The Digital Hospital

Baldur Johnsen
Worldwide Health & Life Sciences
Hewlett-Packard Company

© 2006 Hewlett-Packard Development Company, L.P.

The information contained herein is subject to change without notice
“High information costs are characteristic
of many health care markets; frequently
the only way a person can know
whether he needs to see a physician is
to see a physician.”

Professor Victor R. Fuchs

“Who Shall Live?”
Worldwide HP Initiatives in Health ICT
1 Adaptive Infrastructure 2 Adaptive Enterprise 3 Adaptive Industry
Physical Consolidation Logical Consolidation Ecosystem Consolidation

Technology People & Value Chain Centric

Centric Process Discovery & Manufacture & Health

Centric Basic
Development

Clinical
Distribute Primary Management
Care
Payment
Research Trials
Acute Extended

Strategy: Consolidate Strategy: Integrate and Strategy: Extend

and Integrate Technology Simplify the Process Information-enabled
Processes
Key Principles: Connect and Key Principles: Integrate and
Consolidate Modularize Key Principles: Innovate and
• Data centers • Application Rationalization Collaborate
• Devices • Intra-Enterprise Process • Service based offerings
• Facilities Improvement • Inter-Enterprise Process
• Networks • Architecture & Improvement
• Stacking, Virtualization Governance • Standards and
• Servers • Information Policies Architectures
• Storage • Shared Services • Information Mobility
Clinical Productivity
Doctor’s & Nurse’s daily walking
• Doctors ~ 9 - 13 km per day ~ 2 - 3 hours
− ~ 100 - 150 € per doctor per day
• Nurses ~ 4 - 8 km per day ~ 1 - 2 hours
− ~ 25 - 50 € per nurse per day
• Doctors mileage
− Jones (BMJ 1996;312:1542)
• 10,9 km on call per 24 hours
(Senior House Officers in General Medicine)
− Clement (BMJ 2006;333:911)
• 9 km on a normal day
• 11-13 km on an on-call day.
Clinical Productivity
• Doctors: Seeking data and information
− To and from meetings, rounds and
demonstrations (Radiology, Pathology, Labs)
− To see the next patient
− Professional tasks are done sitting or
standing at a work-place
• Nurses: Seeking data, information,
persons or assets
− To and from patients in general
− Responding to nurse-calls
− Rounds
− Checking and reporting med-tech. devices
− Messaging and transporting paper-based information
− Seeking for, and transporting assets
• Productivity: Healthcare lagging behind other industries
Steps taken to discharge a patient

Steps taken to discharge a patient from Bolton hospital –

results of mapping exercise undertaken by hospital staff

Source: Jones, D and Mitchell, A (2006): Lean thinking for the NHS.
A report commissioned by the NHS Confederation
Lack of information management
in hospitals
• Most information still
paper based
− Can be destroyed
− WW largest user of paper
• Hard to control access
• Retrival of information
lengthy
• Occupies huge spaces
• Risk of miscommunication
− Over 60% of ADE’s attributed to
miscommunication*
• Ownership of information
*From: CPOE Costs, Benefits and Challenges FCG 2003.
Report commissioned by the AHA
HP Digital
Hospital Vision
 What is a Digital Hospital?
− Relies on technology as an integral and
fundamental part of its business strategy

− Enables the organization to leverage it’s

potential for delivering higher quality care
in increasingly efficient ways through the
use of IT and process redesign.

− Goes beyond advanced clinical systems

and includes additional integration between
IT, medical, communication and building
technologies to create a real-time
hospital information environment

Source: PWC
The importance of availability
Clinician Tolerance
for downtime and poor service

View of IT
Value = Value and the Credibility
of the IT Department

Clinical Adoption
of IT solutions

Expectations of Availability and Service

Time Patient tolerance

• As care processes be-come more dependant on IT clinical expectations of availability increase

• Clinicians are used to high availability technical infrastructures e.g. delivery of electricity

Source: CHIME, TLP

The infrastructure
of the hospitals today
Nurse Call Patient TV Door Phone Mobile ward round
Opener Systems
Intercom (PBX)
CCTV Telephones Paper
AGV DECT/Pager
(Robot)
Medical Devices RFID
Wireless LAN
WiFi

Client PC

Hospital
Applications
Light
Blinds
Heating
Facility
Control

EPR PACS HIS LAB EHC

Infrastructure IP Convergence
Patient terminal IP phones IP wireless MDA/ PC Mobile Pager Nurses’
phones PDA phones portal
(SMS)

GSM

OPC, SMTP,
LAN/WLAN
SMNP
IMATIS®
Middleware
PACS
IP converter I/O signal EPR
ESPA 4.4.4 converter EHC
Laboratory etc.

Nurse call Patient monitoring Facility HP WiFi tags

medical equipment control Digital Pen

Everything over IP – IP Everywhere

The Enabling Integration Technology
 Future state:
Digital Hospital Roadmap Technology
enabled efficient
processes

Integrate • Better
• Enhance integration of quality of
applications and services care
Innovate • Seamless communications • Reduced
Current Pilot & rollout e.g & alerts number of
state: • Align applications with errors
• Messaging & alerts
business processes • Improved
Inefficient • Location based
productivity
services • Patient bedside
manual and
• Asset tracking terminal/portal
processes • Organizational decreased
• RFID • Patient monitoring virtualization cost
Enhance
• Ecosystem partner
Infrastructure • IP Telephony • Reinvention and integration
• IP LAN • Wireless redesign of care
• Wireless & processes
mobility • Converged IP network
• Security for voice, data and video

Physical Logical Ecosystem

integration integration integration
Network enhancement / New Infrastructure Change Management Service evolution
Creating the Digital Hospital
Patient Bedside Terminal &
Portal
Messaging & Alerts
- Nurse call
- Medical team assembly
- Hospital orderly
- Event driven alerts

Location and identification

services
- WiFi
- Passive RFID

Device integration
- Patient monitoring
- Infusion pumps

IMATIS Integration
Platform

Network & communication

infrastructure
Scenarios
• Nurse Call
− Nurses walk 6-16km
(4-10 miles) per shift
• Vital Signs Collection
• Division of Labor
• Push Information Delivery
− Doctors walk up to 6 miles per day
• Response Team Assembly
− Congestive Heart Failure
− Door to Balloon Angioplasty
The HP Cardiac Cisco partnership for
Digital Hospitals

System integration & Medical grade network & Imatis integrated hospital
project management clinical connection suite

Consulting & Integration Nurse call integration Medical Device

services IP telephony Integration
Network lifecycle services Location based services Alert Management

Network monitoring, ITSM Collaboration services Hospital orderly

communications
Access control & security Network Infrastructure
Asset tracking
High availability computing Patient terminals
Storage & archiving
Case Study:
St Olav’s
hospital
St Olavs Challenges & Vision
Building a state-of-the art hospital
with the patient in focus

• Managed by the Regional Health

• Hospital was too costly to operate,
Authority of Mid-Norway
rising costs • 920 beds
•Needed to build a hospital that could • 44,000 treatments per year
provide outstanding quality of care • Provides services for other hospitals
and speciality clinics in the region
•Read, understand, and design the
hospital environment from the patient
perspective
•Go from one big structure to 11
separate centres challenges the
infrastructure design
•Integrate University employees
seamlessly
•“Securely provide the required
information to the right persons at the
right time”
 ORGANIZATION ETHICS
-functions and -attitudes and
processes Human communication among
-medical and Resources the staff, the
technical patient and
competence others

Quantitative Qualitative HOLISTIC MODEL

"hard" measures Patient "soft" measures Human and material
(Throughput/Metrics) Focus resources
(satisfaction, Ragnhild Aslaksen
wellbeing) Chief Architect
St Olav’s

TECHNICAL AESTHETICS
PROPERTIES -experiential quality
- functionality in design and
- technical quality of Material
organization of
buildings and Resources rooms and
equipment buildings
St. Olavs Hospital, Norway
Building the hospital of the 21st century

Customer needs
• Re-build hospital over a period of 10 years
• Provide outstanding quality of care to patients
• Integrate research and educational activities
• State-of-the art hospital with patient in center

St. Olavs’ Hospital Solution

• Campus-wide Wireless LAN, VoWLAN
• Secure, scaleable, resilient and responsive, 99.999%
• IP based patient terminal, nurse call
• All communication on IP – no legacy systems
• IPC integrated with all notification & alarm systems
• Advanced logistics solutions
Expected results at St. Olavs
• Converged network means improved TCO and reduced
network operating costs
• Improved patient care with better access to data
• Patient stays are shorter, less inpatients
• Staff productivity increased through better collaboration
and should reach a productivity gain by 26,1% within 2015
• Estimated reduction in yearly workload equals the a
workforce of 472 (6% of total staff)
• Estimated improvement to yearly earnings of Euro 22 mill
of which ICT represents 15 mill.
Summary
“The reasonable man
adapts himself to the
world: the unreasonable
one persists in trying to
adapt the world to
himself. Therefore all
progress depends on
the unreasonable man.”
George Bernard Shaw
“Man and Superman”
Questions