peter mcmahon

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

Digital by Default or Digital by Design

Peter McMahon

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 2

HP Confidential

Hospitals face substantial challenges

Increasing healthcare costs

Improving quality of patient care

Low productivity, stagnant even declining

Regulatory imperatives

Clinical staff shortages


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Where do we need to improve?

20-40% 2

WHO’s estimate of all health spending wasted through inefficiencies in the system

19.3% 1

The average proportion of time a nurse spends on direct patient care during the active nursing part of a shift

5.4% 3

Average annual increase in recurrent health expenditure in Australia

1 A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time? Permanente Journal, Summer 2008 2 World Health Report (2010), Background Paper 28, data sourced from WHO National Health Accounts 2009 3 The Australian Institute of Health and Welfare 2010: Health expenditure Australia 2008-09. Health and welfare expenditure series no. 42.

• Improve productivity

• Reduce inefficiency

• Spend the $ wisely with a view to sustainability


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Considerations in new facility

Limited funding and focus needs to cover:

• The building itself – with considerations for a 70 year + lifespan

• Patient experience and flow

• Clinical department considerations

• Changing demographics and long term sustainability

• Integration of research and teaching organisations

• New equipment – F&F, biomedical, communications, building systems, patient interactive, end user devices

• Pharmacy, lab, imaging, outpatients, ED, ambulatory

… Oh, and your Information & Communications Technology (ICT)


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What you will invest in – by default…

PAS CIS LAB RAD


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But wait, there’s more…

PAS CIS LAB RAD

Pharma

CathLab

NICU

Onc

Dietary

Dept CISs

AIS

BYOD Nav


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So it seems you will have a “digital hospital”

Your investment in clinical and operational technology means that the hospital will be “digital” whether you plan it that way or not; whether you allocate funding to “digital hospital” or not.

So, will you be digital by default? Or digital by design?


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Without a plan, there will be piecemeal integration

Technology “Hairball” Integration “Hairball”

Costly to establish

Costly to maintain

Compromises agility


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Digital Hospital – by Default

User access complexities, multiple/shared sign-ons and barriers to mobility

for clinicians

Inefficient use of infrastructure tools and

technologies due to broad range of underpinning

technologies

Stretched ICT staff without critical

support skills. Clinical staff performing ICT support

functions.

Disparate and incompatible applications

& technologies with resulting integration

challenges

Constant pressure on budgets to do more with

less, reduce ICT costs

Unclear TCO/value of ICT services to the

business

Inadequate executive oversight of ICT

investments

Departmentally driven investment undermines

need for enterprise wide interoperability

Redundancies in a diverse application & technology

portfolio


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What’s the solution?

Devolve responsibility?

• Let departments make their own decisions using their own budgets, after all they are the experts…

Take control and dictate?

• The only way to get an environment that is secure and works is to centralise it all…

Or create an ARCHITECTURE (an enterprise architecture) that allows the digital environments within the hospital to integrate and to support the clinical and operational processes?


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Digital Hospital – by design

To achieve this integrated and underpinning information fabric, you need a combination of architecture and technology.


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What is Possible Today


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HP’s Digital Hospital Maturity Model

IT Domains

Facilities

Medical

Communications

Level 5

Adaptive

Level 4

Managed

Level 3

Co-ordinated

Level 2

Connected

Level 1 Initial

Level 6

Optimised

Speed Innovation to Practice, Improve Operational Efficiencies, Improve Quality of Care

• Primitive building and

security systems • Dependence on

human surveillance

• Building and security

systems integrated • Single card based

facility access

• Tasks communicated

electronically to mobile decides

• RTLS location awareness

• Closed loop task

mgmt with escalation • Role-based two factor

authentication

• Demand based

delivery of services • Bulk reconfiguration

of security privileges in near real time

• TBD

• Stand alone

modalities • Wholly paper Patient

Record

• Post-care updating of

basic EMR • Modalities accessed

and viewed separately to patient record

• Ability to view some

aspects of EMR from a central point

• Modality/ Lab/Rad outputs attached to EMR

• Full EMR update at

point of care • Some clinical decision

support • Modality/Lab/ Rad/

Meds fully integrated

• Fully integrated EMR

across facility • Support for

personalised medicine

• TBD

• Dependent on wired

telecomms • Manual routing of all

requests

• Combination of wired

and wireless comms • Some requests rules

based

• Ubiquitous wireless • Comms routed and

escalated automatically

• Presence managed • Comms routed to

nearest available

• Device independent

• TBD

• Tribal • Opportunistic

• Budget driven • Departmental

• Rationalised

• Virtualised • Facility-centric • Multi-Year Plan

• Semantically

interoperable • Care Community

Oriented

• TBD


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IT Domains

Facilities

Medical

Communications

Level 5

Adaptive

Level 4

Managed

Level 3

Co-ordinated

Level 2

Connected

Level 1 Initial

Level 6

Optimised

Speed Innovation to Practice, Improve Operational Efficiencies, Improve Quality of Care

• Primitive building and

security systems • Dependence on

human surveillance

• Building and security

systems integrated • Single card based

facility access

• Tasks communicated

electronically to mobile decides

• RTLS location awareness

• Closed loop task

mgmt with escalation • Role-based two factor

authentication

• Demand based

delivery of services • Bulk reconfiguration

of security privileges in near real time

• TBD

• Stand alone

modalities • Wholly paper Patient

Record

• Post-care updating of

basic EMR • Modalities accessed

and viewed separately to patient record

• Ability to view some

aspects of EMR from a central point

• Modality/ Lab/Rad outputs attached to EMR

• Full EMR update at

point of care • Some clinical decision

support • Modality/Lab/ Rad/

Meds fully integrated

• Fully integrated EMR

across facility • Support for

personalised medicine

• TBD

• Dependent on wired

telecomms • Manual routing of all

requests

• Combination of wired

and wireless comms • Some requests rules

based

• Ubiquitous wireless • Comms routed and

escalated automatically

• Presence managed • Comms routed to

nearest available

• Device independent

• TBD

• Tribal • Opportunistic

• Budget driven • Departmental

• Rationalised

• Virtualised • Facility-centric • Multi-Year Plan

• Semantically

interoperable • Care Community

Oriented

• TBD

HP’s Digital Hospital Maturity Model

Closed loop task mgmt with escalation Role-based two factor authentication

Full EMR update at point of care Some clinical decision support Modality/Lab/ Rad/ Meds fully integrated

Presence managed

Comms routed to nearest available

Virtualised

Facility-centric Multi-Year Plan


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You need to recognise the real (hidden?) investment in ICT

PAS CIS LAB RAD

Pharma

CathLab

NICU

Onc

Dietary

Dept CISs

AIS

BYOD Nav


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And DESIGN a sustainable approach to integration

Pharma

CathLab

NICU

Onc

PAS CIS LAB RAD

Dietary

Dept CISs

AIS

Nav BYOD


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Creating a sustainable architecture and maximising ROI

Integration Engine

Staf

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Staf

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Payr

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Payr

oll

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Fina

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Fina

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EPR

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REP

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MR

HIS

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IS/P

AS

PAC

S/R

ISPA

CS/

RIS

LIS

LIS

Mat

ern

ity

Mat

ern

ity

OR

Sc

hedu

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OR

Sc

hedu

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Building Automation System

Mec

hani

cal

Ligh

ting

Hyd

rau

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Chu

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yste

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Elec

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Esca

lato

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Car

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Ver

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ansp

-

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Pneu

mat

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Tube

Building Automation SystemBuilding Automation System

Mec

hani

cal

Mec

hani

cal

Ligh

ting

Ligh

ting

Hyd

rau

licH

ydra

ulic

Chu

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yste

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Sys

tem

Elec

tric

alEl

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ical

Esca

lato

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Car

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Ver

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Tran

sp-

AG

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GV

Pneu

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Tube

Pneu

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Hospital/Clinical Information System Hospital/Clinical Information System

ActiveDirectory

Vid

eo C

onf

Vid

eo C

onf

VoI

P Te

leph

ony

VoI

P Te

leph

ony

AuditRepository

Way

find

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&

Sign

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Way

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&

Sign

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Kios

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ftw

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Kios

k So

ftw

are

Bed

sid

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Bed

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PA-S

yste

mPA

-Sys

tem

BACNet, OPC, WS

TAP,

ESP

A 4

.4.4

HL7/WS

WSWS

WS

LDAP

Das

hboa

rd/

Nur

se S

tati

on

Das

hboa

rd/

Nur

se S

tati

on

Unified CommunicationUnified Communication

Video/Audio Video/Audio

Fire

Ala

rm S

yste

mFi

re A

larm

Sys

tem

Secu

rity

Secu

rity

Nur

se C

all

Nur

se C

all

E-m

ail

E-m

ail

IMIM

IV P

umps

IV P

umps

Mon

itor

sM

onit

ors

Pow

er

Syst

ems

Pow

er

Syst

ems

……

..……

..

Medical Device Middleware

Medical Device Middleware

Loca

tion

Sys

tem

Loca

tion

Sys

tem

External OrganizationsExternal Organizations

Staff Sup. Service NurseClinician Patient

• Take work out of the system

• Intelligent workflows

• Actionable alerts

• Value adaptability and standards


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The HP digital hospital solution and approach reduces costs

Integrated environment

Systems used more efficiently and effectively

More timely and accurate information

Service oriented architecture environment


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Akershus University Hospital, Norway

The hospital

• Serving an aging population of 450,000

• Obsolete and failing facilities replaced

The decision

• Build the most modern university hospital in Europe, fully equipped with the latest digital technologies

The results

• 50% reduction in adverse events

• 20% shorter length of stay

• 20% increase in activity covered by only a 2.7% increase in staff

http://www.ahus.no/


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Example of integration between a StateCo & ProjectCo

Integration Engine: A Model to Consider

• Integration of State Health ICT systems is a StateCo responsibility via a Health Information Broker (HIB)

• Integration of ProjectCo systems is a ProjectCo responsibility via the HP Integration Engine (IE)

• Orchestration and Choreography between StateCo and ProjectCo is achieved and simplified via interfaces between the IE and HIB

ProjectCo Systems StateCo Systems Identity and Access

Management

IPPABX

Real Time Location

System

Security

Audio Visual Systems

Facility Service

Management

Catering

Building Management

Systems

Nurse Call

Wayfinding

Logistics, AGV,

Pneumatic tube

Identity and Access

Mangement

Patient Administration

System

Pharmacy

Pathology

Radiology

Help Desk

Supply Chain

Linen Supply

Inte

gra

tion

En

gin

e

He

alth

Info

rma

tion

Bro

ke

r

EHR/EMR

Other Clinical

Systems

Orchestration

Choreography

Events

Reference Data

Metrics

Correlations

Asset Management

Asset Management

ProjectCo

Processes

StateCo

Processes


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ICT: a small cost centre

• The bulk of costs are salaries (66%)

• Goods supplies 14%

• ICT is a small part

• ICT is the KEY to making personnel more efficient, data more accessible and reducing overall TCO

Pay cents to save dollars

Source: Australian Institute of Health and Welfare, Recurrent expenditure, public hospitals, 2009–10

ICT: a component of Administrative expenses


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Conclusion

When planning a hospital, the quality of the interactions between different stakeholders, care providers and areas of the hospital as they support the patient journey will be one of the determinants of outcomes and efficiencies. ICT has a role to play in the quality of those interactions.

So, a planned “Digital Hospital” is one of the opportunities to increase productivity and improve outcomes in the health system, and it’s a proven way to drive efficiency and save money.

This won’t happen by default.

The journey has to consider all aspects of the hospital – not just medical or communications, facilities or ICT; it’s the interaction of the various domains that releases the real value.

Nothing happens in isolation…

So, when you are planning your hospital, understand that you will be a digital hospital but that the choice – “digital by design” or “digital by default” is yours.

peter mcmahon

Technology

rtls location

telecomms

packard development

closed loop

budget driven

meds fully

full emr update

services bulk