projecte del st. olavs trondheim university hospital
DESCRIPTION
Alfons Buxó. Director de Prevenda HP. Barcelona.TRANSCRIPT
© 2008 Hewlett-Packard Dev elopment Company, L.P.The inf ormation contained herein is subject to change without notice
HP Digital HospitalSt. Olav’s Hospital experience
Alfons BuxóSpain Presales Director
Current issues facing hospitals todayConvergence of several factors and challenges
Growing demand InnovationCost increase
•New diseases•Chronic diseaseincreasing•Skilled workforce needs•Hospital technology silos•Clinical Productivity•Process complexity•Resource optimization•Knowledge sharing•Technology alignment to business/clinical priorities•Labor shortages
•Aging population•Immigration•Universal benefits
•Improve Diagnostic capability •Targeted treatment•Manage pace of innovation •e.g for chronic disease management,•Best practice adoption
•Diagnostics and treatments•IT greater embracement•Technological complexity raise•Patient safety and quality of care•Care continuity•Clinical communication•Patient Satisfaction•POC information access•Clinical traceability
Speed innovation to transform health
Improve quality of careMitigate risks
Improve operational efficiencies
Clinical Productivity challengesExamples• 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
How ICT can help• Medical staff
− Manual processes automation− Digitization process / analog systems− Improve the capture and dissemination of clinical information− Facilitate mobility and location of personnel and health
equipment− Integration of Clinical and Business Applications− Exchange and distribution of data, images and clinical information
(i.e. e-salud initiatives)
• Patient− Ensure that the required information is at the right time and
place− Enable personalized and remote attention through
collaborative tools (Telehealth, remote diagnostic, remote assistance, etc. ..)
− Facilitate the monitoring of chronic and infectious diseases− Dissemination of health information (prevention campaigns,
vaccinations, etc. ..)− Empower the individual to manage their own health
What is a Digital Hospital?
− Relies on technology as an integral & fundamental part of its business strategy
− Enables the organization to leverage its potential for delivering higher-quality patient centric care, in increasingly efficient ways through the use of technology & process redesign.
− Builds on an Enterprise Architecture that goes beyond advanced clinical systems & includes technology integration to create a pervasive, real-time health information environment
The infrastructure silos in hospitals today
Nurse Call Phone Systems (PBX)TelephonesDECT/Pager
Door OpenerIntercomCCTVAGV (Robot)
LightBlindsHeatingFacility Control
Mobile ward round
Wireless LAN
WiFi
Client PC
Hospital Applications
Paper
Medical Devices
EPR PACS HIS LAB EHC
RFID
Patient TV
Everything over IP – IP Everywhere
IP Convergence through a resilient, protected network Enabling the transmission of vital information
Patient terminal
LAN/WLAN
IP converterESPA 4.4.4
MDA/PDA
PC Mobile phones(SMS)
IP wirelessphones
OPC, SMTP, SMNP
I/O signalconverter
HP Digital Pen
Patient monitoringmedical equipment
WiFi tagsFacilitycontrol
EPRPACSLaboratory Etc.
Nurses’portal
GSM
Nurse call
PagerIP phones
What constitutes the Digital HospitalPatient Bedside Terminal & Portal
Messaging & Alerts• Nurse call• Medical team assembly• Hospital orderly• Event driven alerts
Location & Identification Services• WiFi• Passive RFID
Device Integration• Patient monitoring • Infusion pumps
Integration Platform
Network & CommunicationInfrastructure
•Patient bedsideinteractive services &communications
•Digital signage
Collaboration•Telehealth video & conferencing solutions (Web, audio, video, IM, presence)
HP Digital Hospital Solutions framework
Converged Network, upgrade & security servicesWired & Wireless
Voice, Data, Video
IP Telephony, PBX replacement
Presence, Instant Messaging, Unified Messaging
Workflow Management / integration
Directory integration
RFID enabledlocation
& trackingservices
•Hospital messaging &alerts•Mobile nurse call•Medical team assembly•Hospital orderly•Order entry & results alerts
•Asset tracking•Patient & staff safety•Temperature monitoring
•Electronic whiteboard•Medical equipment interconnect
•Integration with hospital applications- EPR / CIS / HIS- Lab IS- …
(Man
agem
ent,
QoS
, Use
r Ad
min
)
The Digital Hospital Journey
• Converged IP network for voice, data and video
• Messaging & alerts• Patients & Assets
tracking with RFID
• Enhance integration of applications and services
• Seamless communications & alerts
• Align applications with business processes
Physical integration
Logical integration
Ecosystemintegration
• Patient bedside terminal/portal
• Patient monitoring
• Reinvention and redesign of care processes
• Organizational virtualization
• Ecosystem partners integration
Inefficient manualprocesses
Technology enabled efficient processes
•Better quality of care
•Reduced number of errors
•Improved productivity and decreased cost
St Olavs hospitalExperience
St Olavs Challenges & VisionBuilding a state-of-the art hospital to deliver patient centric services
• Hospital was too costly to operate, with annual rising costs
• Decision to build a patient centric new hospital that will provide outstanding quality of care
• Opportunity to integrate clinical and teaching/research areas
• From one large structure to 11 separate centres
• Exploiting ICT to deliver information to the right persons at the right time at the point of care
• Located in Trondheim - Norway’s largest hospital
• Premises: Main Acute Services Unit (75%) & University Hospital (25%)
• Managed by the Regional Health Authority of Mid-Norway
• 950 beds• 8,000 Staff (+1,250 students) • 413,000 patient treatments per year• Provides services & specialties for
other hospitals in the region
St Olavs’ hospitalAdvanced logistics choices
Automatic Guided Vehicles (transportation robots )Pneumatic tube systems
Clothes management
through RFID chips and
cabinets
Automatic waste handling
The new St. Olavs’ hospitalA state of the art, patient centric hospital
IP over all – all over IP : A single, converged IP network for voice, data and video
• Secure, scaleable, resilient and responsive, 99.999%• Campus wide Wireless LAN in 11 buildings, inside/outside, Voice over WLAN• Seamless communications through 1400 IP phones messaging• Nurse call for 350 beds, 50 Nurse Stations• Emergency calls management from handhelds or patient signal system• Hospital Orderly – transport ordering, dispatching• Building alerts (30 technical systems integrated)• Patient terminal – Entertainment, integration with building control, access to clinical systems•HP Ipaq PDA’s (500)
Creating the Digital Hospital Assets – division of labour
Nurse request wheelchair.
LBS selects the nearest one.
Transporter dispatch chair to the nurse.
Real time location and tracking
Asset Management
Equipment Maintenance
Temperature Monitoring
Workflow & Resource
Management
Patient & Staff Safety
Reduce costs Improve operational efficiencies Increase patient safety
Track…current and
historical location of medical devices and people, from a Web
interface
Alert…automated alerting and
notification (pump leaving a protected zone, overdue for
maintenance, requiring delivery, etc.)
Manage…the utilization of equipment, control the workflow and
utilize location data for operational
analysis
Integrate…location and status information to existing
hospital applications (e.g asset mgmt, EMR, etc.)
Melding-sentral
Patient
Send and receive messages
Custommenus
and predefined messages
Personnel FireTeam
Predefined acknowledge alternatives
Replay and forward(auto and manual)
On-touchduty or assault calls
Hospital Communication System
• IP Phone messaging • Nurse Call• Medical team assembly• Hospital Orderly• Building Alerts
AGVLifts Notifications Clinical Applications
Hospital Comm. System
Creating the Digital HospitalNursecall – Emergency Response
2 patients initiates nursecall.
Each patient’s primary nurse receives request via IP phone.
1 patient requires emergency care and initiates emergency team assembly.
System locates closest care provider for each of the team role and directs them to the patient.
Creating the Digital Hospital Information push – Lab Test
Orders blood test using PDA.
Nearest qualified technician draw sample.
Sample sent to lab via tubes.
Lab process samples.
Results are pushed to Doctor ’s PDA.
Creating the Digital HospitalMonitoring – Locating nearest nurse
A biomedical device generates an alarm.
System locates closest nurse and instruct her to evaluate patient’s condition.
Benefits for Nurses – St Olav’s hospital
Walking distances significantly reduced− Old facility 5.3 km = 1 hour 7 minutes of a 7 hour shift− New facility 3.5 km = 45 minutes of a 7 hour shift – 23
minutes per day released for patient care
“I now have greater freedom to deliver on the core services and more time to spend with my patients, which I used to spend filling out forms, making endless phone calls, chasing relevant patient information and test results, or just tracking down people.”Aud Olsen, Head Nurse, St Olav’s hospital
Productivity
Business Technology-In-ActionDigital Hospital Solution at St. Olavs
Operational Tools
IP TelephonyFixed/wireless
NetworkInfrastructure
Digital dictationPatient Alarm
Appl. .Data
NTNUAppl. .
DataSt Olavs
Patient terminal
Peripherals
Cabling
Public Network
Secure LogonCertificates
TV distribution/VideoAudio
Medical DigitalAssistant (Ipaq)
Meta Catalog
Alarm and tracking
Messages application
Excerpts from IDC Case Study (Sept 2006)
… a groundbreaking project … … St. Olavs Hospital has been
tagged the most modern hospital in Europe and probably
among the world’s leading healthcare technology initiative and is now fully operational …
… St. Olavs Hospital should be considered the world’s
benchmark in terms of tactical and strategic usage of
technology in life and death scenarios for the better of their
customers, the patients …
Experienced Results at St. Olavs
• Treated more patients in 2007 than 2006 with smaller budget
• Improved patient care with better access to data
• Patient stays are shorter, less inpatients-20% in Neurology centre, 5.9d => 4.7d
• Staff productivity increased through better collaboration
• Reduction in yearly workload in 2006/2007
© 2008 Hewlett-Packard Dev elopment Company, L.P.The inf ormation contained herein is subject to change without notice
Conclusion
Conclusion
• Partners management• Delivery capacity• Commitments• Design, project management, complex
solutions integration• Costs and risks reduction• State of the art technologies• Availability and security of information
access, anywhere, anytime
HP and its partners can help healthcare providers increase efficiencies, optimize resources et improve quality of care by integrating IT, medical devices, and applications within the digital hospital. HP brings industry leading track records in
Backup
Agenda• The Digital Hospital – vision, solutions framework• Functional view, solution benefits• St Olav’s hospital experience • Cost Benefits analysis
Healthcare Providers Business Challenges
Speed innovation to transform health
Improve quality of careMitigate risks
Lower costs/Improve operational efficiencies
•Hospital technology silos•Clinical Productivity•Process complexity•Resource optimization•Knowledge sharing•Technology alignment to business/clinical priorities•Cost containment•Labor shortages
•Improve Diagnostic capability •Targeted treatment•Manage pace of innovation •e.g for chronic disease management,•Best practice adoption
•Patient safety and quality of care•Care continuity•Clinical communication•Patient Satisfaction•POC information access•Clinical traceability
¿Cómo pueden ayudarnos las TIC?• Personal Sanitario
− Automatización de procesos manuales− Digitalización de procesos/sistemas analógicos− Mejorar la captura y difusión de la información clínica− Facilitar la movilidad y localización del personal y el equipamiento sanitario− Integración con las Aplicaciones Clínicas y de Negocio− Intercambio y distribución de datos, imágenes e información clínica mediante iniciativas de tipo e-
Salud
• Paciente − Garantizar que la información requerida está en el momento y lugar adecuados− Habilitar la atención personalizada y a distancia por medio de herramientas de colaboración
(Telemedicina, Telediagnóstico, Teleasistencia, etc..), − Facilitar el seguimiento de enfermedades crónicas y contagiosas− Difusión de información sanitaria (campañas de prevención, vacunas, etc..)− Darle al individuo poder para administrar su propia salud
IDC Healthcare IT Maturity Model
© 2008 Hewlett-Packard Dev elopment Company, L.P.The inf ormation contained herein is subject to change without notice
Improved patient care andefficiencies through bettercommunications, collaboration,information flow
Built on
• a converged, resilient, securedand adaptive network infrastructure,
• Unified IP based communications, alerts
Enabling • incremental solutions and
integration to improve healthcare processes efficiencies, quality of care
The Digital Hospital
© 2008 Hewlett-Packard Dev elopment Company, L.P.The inf ormation contained herein is subject to change without notice
InformationIntegration
Across devices, instruments,applications
The need for integration
• A patient-centric healthcare service is increasing the dependency on information integration, to create complete and up-to-date Electronic Patient Records
• EPR systems require integration at various levels, with objectives − To support the coordination, quality, and continuity of care− To improve health information communication under the
control of the concerned patient− To reduce accidents and redundancies− To improve productivity
• HP and our partners offer a new approach to integration, covering both applications, medical instruments for examination and observation, ICT devices and building control.
Application integration layers
Clinical & Admin Information SystemsApplications views
Processes components
Integration layer (Middleware)
SW infrastructure (network, virtualization, …)
Hardware infrastructure (cabling, processors, disks…)
Legacy applications (departmental)
Technologicalarchitecture
Applicationarchitecture
By specialty, processes,(patient files, prescriptions, …)
Blood bank
ClinicalChemistry
Medical applications & instruments integration
CTG, ECG, etc.
Software Discrete data Waveform (real time)
Endoscope, Microscope,Remote Lab Instruments,FAG, OCT, etc.
Infusion Pumps, CTG, ECG, Blood Pressure Monitors, etc.
DICOMHL7
ASTMNon Standard
Integrations
Examination Observation Observation/Monitoring
IMATIS Application Platform and Middleware
Presentations
Clients devices
Sources of data and information
Applications
HP and Imatis information integrationsolution
Benefits• Connecting different
communication and medical devices as well as applications
• IMATIS portal sends data to the right communication device
• Transaction processing with real-time control and storable sets of rules provides necessary security
• Instant real-time event driven information delivery
IMATIS portal
Adapters, Gateways, Drivers
IMATIS SOA Platform - Middleware
Functional View & solutions benefits examples
Example: Asset tracking at St Vincent’s hospital improve productivity and time with patients- Active RFID solution to track assets - Automated inventory management and alerts- Integration to order fulfillment system
Benefits
- Improved equipment availability - 20% cost reduction in rental costs and lost equipment
- Improved service unit staff productivity -20% increase in nurse time with patients
Costs savings
Patient services (QoC)
Productivity
•Reduce purchase of new equipment•Reduce rental costs•Staff efficiency
•Reduced safety incidents•Reduced wait times•Increased staff time with patients
•Increased patient throughput•Increased capacity of critical departments (OR/ER)•Increased staff productivity•Reduce staff time spent on manual searching, logging and monitoring procedures
Real time location and tracking solutions
Asset Equipment Temperature Patient & Workflow & Management Maintenance Monitoring Staff Safety Resource
Management
Patient Terminal
• gives patients more control whilst recovering, enables them to communicate with external world
• Opportunity to carry training programs for patients with long term condition
• TV, Video, Radio, Telephone via IP• Internet/ E-mail / Access to hospital information
system• Lights & blinds control• Integrated Nurse call system (IP or analog)• Console Games• Patient Billing
• Access for clinicians to the hospital information system via smart card
Patient services
Productivity
• Highly accurate remote diagnosis and knowledge-sharing with specialty centers and other hospitals regionally and globally
• Peer-to-Peer clinical discussions• Shortened decision cycles• High level patient case management,
bringing greater patient safety and convenience
• Community outreach for specialty counseling and resources between facilities
• Community outreach for specialty counseling and resources between facilities
• Foreign language patients assistance• Staff development – Training, Peer to
Peer interaction, Mentoring and best practices
Video conferencing and high resolution images sharing
Costs savings
Patient services (QoC)
- Large US orthopaedics specialty practices with 19 offices, six surgery centres- Adopted UC real-time video collaboration to relieve physicians attending training and compliance meetings travel burden- In nine months, the system saved 100 hours of physician travel time, meaning more time for patient care
• Dramatic improvements in quality and cost of care are possible by the introduction of UC tools such as presence, IM, conferencing with PACS, to enable instant communication between physicians as an integral part of the radiology workflow (*)
Costs savings
Patient services (QoC)
Productivity
Presence, Instant Messaging
• Large NHS Healthcare trust employing 7,000 people over 8 hospitals improved employee collaboration using a UC solution providing IM, VoIP, video and web conferencing. • Benefits reported include enhanced patient care through improved collaboration, significant time savings through presence, and much reduced email traffic.
* Survey conducted by Carestream Business Diagnostic Studies
• Contact specialists to rapidly respond to patient queries and react faster to medical emergencies•Location information can also help identify the closest and most suitably qualified person to respond.
Digital Signage in hospitals
• Digital Signage in Waiting Areas −displays carrying a mix of news, health and wellness information −content tailored by department−for private health providers, promote higher-margin services
• Touchscreen Directories and Wayfinding Systems−help patients navigate your facility, increasing on time arrival at appointment
• Patient Registration and Check-In Kiosks−self-service kiosks to fill out new patient profiles −Staff savings, while reducing wait times
Costs savings
Patient services
Productivity
Registration zoneSmart Technologies
Registration Area
While waiting, havea coffee or some gaming
Self Service Counter
Digital Signages
Wireless Network Technology
HP Digital Hospital Customers• St Olav’s hospital, Trondheim, Norway• Nye Ahus hospital, Oslo, Norway• Asklepios, Bamberg, Hamburg Germany• University Hospitals Leicester NHS Trust, United Kingdom• Medish Spectrum Twente hospital, Netherlands• Katharina Hospital, Netherlands• University of Michigan Health System, MI USA• University Health Network, Toronto Canada• IMSS, Lagos de Moreno, Mexico
© 2008 Hewlett-Packard Dev elopment Company, L.P.The inf ormation contained herein is subject to change without notice
HP Digital Hospital Cost-benefits analysis case study
Business Context• New Hospital building planned in Northern France• Opportunity to provide modern care based upon modern
hospital – equipment, facilities AND IT infrastructure• Want to assess impact of many solutions together• Model data set at 250 beds
Solution Components:• Hospital Messaging• Information Integration• Location Based Services• Patient Terminal• IP Infrastructure
Cost/Benefit Analysis• Identification of business
objectives • Establish key facts – salaries,
time taken for tasks• Estimate process improvement
with solution• Calculate benefit in time saved• Convert time saved to financial
value using key facts• Assess impact on qualitative
measures.
• Measures:− Quantitative benefits
• Time saved• Cost reduction• Revenue enhancement
− Qualitative benefits• Patient satisfaction• Staff satisfaction
Can be applied pre- and post-implementation
Business Objectives - Examples
Driver Strategy
Increase operational efficiency:
Information available anywhere Asset trackingSingle network
Improve Patient Safety: Prescription Policy onlineMedical Team Assembly
Increase patient satisfaction: Enhance bedside facilities
Increase staff satisfaction Automate patient administration
50 9 March 2009
Impacts of the solution - examples
Strategies• Information available everywhere
• Find & locate personal equipment
• Unified and integrated network
• Specialised medical equipment alerts
• Provision of bed side services
• Automated administration processes
Converged Network and
VoIP
Wired, Wireless
Location Services
Patient terminal
Hospital alerts and
messaging
Secure integration of information and medical equipment
Necessary solution components
Implementation Plan
Phase 1
•100% IP backbone, VoIP; Wireless•60% Information intégration
•60% Hospital Alerts & Messaging•50% Patient Terminal•40% Information Integration•100% Location Services
•40% Hospital Alerts & Messaging•50% Patient Terminal
6 1812Time (months)
Content
Release 1
Release 2
Release 3
Development of the Roadmap
• Align opportunities• Identification of pre-
requisites • Definition of the project
phases• Identification of costs and
benefits by phase
Benefits and Costs
At current prices; 4 years illustrated
0
2000
4000
6000
8000
10000
Phase0
Phase1
Phase2
Phase3
Phase4
Phase5
Phase6
Phase7
Benefits
Total Costs
(K€)
Release of Benefits
Hospital Messaging
Information integration
Location Based Services
Patient Terminal
Total Benefits (M)
Costs
Net Benefits
0
0
0
0
0
(6.5)
(12.9)
Return on Investment = 28 months; Total Net Benefits (3 years) = 9.1M€
Phase = 6 months
Value released
4.2
10.8
1.0
2.0
18.0
(1.3)
16.7
2.1
5.4
0.5
1.0
9.0
(1.3)
1.4
2.1
5.4
0.5
1.0
9.0
(1.6)
(6.3)
1.0
3.2
0.5
1.0
5.7
(6.5)
(13.7)
0
0
0
0
0
(6.4)
(6.4)
Phase 0
Phase 4
Phase 3
Phase 1
Phase 2
2.1
5.4
0.5
1.0
9.0
(1.3)
9.1
Phase 5
Following Year 5
Digital hospital – workshop• Looks at the hospital from
− Business view− Functional view− Technical view− Implementation view
• Determines− Business drivers− Vision, goals and analysis criteria
• Defines the digital hospital strategy− Principles− Motivations − Implications
Result Management report & presentation incl.• Strategy and solution description• Business benefits and ROI• Investments and work packages
WhyBusiness view
Functional view
Technical view
Implementation view
Which
How
• With which products?• With whom?• When/where
(rollout, implementation)?
• Drivers, goals?• Content?• Criteria for
measurement?
• Data?• User?• Services?• Quality?
• Structured?• Planned?• Realised?
Partner selection• Cisco, Cardiac and• Xevit • Lincor• Nortel• ProCurve• Trident (Jaotech)• Ascom• Lifeline (Cloaverleaf)• JDM• Axis• J&K• Aeroscout• Philips• Nervecenter
• Create a roadmap of deals • Point solutions pave the
way to the total Cardiac solution.
ConclusionDigital Hospital Delivering Business Outcomes
• Clinical information automatically captured and fed into elec patient record
• Electronic decision support --- accelerating and improving treatment decisions
• Interactions between patients and staff are radically improved
• Changes in patient conditions can be communicated real time enabling faster response
• Location-based services and WiFi tags helps staff locate resources faster and manage assets better
• Bar coding and RFID technologies greatly improve medication administration – one of the most error prone care procedures
• Portable devices and wireless communication extend the organizational boundary, leading to better, more efficient care for chronic-condition patients
• Vast amounts of data can be captured for medical research, speeding the creation of new treatments and healthcare delivery options
• Happier Patients
Accelerate business growth:Speed innovation to transform health
Lower costs / increase efficiency:Improve operational efficiencies
Mitigate risks:Improve quality of care