It-HealthCOMPUTERWORLDNORWAY No.17FRIDAY8.MAI2015 PAGE13

"We are now starting the initial production on the new infrastructure.”

Terje Gårdsmoen, Østfold Hospital.

OPENING: Each given a cake to cut were State Secretary at the Ministry of Health and Care Services Anne Grethe Erlandsen, CEO of the South-Eastern Norway Regional Health Authority Cathrine M. Loftshus and Østfold Hospital Trust Managing Director Just Ebbesen

PHOTO: AHLERT HYSING

As soon as the Østfold Hospital at Kalnes reaches full operational mode, some time later this year, it will be the mostadvanced hospital in Norway. The brand new self-check-in kiosks were the first new additions greeting the patients.

More efficient collaborationAHLERTHYSING

The new Østfold hospital at Kales hasbeen planne d for six years. The membersof the management team were all smilesthe entire ope ning day; Should erslowered and no signs of stress.

The occasion was marked with cake,and not just one, but three. Each giventheir own ina uguratio n cake to cut wereState Secretary at the Ministry of Healthand Care Services Anne GretheErlandsen, CEO of the South-EasternNorway Regio nal He alth AuthorityCathrine M. Loftshus and Østfold Hospita lTrust Managing Director Just Ebbesen.

The hospital is still referred to as PNØ,or Project New Østfold Hospital, but thatwill end later this year.

A gentle startThe hospital is be ing cautio usly andgradual ly started up. Everything is brandnew and must be given time and care towork within the organisation - includingworkflows, buildings, patient flows,processes and technical equipment

The first departments to move in are theneurolo gical a nd ear-n ose-throatoutpatient clinics and the psychiatricdepartment includin g the unit for juvenileand adolescent psychiatry. Following areparts of the medical imaging department,the outpatient dialysis unit, medicallaboratory services, department ofanaesthesia and the s urgical department.Most clinical functions will continue to becarried out at the hospitals in Moss,Fredrikstad and Sarpsborg.

During the initial phase, the activity willinclude approximately 8 00 employees,100 inpatie nts and 350 daily outpatients.One o lder cou ple, where one h ad anoutpatient appointment,

arrived one day before the ap pointment,in order to famili arise themselves with thenew surroundings.- We are now starting the initial productionon the new infrastructure, says TerjeGårdsmoen, technolo gical dir ector at theØstfold Hospital.

Hewlett-Packard has de livered theinfrastructure, which is being run as acloud service from Sykehuspartner. A llequipme nt is located at the Digiplex Lørendata centre. There are two separatenetworks; one closed and one open.- Available techn ology is us ed in ord er to

provide o ur services in a better way, JustEbbesen says.

The end of phone callsThe new system will put an end tosearching for important data and doctorshaving to call the laboratory for testresults. Instead, test results will be sentdirectly to the doctor, and according totheir preferences. Increasingly, the choiceof preference for receiving information w illbe smartphones and smart watches.Pagers is fully replaced w ithSmartphones, also for nurse call.

- We stopped using phone calls as soonas we started sending messages.Housekeep ing staff members receivemessages with new tasks, alon g with a nycontamination warnings and procedureinstructions. This saves a lot of phonecalls, says Tormod Larssen, ØstfoldHospital project manager of the Imatisdelivery. The Smart Phone used is fromMicrosoft, running a secure Portal Appfrom Imatis, in total 1500 phones is inuse, and it will be up to 5000 phoneswhen the hospital is full open.

”We use technology to serve users in new and more

efficient ways”Just Ebbesen, New Østfold Hospital at Kalnes

Roles are key in this, as staff members are given access to informationbased on r oles. The information a ppears o n their tablet (MS Surface) orsmartphone (Windows Mobile), but mainly on large touch whiteboards

Electronic whiteboards100 electronic whiteboards have been place d around the hospital. Eachwhiteboard is fitted with a smal l computer, and th e monitors are state-of-theart, to be used in the coming years. Follow ing recommen dations, themonitors that were selected are touch-sensitive Nec monitors, which havebeen tested in production. Nec have made improvements to their monitorsbased on the hospital’s feedback.

To access information on the monitors, each user must authenticate byswiping the ir ID cards across a card reader. The information d isplaye d is therelevant information according to the user’s role.

The whiteboards disp lay important information for a wide range of processes.The outpatient clinic whiteboard sho ws time of registration and time ofappointment, purpose, treating physician, estimate of waiting time, status,test results, notes, an option to send a text message to the patient, an optionto send a message to a p orter, transport options, historical info, pin number,waiting zone and location. The portal supports single sign on and open theheavyweig ht systems like HER and HIS with patient context. The steps andcontents of each process is design ed by Imatis. Many fields ar e pred efined,but Imatis offers training for staff members, so that they may themselvesdesign pr ocesses tailore d specifical ly to the own hospital. A wor ld ofpossibil ities is availa ble, but they can only be spotted whe n the user haslearned the basic use of the Imatis system.

The possibilities of desig ning a nd impleme nting efficient processes is whyImatis is counted as a game changer within streamlining health processes.Imatis is well-known for this in Australia, as well as the hospitals of RegionZealand in Denmark.

All facility system and clinical applications, includ ing LAB and PACS/RIS isintegrated with the Imatis integration engin e that is based on MS BizTalk. It isrun from the Digiplex Cloud data centre..

Gain ing e ntry at Norwegia n hospita ls has not b een e asy. The new hos pitalsall use Imatis - first St. Olav’s Hospital in Trondh eim, then AkershusUniversity Hospital an d now the new Østfold Hospital. The Nordland Hosp ita lTrust will upgrade in the autumn, havin g so far had a similar outpatient cli nicsolution to Østfold Hospital.

Collaborative effortsOther hospitals use parts of what Imatis has to offer. It is hoped thatNorwegia n hospita ls realise th at sharing information on co llab orativewhiteboards le ads to streamlining and increase d efficiency within healthorganisatio ns. Deputy CEO of He lse Sør-Øst Steinar Marthinsen has gain edgreat confidence in Imatis. He is eager to se e other hos pitals within theregion start using the system.

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Morten Andresen, the Imatis CEO, is behind most of the Imatis development used in the efficiency improvement of health processes. The information is shown in whiteboards and on smart phones. Abroad, Imatis is considered one of the most advanced companies within health technology, though this understanding has yet to reach the Norwegian health officials and the managers of the health regions. The health professionals are very eager to use Imatis, for example the new solution for cancer pathways.

“The New Hospital in Østfold is the first in Norway using Smart Phone all over and replace pagersMorten Andresen, Imatis

Important information is displayed with an alert. Behind the scenes, there areautomatic processing rules for timeouts, should the recipient not resp ondwithin the time limit. The goal is increased efficiency. Many doctors arecomplaining of the amount of administrative work replacing the work theyhave been trained for.

Health is b ecoming more efficient, so Minister of Trade an d Industry MonicaMæland asserted at the IKT-Norge conference Neo2015.

"Efficiency" in this context mainly applies to the the patient pathwaysupporting proc esses. Sector-specific ICT systems, such as electronic healthrecords, are necessary but do not declutter the patient-related workprocesses. The process management tool from Imatis is responsible forincreased efficiency, in concert with the specialised health ICT systems.

Providing access to patient pathways, patient journals, information from thelab systems, medical images and dynamic staff planning systems, listsMorten Andresen, founder of Imatis and CEO.

The strength of the medical record Dips lies in storing information, notsharing it. We abso lutely have to b e able to proc ess real-time data, JustEbbesen points out.

“This is the first time Imatis has been used within mental health care”,according to Terje Gårdsmoen.

High-quality interfacesThe access to the different specialised hea lth applicatio ns depen ds on thequality of the technical interfaces.

The dynamic staff planning system is delivered by Gatsoft, who were workingclosely with Dips on e lectronic medica l records and inte grated with Imatiswhiteboards.

The Imatis system has been delivered without arrears and according to thecontract, but there is a clear potential to add to the delivery, Tormod Larssensays.

Imatis is far from new for the Østfold Hospital. The Fredrikstad branch of thehospital has used Imatis to increase efficiency at ward units, built identicallyto the new ward units at the new hospital at Kalnes.

“The introduction of Imatis is about more tha n technology, it alsoencompasses changes to work processes, routines and patient pathways”,says Terje Gårdsmoen.

Specifying which processes to define a nd the different tools to work with hasbeen carried out in close collaboration with Imatis.

The first sales meeting was eight years ago, Morten Andresen recollects.

A set of efficient treatment processes is the goal of the hospital. Achievingthis goal requires overview and staff working and collaborating in unison

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Imatis Patient self-check-in was among the first systems to be used on the first day of operations. Two of the first patients had already paid a visit 24 hours early, in order to familiarise themselves with the new hospital. They could, however, not check in that far in advance, not even with assistance - quite according to the system specifications.

Microsoft has classified Imatis as one of the most exciting health developments, told thenational interest group for the Norwegian ICT industry (IKT-Norge) at their Neo2015conference.

One of the reasons being techno logica l affiliations - Imatis uses software technologyfrom Microsoft. The solutions can be run in Microsoft’s cloud, Azure.

The Imatis solution at the Østfold Hospital consists of one basic module, Fundamentum,and three user-ce ntric modules: the patie nt module Porta, the process mod ule Vis ielectronic whiteboards and the mobile alert module Mobilix.

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A nurse playing close attention to the new outpatient whiteboard. Large-monitor whiteboards are new at the Østfold Hospital. The challenge is including enough information, whilst avoiding information overload. Users can adjust the balance after having completed the super user training .

”We use a new app, designed for the Windows phone”, Terje Gårdsmoen explains.

The Østfold Hospital is the first Norwegian hospital which uses smartphones to relayinformation throughout the entire hospital organisation, Morten Andresen asserts.

Important messages are routed to the smart phones, this also includes duress, nursecall, hospital ord erly and all type of messagin g and w ork item´s. The hospital usesphones from Microsoft. The acquisition was ma de by the h ospital, for members of staffthat need to be able to receive messages.

Imatis also offers technology to separate work-related messages from privatemessages, though this is not used at the Østfold hospital, then yo u can bring your ow ndevice.

AlertsAlerts, such as code blue emergency alarms, are vital to hospitals. Mobilix can relayalerts to whiteboards, tablets, pagers, smart phones and smart watches. Emergencyalarms, such as code blue, is sent to the entire code team. Other acute alerts includeemergency pacemaker or C-section alarms. New uses for alerts may be included afteran initial phase of use.

The types of alarms and how these alarms should be displayed must be learnedthrough experie nce. Should the main power fail, the hospital has an emerg ency fall-back option of alerts based on analogue technology and units.

The load dispatching centre is integrated with the alarm system at the hospital.Technical alarms generate work tasks, and the dispatch centre makes g ood use of thesystem. Every public restroom has a responsible security staff member. Should a nalarm be triggere d in o ne of the restrooms, the alarm is sent directly to the respo nsiblesecurity staff member.

Responsib ility mapping within a hos pital is very complex and ch alle ngin g. The porter isresponsible for moving patients. Using a smart phone, p orters are messaged with ne wtasks and can sign for completed tasks. Nurse call sig nals are se nt directly to theresponsible nurse, who signs directly on their smart phone, Morten Andresen explains.

Each alarm is defined with a time limit, within which the user must acknowledge thealarm. When the limit is exceeded, a set of predefined rules forwards the alarm to thenext user.

Imatis believes that smart watches will become popular additions to or alternatives tothe mobile phon e, and is alrea dy working to inclu de sup port for the Apple Watch.Functions are made using App le’s dev elop er kit. Imatis will be ready by October, whe nthe watch is released in Norway.

“The introduction of Imatis is about more than technology, it also encompasses chang esmade to work processes, routines and patient pathways”, says Terje Gårdsmoen.

Patient self-check-inThe use of IMATIS Porta is new to the hospital. It is used by arriving patients who wis hto check in by themselves. After checking in, they are provided with an overvie w of thewaiting areas. The system can also provide estimates of waiting times.

Patient self-check-in is gaining market momentum. Similar functionality is widely used,for example for visitor registration, picking up pre-ordered cin ema tickets or self-check-inat airports. The threshold for users to a pply the s ame principle w hen re gistering at thehospital shou ld not be too hig h. Patients in need of assistance - old age p ension ers etc.- are helped by qualified hospital employees.

Self-check-in provides the hospital with accurate patient arrival information, as well asnon-arrival informatio n when patie nts fail to show for appointments. This information,after a period of gathering information and exper ience, may lead to ad hocrearrangements of appointments, to better exploit free capacity within the same day.Older patients tend to arrive early for appointments, and patients who travel may alsoarrive early.

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Senior solution architect Else Marit Tiset Kittelsen has designed the application used on the large touch-monitors, after input from the hospital’s own super users, based on their knowledge of local needs. Key status information, such as test results and important messages that require follow-up work,must be included. Colours are used to indicate priority. Red means urgent.

The hospital can sen d text messages to checked-in patients, in case of gaps in the scheduleand an earli er opening. The patient may also be advised via text messages of incidents whichmay lead to delays. These resources can be spent elsewhere, Morten Andresen explains.

Patients are given an eight-digit reference code after having checked in, and are told whichwaiting area to use. The reference code is sent to the patient’s smart phone and used inwaiting area progress monitors.

Included in the de livery is a patient portal, with TV and streaming content, video collaboratio nunit based on WebRTC, daily h ealth reports and access to the patie nt’s own medica l recordsusing a new, highly visual approach. This solution is used by the Western Norway Regiona lHealth Authority. The functionality is built into the standard product, but not used in ØstfoldHospital Kalnes.

Whiteboards as collaboration toolsThe touch-sensitive monitors, whiteboards and portal are vital in improving processes an dintra-departmental collab oration. The portal acts as the virtual glue between all the differentsystems, providing the users with visualisations of informatio n and alarms from the othersystems.

Colours are used to indicate priority, i.e. red for "urgent, take action". Scenarios like thesereally justifies the use of real-time data. After much research, the hospital chose wards withsingle-b ed rooms which have be en organ ised in small un its, each with one room forcontagious patients.

Electronic whiteboar ds are used to increase efficiency, connecting al l the associated be dwards and provid ing q uick situational overviews to the nurses, physicians an d other staffmembers.

Team gatherings at the whiteboards prior to visitation roun ds and through out the day enab lesinformation sharing, collaboration and discussions.

“One cha llen ge is avo idin g information overloa d with the wh iteboards. We nee d simple to olsto support the running of the ward”, says Terje Gårdsmoen.

The whiteboards are set up with role-based access to avoid passers by gaining access toinformation. The logged-in role determines which information is displayed to the staff member.

Much of the real-time patient treatment is performed in front of a whiteboard. Patient sensitiveinformation is closed down as soon as the healthcare staff leave the whiteboard. Theinformation is retrieved as soon as the RFID tag is held u p to the monitor, Morten Andrese nexplains.

The ID tag of the authenticated user d etermines whic h information is sh own in thewhiteboard.

This article has been translated to English, the original article appeared in Computerworld Norway, which can be viewed here:

Additional whiteboardsExperiences from the Danish R egio n Zealan d are that staff members wish for additiona lwhiteboards, preferab ly up to 100 inch mon itors. Real time data is the culprit behin d thetrend. The Danes prefer using the nearest whiteboard monitor, where informatio n is displaye din context, rather than having to make sense of single pieces of information to their pocketdevices.

The whiteboards are tail ored to the needs of the different departments; Emergency, intensivecare, surgery, mental health and bed wards, to mention a few.

The solution from Imatis is based on several databases, one of which is a real-time server.The company’s backgro und from the o il an d gas industry contributes to the efficiency of theprocessing. Imatis considers applications on two levels - lightweight or heavyweightapplications. The user-centric applicatio ns are lig htweight ap plicatio ns, whilst the backgroun dapplications are heavyweight.

Amongst the heavyweight applications are all the specialised systems, integrated using theregion’s integration framework. Other heavy app lications include n urse call systems, real-timelocation systems, pneumatic tube and AGV, hospital admin istration appl ications and SMSmessaging. Many of the "heavy" applications are in fact lightweight, but classified with thecommon services.

There are many different nurse call vendors, and Imatis must be able to relay informationfrom all of the vendors, using the Fundamentum integration, orchestration and messagin gserver. The brokering function provides interaction betwee n the Sykehuspartner specialistapplications and the nurse cal l app lications, registerin g and passing on the sig nals from thebutton or the pull cord.

TrainingSuper users are trained to configure the whiteboards accordin g to the needs of theirdepartment or unit. Included in the Imatis system is a configuration toolkit for this purpose.Automatic tasks can for instance be ordering technical services of medical equipment,depending on the technical state of the equipment.

Super users do n ot write code; Imatis’ develo pers do. How ever, the super users des ign n ewprocesses adapted to the hospita l’s needs a nd requ irements. These needs and req uirementswill be uncovered as experience is gathered.

Results from Region Sjælla nd in Denmark shows th at nurses can save as much as 4 4minutes on each shift each day by using e lectronic white board with rea l time informationabout patients, resources and service.

In Region Sjæl land they now h ave rolle d out IMATIS Visi whiteboard on more than 95% of al lwards across all there hospitals in the health thrust.

http://www.cw.no/artikkel/offentlig-it/digitale-prosesser-limet-pa-sykehuset-ostfold

Imatis deliver lightweight IT with extended integration to all heavyweight IT systems used. The lightweight IT systems includes, a complete integrated and perfect environment that include Imatis products like the Porta outpatient management system, the Visi Whiteboard for Resource, Process and Collaboration, the Mobilix mobile logistics management and clinical coordination system. In addition we also have the IMATIS Visual Health HER access and navigation system, but this is not a part of the Østfold project at the moment.

Imatis everywhere !The Østfold Hospital at Kalnes is the most advanced hospital in Norway. The Hospital has implementedsolutions from theMicrosoft Gold Partner Imatis. This includes lightweight IT system on a amazing numbers oftouch devices all over the hospital, a truly real time digital hospital with mobility.

Imatisnewsletter 2015

CopyRight 2015- Imatis

H E A V YWE I G H T I T

Facilitiesmanagement

Patientcentricsolutions Buildingsystems

Hospitalinformationsystems

I N FRA S T RU C TU RE , S E RV E R S , I T N E TWORK

L I G H TWE I G H T I TSmartphone

Whiteboards

WorkstationBedside PC

IP phones

Wearables

Tablets

Check-in

Displays

Imatis lightweight IT solution is integrated to the heavyweight IT system with the IMATIS Fundamentum Integration, Messaging and Workflow Engine.

The hospital can send text messages to checked-in p atients, in case of gaps in theschedule a nd an earlier open ing. The patient may als o be adv ised via text messages ofincidents which may lead to delays. These resources can be spent elsewhere, MortenAndresen explains.

Patients are given an eight-digit reference code after having checked in, and are toldwhich waiti ng are a to use. The reference co de is se nt to the patient’s smart pho ne a ndused in waiting area progress monitors.

The hospital can send text messages to checked-in p atients, in case of gaps in theschedule a nd an earli er open ing. The patie nt may also be a dvised via text messages ofincidents which may lead to delays. These resources can be spent elsewhere, MortenAndresen explains.

Patients are given an eight-digit reference code after having checked in, and are toldwhich waiti ng are a to use. The reference c ode is se nt to the patient’s smart ph one a ndused in waiting area progress monitors.

Imatis deliver lightweight IT with extended integration to all heavyweight IT systems used. The lightweight IT systems includes, a complete integrated and perfect environment that include Imatis products like the Porta outpatient management system, the Visi Whiteboard for Resource, Process and Collaboration, the Mobilix mobile logistics management and clinical coordination system. In addition we also have the IMATIS Visual Health HER access and navigation system, but this is not a part of the Østfold project at the moment.

Response CentreImatisnewsletter 2015

Patient set up video and voice meeting with the Nurse at the Response Centre. Data from sensors like SPO2 is registered and stored in the cloud service

IMATIS Response Centre service supports information flow related to thehandling of warning and alarms from welfare technology products,including video and voice as well as Home Care solutions. Imatissolutions safeguard uses and ensure optimal work processes and flow.The information flow and integration between solutions follow nationaland international recommendations on architecture and standards. Theplatform is also used for remote monitor chronical patients (COPD,Diabetes etc.) that lives in there own home. The Response centresolution has is focus for Municipalities that follow up patients that canstay and live in there own home, but need security and need follow upactivities from Doctors and Nurses, that can be done remotely.

Imatis has developed a large-scale pilot for two health regions inNorway, where they work closely with Ministry of Health to establishreference architecture. Large scale pilot where more than 500 pasineterwith various chronic disorders and established a number of Appsfacilitated standardized patient care and capture of information to centralresponse centre, where data is shared to the teams should have accessto data in real time. Data captured from digital sensors and modernApps, stored in the cloud and distributed to private practitioner, hospitalsand others who are part of the treatment.

The IMATIS Response Centre solution runs from Cloud by using MSAzure.

Patients register there own health situation on a App, and data is stored in the Cloud for access and follow up by the Municipality Response Centre. I.e. in this case the patient has COPD and are followed up the first 14 days from the Hospital, and later follow up is done from the Municipality Call Centre.

Trondheim and Stavanger Municipality is implementing a large scale project for remote monitoring about 500patients with chronical disasters. The goal of the project is to test out newwelfare technology in la rge scale , us inginternational integra tion standards. To save cost and to make it easier for patients to live in there own home, thesystem can remote follow up the patient from the a central Response Centre.