual incompetence. The Swiss cheese model of accident analysis and focus on human factors engineering can help identify root causes of errors and design safer systems through checklists, computerized order entry, and other interventions. Reactive risk analysis includes root cause analysis while proactive analysis uses failure mode and effects analysis. The document outlines definitions of adverse events, sentinel events, and near misses, as well as seven steps hospitals can take to
The document discusses key concepts in quality management and patient safety, including definitions of safety in healthcare. It notes that medical errors lead to tens of thousands of deaths annually in the US healthcare system according to the 1999 IOM report. Both active errors at the sharp end and latent errors in system design can cause harm. While individuals may slip or make mistakes, most medical errors are systems-driven according to IHI research. A safety culture and focus on systems improvements rather than blame can help reduce errors. The Swiss cheese model of accident analysis and human factors engineering are approaches to analyzing root causes and designing safer systems.
Medical errors are ubiquitous and the costs (human and financial) are substantial. The top priority must be to redesign systems geared to prevent, detect and minimise effects of undesirable combinations of design, performance, and circumstance.
Health care consumers benefit from understanding some of the issues involved in providing them with the best care, and some things they can do themselves to prepare for and learn about these issues. Doctors, nurses, and other health professionals dedicate their lives to caring for their patients. But providing health care can be complicated.
Whitepaper: Hospital Operations Management reduces wait states and replaces d...GE Software
No Wait States … in pursuit of the frictionless patient experience. Electronic health records have fallen short. Patients continue to wait. Costs remain high. Why focusing on operational management can help hospitals make things right … starting now.
This document summarizes a report on reinventing hospitals for the 21st century. It discusses how hospitals often harm patients due to errors and a lack of focus on patient safety and experience. The report recommends redesigning hospitals physically, operationally, and culturally to improve safety, quality of care, efficiency, and staff satisfaction by placing greater emphasis on patient-centeredness. Hospitals of the future should ensure patient safety, quality care, efficiency, and support staff well-being through an evidence-based, transparent approach focused on continuous learning and the patient experience.
patient safety and staff Management system ppt.pptxanjalatchi
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
patient safety and staff Management system ppt.pptxanjalatchi
What is Patient Safety? Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
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This document discusses patient safety in healthcare. It defines patient safety as the absence of preventable harm during healthcare. It notes that most patient harm is due to systemic flaws rather than individual negligence. It then discusses various types of patient safety concerns like medical errors, adverse events, infections, and falls. International patient safety goals are also presented, such as properly identifying patients, improving communication, and reducing healthcare-associated infections. The document emphasizes that improving safety requires efforts across many areas to protect patients from harm.
1) U.S. hospitals harm 1.5 million patients and kill 440,000 people each year due to preventable errors, despite efforts to improve patient safety.
2) A new GAO report found that hospitals face challenges in collecting safety data, determining best practices, and ensuring consistent use of safe practices by staff.
3) Simple and cost-free behaviors like hand washing could save hundreds of thousands of lives each year if patients understood and demanded their consistent use, but critical safety steps are often skipped.
1) An ICU provides around-the-clock specialized care for critically ill patients, including mechanical ventilation and cardiac monitoring. Mortality rates in ICUs average 10-20% in most hospitals.
2) Whether intensivists, who are specialists in critical care, are providing care in the ICU and how the staff is organized can strongly influence outcomes. Intensivists are better equipped to minimize errors and complications.
3) Hospital-associated infections are a major issue in ICU care and a leading cause of mortality and morbidity. Surveillance of ICU-acquired infections and monitoring of antimicrobial resistance patterns are important for improving practices and outcomes.
This document provides background information on a project to design a new medication distribution system for a hospital in Estonia. It discusses the current paper-based system which is prone to errors due to handwritten notes and multiple documents. The project aims to create a safer digital system to help prevent medication errors by nurses. It provides context on patient safety being an important but under-addressed issue in Estonian healthcare policy. The document outlines the objectives to design a system that makes it harder for errors to occur and easier for nurses to do their job correctly. It also gives an overview of common causes of medication errors to help inform the new design.
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The Human Hospital: How to create an Autonomic Nervous System for your Facility
1. Executive summary
Proper safeguards can reduce adverse patient events
such as healthcare-associated infections, medical
errors, and patient falls. This paper outlines the
strategies and logic for modeling a hospital’s
infrastructure on the human autonomic nervous system
through the use and integration of intelligent automated
building solutions. These building solutions can lead to
improved clinical outcomes, increased patient
satisfaction and safety, as well as greatly reduced
costs to the hospital.
by Stephanie Taylor and Estelle Schweizer
998-2095-03-31-14AR0
2. The Human Hospital: How to Create an Autonomic Nervous System for Your Facility
Schneider Electric White Paper Revision 0 Page 2
Healthcare costs are increasing around the world without a proportional improvement in
patient outcome. This is more evident in some countries, but the trend exists globally.
1
Why is
the discrepancy between cost for medical care and patient outcome increasing despite the
development of more precise and less invasive diagnostics and interventions? One reason is
the often hidden cost of treating patients for harm sustained during their hospitalization.
Statistics show that inpatient harm results from adverse patient events (APEs), which include
healthcare-associated infections (HAIs), falls with resulting injury, serious medical errors, and
wrong site surgeries. APE’s are extremely costly for hospital budgets and human lives,
2
and
many are preventable.
It is estimated that in the US alone, over 400,000 premature patient deaths every year could
have been prevented.
3
The number of patients that have incurred preventable serious harm is
10 to 20-fold times higher.
4
This paper examines APEs and their relationship to a hospital’s physical environment. It
examines how building automation and monitoring solutions can optimize a hospital’s
infrastructure, improve clinical care, and support better patient outcomes, thereby decreasing
costs. Human anatomy and physiology is used as the model for creating an ideal structure to
function relationship in a hospital.
Hospitals are complex environments in both their structure and function. An optimally designed
hospital structure needs to accommodate the use of sophisticated equipment, allow for rapid
responses to emergencies, as well as provide peaceful spaces for patients to heal and the
clinical staff to work. The mechanical and physical infrastructure of the hospital should support
these functions through thoughtful design that includes built-in protection against human errors
and mechanical failures that can lead to APEs.
This built-in protection comes in the form of intelligent automation solutions that can help save
patients’ lives and hospitals millions of dollars. For example, as shown in Figure 1, if a
1
Peter S. Hussey, Samuel Wertheimer, Ateev Mehrotra, ―The Association Between Health Care Quality
and Cost: A Systematic Review‖, Annual Internal Medicine., 2013;158:27-34
2
Denise Murphy, RN, BSN, MPH, CIC, Joseph Whiting, MBA, Christopher S. Hollenbeak, PhD,
―Dispelling the Myths: The True Cost of Healthcare-Associated Infections‖, An APIC Briefing, February
2007,
3
James, John T. PhD, ―A New, Evidence-based Estimate of Patient Harms Associated with Hospital
Care‖, Journal of Patient Safety: September 2013, Volume 9, Issue 3: p 122– 128, Review Article
4
Ibid.
Introduction
Figure 1
Savings per bed per year
with automation solutions to
reduce APEs
Life-Changing
solutions for
patients and
the CFO
3. The Human Hospital: How to Create an Autonomic Nervous System for Your Facility
Schneider Electric White Paper Revision 0 Page 3
hospital decreased the occurrence of three prevalent APEs, they could expect to see a total
savings of over $151,000 per bed per year. A 250-bed hospital utilizing these building
automation solutions could save, in just one year, a staggering $35 million dollars.
Calculations and references for these numbers are provided later in the paper.
In a busy healthcare environment, hospital staff may make mistakes or not follow proper
protocol in an urgent or rushed situation. However, in a hospital, patient lives are at stake and
the consequences of these errors and omissions can be costly and deadly.
Below are examples of some human error scenarios that lead to avoidable APEs:
1. When performing daily examinations of patients, a clinician decides the hand hygiene
station is too far away and forgoes hand cleaning, ―just this once.‖ The clinician’s
hands, now contaminated with virulent bacteria from patient A, passes these dangerous
micro-organisms to patient B’s surgical incision, causing a serious HAI. This one ―time-
saving‖ shortcut costs the hospital thousands of dollars in prolonged care and the
patient his life.
2. Frequently, medications are contained in bottles of similar shape and color. A rushed
nursing staff forgets to double check the fine print on a label and the wrong medication
dose is dispensed to the patient. This potentially lethal error endangers the patient’s life
and consumes hospital resources.
3. The air filter to a patient’s room is in a hard-to-reach duct and has not been checked for
months. The filter becomes clogged with mold which is then blown into the patient
room. The patient has a compromised immune system from chemotherapy, develops
Aspergillum pneumonia and dies – not from cancer, but from a fungal infection
introduced through the ventilation system.
In the hospital the clinical staff’s primary responsibility is to focus on the patient-oriented tasks
in front of them. Rarely does their awareness extend to how components of the building’s
structure will impact the patient’s wellbeing. Conversely, the building facility staff members are
not involved with clinical care and may not fully understand how the physical structure
supports the functions of patient safety and healing. Patient care and hospital budgets have
suffered tremendously as a result of this disconnect.
The proof is in the statistics. Studies show that 7 to 10 of every 100 hospitalized patients in
developed countries will acquire an HAI.
5
This proportion increases to 15 of every 100
patients in developing countries.
6
As shown in Figure 2, England, France, Australia, Greece,
Norway, Thailand, and Guatemala report similar rates of preventable HAIs.
7
Worldwide, the
expenses incurred by hospitals due to APEs are unacceptably high. In fact, data published in
2013 reports that HAIs in US hospitals cost up to $147 billion each year.
8
5
World Health Organization, ―Report on the Burden of Endemic Health Care-Associated Infection
Worldwide‖, 2011
6
Ibid.
7
Ibid.
8
Albert Marchetti, Richard Rossiter, ―Economic Burden of APEs in US Acute Care Hospitals: Societal
Perspective‖, Journal of Medical Economics, December 2013, Vol. 16, No. 12, p 1399-1404.
The cost to
lives and the
bottom line
Understanding
the disconnect
4. The Human Hospital: How to Create an Autonomic Nervous System for Your Facility
Schneider Electric White Paper Revision 0 Page 4
Figure courtesy of: Report on the Burden of Endemic Health Care-Associated Infection
Worldwide, WHO 2011
When researching ways to fix this disconnect, a model was found which has been tested and
improved upon over hundreds of thousands of years. Perhaps surprisingly, this solution has
developed within the human body – the autonomic nervous system (ANS). The ANS regulates
the physiological structure unconsciously so humans can focus their conscious thinking on
functional activities. The ANS only demands conscious attention when there is a problem.
Without this specialised neurological network humans would never be able to sleep or work
because they would be necessarily preoccupied with keeping their bodies alive.
9
Compare a hospital to a complex, multi-system organism. How can a hospital’s infrastructure
be designed and maintained to emulate the biological and involuntary 24/7 monitoring and
alarming strategy of the ANS to assist with patient safety and optimal clinical outcomes?
The human body’s strategy for structural support of functioning provides us with the following
guidelines for a well-designed and fully integrated hospital building:
A functional layout that reduces opportunities for infections, falls, and human errors
Barriers against infection transmission from external sources
Automatic alerts when a critical barrier is breached or when other problems occur
Minimal opportunities to harbor infectious organisms in sterile spaces
Facilities that are continuously cleaned and disinfected
Healthy people have bacterial and fungal organisms living within their bodies in properly
contained non-sterile spaces.
10
When the barriers maintaining these spaces are lost as a
result of disease, surgery, or medical intervention, deadly infections can result if great care is
not taken. A similar organization of sterile and non-sterile spaces and potentially deadly
9
Anthony S. Fauci, Eugene Braunwald, et al., ―Harrison's Principles of Internal Medicine ―17th Edition, p.
2576 – 2582, 2008.
10
Barbara A. Methé, et al, ―A Framework for Human Microbiome Work‖, Nature, Dec. 14, 2012;
486(7402): 215–221.
The human
hospital model
Learning from
biology
Figure 2
Worldwide
prevalence
of HAIs
5. The Human Hospital: How to Create an Autonomic Nervous System for Your Facility
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consequences of barrier breakdown exists at every scale within a hospital, from within the
patient room to the hospital building as a whole.
It is impossible for each individual in a hospital to know if all safety measures are functioning
properly. Like the human body, a healthcare building needs a fully integrated ANS for
continuous ―behind-the-scenes‖ surveillance, alerting the proper staff only when problems
arise. Existing automation technology developed to monitor building mechanical systems can
be utilized with this new insight, allowing hospital staff to respond before errors and safety
breaches cause patient harm. With the protective ANS in place, healthcare organizations can
reduce avoidable APEs such as HAIs, falls, medication errors, and wrong site surgeries and
the accompanying loss of financial and human wellbeing.
In order to design and optimise a hospital’s infrastructure to mimic the human ANS and thus
improve patient care, one needs to understand that APEs can arise from a variety of sources:
The patient
The patient’s room or environment
Staff and visitors
The physical structure of the building
Figure 3 illustrates those areas in a patient’s bedroom that represent potential risks.
Origins of harm
Figure 3
Example sources of APEs
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The patient
A patient's own body and mind is a source of potential harm. For example, the universal law of
gravity acting on a patient body can cause pressure sores if the patient is not turned frequently
in bed, or falls if the patient’s musculoskeletal system or coordination is faulty. Often patients
with chronic conditions are on medications in doses carefully titrated by their out-patient
provider. When admitted to a hospital, patients can easily forget part of their medical history or
medication doses. The patient can also come with or develop a psychiatric illness which
propels him or her to bring harm to themselves.
Serious infections can arise if a patient’s carefully tuned and compartmentalised body loses its
healthy structural or physiological barriers. Normal endogenous organisms in the mouth create
a micro-flora necessary to begin the digestion of food, yet would cause a deadly infection if
they reached the brain or lungs. Life-saving treatments often require penetration of the skin
due to surgical incisions or intravenous catheters. Breach of this barrier, however, can allow
normal skin bacteria direct access to the entire circulatory system, causing potentially fatal
blood sepsis if errors occur.
The room
Other APEs can result from elements in the hospital room. For example, handrail design and
placement may not provide balance at key places on the path to the bathroom, resulting in a
fall with injuries. Excess noise, undesirable lighting, and uncomfortable temperature conditions
can increase stress and slow the healing process.
11
New finishes or cleaning agents used in
patient rooms can emit compounds which provoke allergic reactions.
12
Staff members and
visitors can transfer pathogens left on furniture surfaces if hand hygiene practices and room
cleaning are not properly performed.
13
Bed bugs and other insects living in buildings can
transport infectious particles to the patient.
14
Improperly installed plumbing fixtures in the
bathroom can spray droplets containing bacteria, viruses, or fungal organisms on the patient.
15
HVAC systems can transmit contaminated air between hospitals rooms if proper humidity
levels are not maintained.
Staff and visitors
Hazards from outside the room can be unknowingly introduced to the patient by caregivers.
Infectious organisms can be transmitted to the patient through contact, airborne, or water
routes. If a clinical staff member is distracted or lacks thorough knowledge of the patient’s
diagnosis; incorrect medications, procedures, or worse can occur. Wrong-site surgery sounds
unthinkable, yet it happens more frequently than any of us like to imagine.
16 17
11
Anjali Joseph, Ph.D , ―Impact Of The Environment On Infections In Healthcare Facilities‖, The Center
for Health Design, 2006, Ulrich R, Zimring C. (2004)
―The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime
Opportunity‖, The Center for Health Design. Concord, CA.
Leonard L Berry, PhD . et al., ―The Business Case for Better Buildings. Frontiers of Health Services
Management 21:1‖ The Center for Health Design.
12
Ibid.
13
S. Harbath, H. Sax, P. Gastmeier, ―The Preventable Portion of Nosocomial Infections: An Overview of
Published Reports”, Infection Control Programme, Department of Internal Medicine, University of
Geneva Hospitals, 24, rue Micheli-du-Crest, CH-1211, Geneva 14, Switzerland, Division of Hospital
Epidemiology and Infection Control, Institute of Medical Microbiology and Hospital Epidemiology,
Hanover Medical School, Germany. Journal of Hospital Infection (2003) 54, 258–266.
14
Lowe CF, Romney MG, ―Bedbugs as vectors for drug resistant bacteria‖, CDC: Emerging Infectious
Diseases, June 2011.
15
Dror Marchaim MD, et al., ―Hospital bath basins are frequently contaminated with multidrug-resistant
human pathogens‖, American Journal of Infection Control, 2011
16
Robert M. Wachter, M.D., Nancy E. Foster, R. Adams Dudley, M.D., M.B.A., ―Medicare’s Decision to
Withhold Payment for Hospital Errors: The Devil Is in the Details‖, The Joint Commission Journal on
Quality and Patient Safety, February 2008 Volume 34: No 2.
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Hospital infrastructure
The design of a hospital’s infrastructure must support reliable monitoring, maintenance, and
systems back-up in the event of loss or malfunction of external power. Without proper
maintenance, heating, ventilation, air-conditioning, and decorative water elements can harbor
and transmit infectious organisms, toxins, and irritants;
18
the hospital room essential gases
which a patient may require for breathing support could mix incorrect proportions of oxygen,
nitrogen, and CO2. A power failure without emergency backup could cause a patient to miss
an opportunity for a life-saving operation or kidney dialysis, or if a failure occurred while the
patient is undergoing surgery the consequences from loss of temporary respiratory or
circulatory support could be deadly. Other potential accidents from equipment failure are too
numerous and scary to contemplate.
The following fictitious scenario follows a ―Mr. Smith‖ through a realistic admission and
hospitalisation process to help better explain how the patient can be exposed to dangers from
themselves, others, and the hospital infrastructure.
Mr. Smith experiences uncomfortable chest pain following a large dinner at a family event. His
wife, with flash-backs to her late father’s heart attack, rushes her husband through the doors
of the local hospital Emergency Department at 11:00 pm, stating that her husband is having a
heart attack. The nursing staff members are changing shifts so the usual patient evaluation
process is shortened. The triage assessment from an exhausted nurse’s first-glance at the
pale, elderly man in evident distress is a heart problem. A quick electrocardiogram is done and
looks normal enough, so brief orders are written for Mr. Smith’s transfer to the adult cardiac
unit. The triage nurse assumes that the patient will have a complete history and physical
examination done within the hour, once he is in his room.
There is an available patient room; however, nighttime housekeeping is short-staffed and the
room has not been cleaned since the previous patient’s discharge. After waiting for two more
hours on a stretcher in the hallway while housekeeping staff find cleaning supplies to ready the
room, Mr. Smith is finally wheeled to his room from the Emergency Department. Meanwhile,
his wife returns home. Once in his room, Mr. Smith forgets to tell the admitting physician that
he has been taking a sedative for sleep every night for the past year. Mr. Smith also does not
disclose that he is a heavy drinker.
The next day, after a long, restless night without sleep medication or alcohol, Mr. Smith gets
out of bed to use the bathroom. His balance is impaired from sedative and alcohol withdrawal;
and he falls and fractures his hip. During a surgical procedure to pin the fractured bone, the
hospital power system malfunctions from an overuse surge. The ventilation system stops,
causing the operating room to lose positive air pressure. Before resumption of the ventilation,
an air current from the procedure room next door flows into Mr. Smith’s operating room.
Microscopic skin flakes harboring MRSA bacteria are carried by this airflow.
19
Unbeknownst to Mr. Smith’s surgical team, the open incision and bone pin are contaminated
with MRSA bacteria. The hip surgery is completed, incision closed, and the patient is returned
to his room. The routine post-operative medication regimen calls for an antibiotic that does not
treat the dangerous antibiotic-resistant bacteria, MRSA. Thirty-six hours later he spikes a high
fever. Blood tests point to a severe bacterial infection. A second antibiotic is started at an
extremely high dose and causes invisible damage to his heart muscles. Twelve hours later
while visiting with his family, Mr. Smith begins struggling for breath, grasps his fist to his chest
and passes out. The family runs from the room and pulls the wall-mounted emergency alert.
17
Deborah F. Mulloy; Ronda G. Hughes, ―Wrong-Site Surgery: A Preventable Medical Error‖, Patient
Safety and Quality: Agency for Healthcare Research and Quality (US); 2008 Apr.
18
Anjali Joseph, Ph.D, Leonard L Berry, PhD . et al., The Center of Health Design, op. cit.
19
I. Eames, J. W. Tang, Y. Li and P. Wilson, ―Airborne transmission of disease in hospitals‖, J. Royal
Soc. Interface, 14 October 2009
A patient
journey gone
wrong
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Mr. Smith is resuscitated, intubated, and placed on a mechanical respirator. Forty-eight hours
later his blood pressure plummets and he is unable to be saved despite heroic efforts by the
medical staff. The autopsy reveals the cause of death to be MRSA blood sepsis causing
overwhelming shock and a massive myocardial infarction. There is no evidence of a prior heart
attack. The ultimate cause of Mr. Smith’s death was not present at the time of his admission.
The above described disasters could have been prevented if the hospital had building
automation solutions in place, alerting the staff to intervene before the errors harmed Mr.
Smith. The previous scenario is just one example of how hospitals encounter APEs on a daily
basis. ―To err is human‖
20
; however errors are also costly, deadly, and avoidable. Figure 4
shows the progression of Mr. Smith’s patient journey and how one APE can lead to another.
Let’s look at the scenario again, this time with an intelligent infrastructure in place, operating
as the hospital’s protective ANS.
Mr. Smith is brought to the local hospital Emergency Department for chest pain after a large
holiday meal. His medical records and current medications are immediately obtained via the
electronic medical records at the nurse’s station. With this information on hand, Mr. Smith is
immediately and thoroughly evaluated by an alert triage nurse who is on a computer-
generated staggered work schedule.
This evaluation indicates that Mr. Smith’s medical condition is stable enough for transfer to an
in-patient room for best-practice 48-hour monitoring. Transfer orders are entered into the
computerised admission, discharge, and transfer system and a room is located. Mr. Smith is
immediately transferred to his private room because the housekeeping staff quickly located the
closest cleaning supplies through the real-time location tracking system. Once settled, Mr.
Smith uses his bedside tablet to set his own room conditions to enhance patient satisfaction
and speed healing.
20
Institute of Medicine, ―To Err is Human. Building a Safer Health System.‖, Washington DC: National
Academy Press, 2000.
A better story
Figure 4
Progression of Mr. Smith’s
patient journey gone wrong
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With the complete history available on his medical card, the admitting staff members note
recent high dose steroid treatment for an arthritis flare-up, making Mr. Smith potentially
vulnerable to infections. By remote access at the nursing station environmental monitoring
screen, the room’s humidity, air filtration status, pressure regimes, and power status were
double-checked prior to arrival to his patient room.
His wife is reassured by the admission process and accurate medication management. She
quietly informs the staff of her husband’s heavy alcohol use. The physician places him on ―fall
risk‖ and the room motion sensors are activated. After she says goodnight to her husband, a
―beep‖ from the infection control hand hygiene station reminds her to cleanse her hands before
leaving his room.
During the night Mr. Smith gets up to use the bathroom, triggering a motion sensor and alert at
the nurse station. Through the intercom, a nurse asks him if he can remain in bed for a few
minutes. The nurse call prompts the lighting system to provide a lit path to the patient’s room.
He then gets assistance to and from the bathroom and soon settles back to sleep.
The patient’s cardiac status remains stable throughout the 48-hour period and there is no
evidence of heart disease. Previously undiagnosed gastro-esophageal reflux is found to be the
cause of the recent chest pain. A dietician recommends appropriate dietary changes and a
social worker meets with the couple to address his wife’s concern about alcohol use. Mr. Smith
is discharged the next morning after a follow-up appointment with the primary care physician is
arranged using the hospital electronic scheduling software. Three days after the family dinner,
the Smiths embark upon a much healthier lifestyle.
At the time of admission to a hospital, patients and their families are usually worried and
distracted. In this vulnerable state they are particularly dependent on the care of dedicated, yet
often hurried staff. The hospital and its occupants need a full-time monitoring system that
protects them from human error and unforeseen events. The solutions described in the second
scenario are founded on a building infrastructure equipped with ―intelligent‖ automation. This
ANS for the hospital integrates mechanical system monitoring, inter-department
communication, and automatic clinical alerts to reduce the chances of APEs. This built-in
protective mechanism sustains optimal conditions, commanding clinical staff attention only
when intervention is required to correct a potential accident. Records of both routine
monitoring and the alerts are then available to monitor trends and improve processes and
efficiencies across the healthcare organization. For example, automatic hand-hygiene
monitoring records can be used for staff feedback, encouragement to meet hospital
improvement initiatives, and in research on the role of surface microbes in disease.
Case studies worldwide provide supporting data on the clinical efficacy of automated solutions.
Four hospitals, Queen Mary Hospital, Caritas Medical Centre, Tuen Mun Hospital, and Yan
Chai Hospital were enrolled in the WHO’s pilot hand hygiene compliance study. Results
showed hand hygiene compliance improved from 15.5% to 65% after 18 months of visual and
automated monitoring.
21
Other studies have associated significant reduction in the annual overall prevalence of HAIs
and MRSA cross-transmission rates with electronic surveillance and reminding of proper hand
hygiene practices.
22 23 24
21
CDC, ―Recommendations of the Healthcare Infection Control Practices Advisory Committee and the
HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force‖, CDC MMWR, Vol. 51 / RR-16
22
Gardner, M., ―Aseptic Technique Is in Your Hands‖, Infection Control Today, 6 (5): 22 (2002)
23
OECD, ―Measuring healthcare worker hand hygiene activity: current practices and emerging
technologies‖, Infect Control Hosp Epidemiol. 2011 Oct; 32(10):1016-28. 2011 Aug 24. OECD (2011),
24
Swoboda SM, Earsing K, Strauss K, Lane S, Lipsett PA., ―Electronic monitoring and voice prompts
improve hand hygiene and decrease nosocomial infections in an intermediate care unit‖, Critical Care
Med 2004; 32: 358–63
Solutions
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Table 1 illustrates the solutions available to help create an ANS in the hospital to reduce APEs
and their impact on patient care and hospital financial health. The solutions are organised by
APEs to clarify the various solutions available for each type of problem.
The solutions in the chart are just some of the intelligent automation solutions that can help
save patients’ lives and hospitals millions of dollars. All of the solutions discussed in this paper
provide the opportunity to help solve multiple problems at once. This leads to significantly
reduced chances for APEs, as well as a greater return on investment because one technology
can be used in almost a dozen different applications to improve patient safety. Due to the high
number of APEs and the costs that hospitals incur because of them, the operational and cost
benefits of solutions are significant. The following example savings are based on calculations
using data from the US and WHO database. No data from long-term care or rehabilitation
centers or litigation costs are included.
Beyond the
patient –
operational
benefits
Table 1
Solutions available to reduce APEs
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The average occupancy rate for hospitals globally is 80% with the average length of stay of
4.838 days.
25
This allows 60.36 annual admissions per bed, or 292 annual patient-days per
bed. Calculation: [365 days/year / 4.838 days/admission] = 60.36 admissions/year
HAIs
HAI in-patient prevalence = 8.5% of all admissions
26
HAI rate per bed per year = 4.53
Cost per HAI = $91,733
27
HAI cost per bed per year = $415,700
Savings per bed per year with hand-hygiene solution if 25% reduction
in HAI’s = $103,800
28
Patient falls with injury
Fall rate 5.87 per 1000 patient days
29
Falls per bed per year = 1.7126
Cost per fall $20,000
30 31
Cost per bed per year = $34,352
Savings per bed per year with 75% reduction in falls with monitoring: $25,689
32 33
Medical errors and wrong site surgery
Error rate per annual admissions: 4.16%
34
Annual errors per bed = 2.51
Cost per error $13,000
35
Cost per bed per year: $32,676
Savings per bed per year with 67% reduction from monitoring $21,893
36
25
OECD Publishing, ―Average length of stay in hospitals, Health at a Glance‖ OECD Indicators, 2011
26
World Health Organization, ―The Burden of Health Care-Associated Infection Worldwide, a Summary.
Patient Safety‖, 2010.
27
Albert Marchetti, Richard Rossiter, op. cit.
28
Swoboda SM, Earsing K, Strauss K, Lane S, Lipsett PA., op. cit.
29
Dykes, P. C. et al., ―Fall Prevention in Acute Care Hospitals: A Randomized Trial‖, JAMA,
304(17):1912-1918, (2010).
30
Stevens JA, Corso PS, Finkelstein EA, Miller TR, ―The costs of fatal and nonfatal falls among older
adults‖, Injury Prevention;12:290–5, 2006.
31
Shumway-Cook A, Ciol MA, Hoffman J, Dudgeon BJ, Yorston K, Chan L., ―Falls in the Medicare
population: incidence, associated factors, and impact on health care‖, Physical Therapy 89(4):1-9, 2009.
32
Hendrich A.L., Bender, P.S., Nyhuis, A., ―Validation of the Hendrich II Fall Risk Model: A Large
Concurrent Study‖, Applied Nursing Research, 2003.
33
Hendrich, A., Nyhuis, A., Kippenbrock, T., & Soja, M. E., ―Hospital falls: Development of a predictive
model for clinical practice‖, Applied Nursing Research, 8(3), 129-139. (1995).
34
Shreve, J.,et al., ―The Economic Measure of Medical Errors‖, Society of Actuaries, Milliman. 2010
35
Ibid.
36
Ibid.
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As mentioned earlier, if the per bed per year savings of each APE are applied to a typical 250-
bed hospital, the savings that one hospital can realise in one year from automated solutions
that reduce APEs is staggering—$35 million see (Figure 5). A large portion of savings is
achieved by reducing HAIs, which accounts for nearly $23 million in potential savings.
A checklist is provided in the Appendix to help you take successful steps toward reducing
APEs and achieving similar savings in your hospital.
Figure 5
Annual savings possible for
250-bed hospital